Identification and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management

Abstract

Background Patients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA. Methods This study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ≥ 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ≥ three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study. Results The primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12–25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x 2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ≥ 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types). Conclusion Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.

Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions

“…A search of electronic databases identified 115 reports, of which 98 were excluded based on information from the title and abstract. The remaining 17 articles were evaluated for inclusion by reviewing their full text and resulted in the exclusion of 6 records for the following reasons: (1) focused on motivational App development and testing ( n = 1; Alismail and Olfman, 2020 ), (2) aimed at validating a screening questionnaire ( n = 1; Sawyer et al, 2014 ), (3) was a review ( n = 1; Weaver, 2019 ) or (4) a protocol study ( n = 1; Williams et al, 2014 ), (5) OSAS was not reported as the primary diagnosis ( n = 1; Whittington et al, 2020 ) and (6) employed a mixed-method study design ( n = 1; Broström et al, 2013 ). Eleven records finally were included in this review (Roecklein et al, 2010 ; Sparrow et al, 2010 ; Olsen et al, 2012 ; Aloia et al, 2013 ; Lai et al, 2014 ; Lo Bue et al, 2014 ; Dantas et al, 2015 ; Bakker et al, 2016 ; Jean-Louis et al, 2017 ; Pengo et al, 2018 ; Rudilla et al, 2021 ).…”