Implementation of sleep medicine reduces readmissions, improves patient outcomes

MORGANTOWN, W.Va. – Doctors at WVU Medicine are turning to a novel sleep disorder screening program to reduce the number of hospital readmissions and improve patient outcomes.

Sunil Sharma, M.D.
Sunil Sharma, M.D.

Sleep apnea and other sleep disorders can worsen cardiovascular and pulmonary conditions, such as congestive heart failure and chronic obstructive pulmonary disease (COPD).

“Congestive heart failure and COPD are two of the most common reasons that patients are admitted, so we decided to launch a screening program to detect undiagnosed sleep disorders in patients admitted with these conditions in order to improve patient outcomes and reduce the number of days our patients are spending in the hospital,” Sunil Sharma, M.D., WVU Medicine pulmonologist and sleep medicine specialist, said. “We are pioneers in establishing this program and have extensively published on the merits of this hospital intervention. Based on the accumulating data in this field, the American Academy of Sleep Medicine has set up an in-hospital task force to study the impact of such screening programs.”

In-hospital screening

Patients are screened using a questionnaire to determine if they have indications for sleep apnea. If the questionnaire suggests the patient may have sleep apnea, they receive further in-hospital screening using one of two devices: high-resolution pulse oximetry and ApneaLink.

Sleep studies are traditionally performed using polysomnography, an ambulatory study performed in a sleep lab that records brain waves, oxygen saturation, heart rate, breathing, and eye and leg movements. There are few accredited sleep labs in the state, and they often have a wait for several weeks to months. 

The physicians at WVU Medicine sought to find a more efficient and cost-effective way to perform sleep apnea screening while the patient is in the hospital. They implemented the use of ApneaLink, a small, less expensive device that was originally designed for at-home sleep testing. This device is more cost effective and portable than traditional polysomnography and can easily be performed in the patient’s room. 

However, advances in pulse-oximeter technology has provided yet another tool: high-resolution pulse oximetry. This non-invasive test only requires that the patient be placed on a monitor the size of a watch that goes on their wrist and finger to record oxygen levels overnight. This data provides insight into the patient’s breathing at a fraction of the cost of a traditional sleep study.

“We were able to validate the results of this study in comparison to traditional outpatient sleep study results,” Dr. Sharma said. “This method is effective because the patients are already admitted and will be in the hospital overnight, allowing us to perform these tests while they are a captive audience. This technology is very simple and can be used by any respiratory therapist with very little training needed.”

If the data suggests the patient has sleep apnea, physicians can begin to take steps to treat it while they are in the hospital, improving recovery and potentially reducing the number of days spent in the hospital. Patients are also provided with education about sleep apnea and how it can affect their health and recovery.

Patients are scheduled for a sleep lab study within two weeks of discharge, allowing for a more comprehensive diagnosis of their sleep disorder and the development of a long-term treatment plan.

“This new approach is helpful because patients with these conditions have an increased readmission rate to the point that Medicare has mandated that hospitals be penalized if these patients are readmitted within 30 days,” Sharma said. “Our studies have shown that if we detect this disease early and provide them with appropriate treatment, the incidence of readmission is reduced. Not only are we improving the patient’s health, but we are also helping hospitals.”

Early success

According to Sharma, since this screening program was implemented, there has been a significant increase in the detection of sleep apnea. 

“We screened 1,000 patients in the first year that this program was implemented. When we crossed that 1,000 mark last month, we wanted to celebrate the hard work that has gone into this by all the members of our staff that are involved. It is a multidisciplinary effort that includes respiratory care, hospitalists, sleep center staff, and other staff members. This program has been a success because they came together to coordinate this effort, despite the challenges presented by COVID-19,” he said. 

“It is a testimony to the success of this program that we are now getting four-to-five consults a day to use this service. The benefit of the program has transcended several departments and specialties, and we are often consulted to screen patients in order to detect the disorder and intervene in the hopes of positively impacting patients’ co-morbid conditions.”

Widespread implementation

The next steps for this program include implementation in WVU Medicine hospitals across the state. 

West Virginia is one of the highest rated states for obesity, the primary indicator for sleep apnea. Because of this, the state also has one of the highest incidences of sleep apnea.

“We found that nearly 50 percent of patients we screened had sleep apnea, and this is primarily due to obesity,” Sharma said. “Our state not only has a high rate of obesity, but high rates of other factors that contribute to sleep apnea, including heart failure, COPD, stroke, and diabetes. Many West Virginians suffer from multiple comorbid conditions, which adds another layer to the cause of sleep apnea.”

According to Sharma, more widespread implementation of this screening program across all WVU Medicine hospitals will improve care and reduce the need for transfers.

“As we continue to fine tune this program, we will develop the template for how it can be implemented in our hospitals and harness the endless opportunities it presents,” Sharma said. 

One key element to widespread implementation of this program is telemedicine. COVID-19 served as a catalyst for greater adoption of telemedicine capabilities, allowing providers to consult with patients regardless of where they are receiving treatment. Data from the sleep studies can be sent to providers to be analyzed and a treatment plan can be developed by the patient’s local provider and sleep medicine specialists.