“In the lab, we are testing over 80 sleep disorders, so it is an important test for the patient,” he adds. “I believe that hospitals will continue to look for companies with experience in the field to manage their labs.”
While some hospitals are delivering comprehensive sleep services, others have limited offerings. “It’s really fragmented now,” Nelson says. “There has been a lack of continuum of care and lack of follow-up. We’re going to see more consolidation and mergers with regional players to improve services.”
Success Key No. 3: Surgery outcomes
At the 957-staffed-bed Thomas Jefferson University Hospital in Philadelphia, physicians were concerned about postsurgery complications among patients who have sleep apnea. Many people with OSA could have an increased risk of complications, especially involving the heart and lungs, following surgery. As a result, the hospital’s sleep disorders center has used a questionnaire, known as STOP-BANG, specifically for patients slated for surgery. The process has led to better surgery outcomes, says Tajender Vasu, MD.
Patients who have OSA usually have undiagnosed conditions and are “almost certainly at risk” in the period immediately after surgery, he says. “The STOP-BANG questionnaire (see box at right) is a convenient and useful tool that appears to reliably identify patients who are at increased risk for postoperative complications.” The questionnaire was developed two years ago by Frances Chung, MD, of the University of Toronto.
In a study, Vasu sought to determine whether high-risk scores on preoperative STOP-BANG questionnaires during preoperative evaluation correlated with a higher rate of complications of OSA.
Adult patients undergoing elective surgery were administered the STOP-BANG questionnaire. Patients at high risk of OSA had a higher rate of postoperative complications compared with patients at low risk, 19.6% versus 1.3%. As a result, it was determined that the STOP-BANG questionnaire was useful for preoperative identification of patients at higher-than-normal risk for surgical complications due to OSA, he says.
Vasu outlined conclusions in comments to HealthLeaders Media and in a report in the October 2010 issue of the Archives of Otolaryngology—Head & Neck Surgery. He says the findings showed that the higher the scores, the more likelihood that there were increased risks of postoperative complications.
According to his study, the findings showed that that 41% of surgical patients had high scores on the STOP-BANG questionnaire, indicating a high risk for OSA.
There are various reasons for higher rates of postoperative complications in patients with OSA. Anesthesia or pain relief medications can play a role in triggering sleep-disordered breathing and other complications, he says. In the study, Vasu notes that rapid eye movement sleep is “diminished the night after surgery, followed by a period of REM rebound. The occurrence of breathing problems during REM sleep can consequently triple on the second and third postoperative nights.
Vasu says Jefferson University Hospital is developing a protocol to address this problem. “There is a need to do more research to find out the best and most cost-effective intervention to reduce the risk of postoperative complications in this population,” he says.
Success Key No. 4: Pediatric patients
Many of the overweight patients being treated for sleep apnea are children. The 323-staffed-bed Swedish Covenant Hospital in Chicago has a two-bed sleep and neurodiagnostic center that usually is booked months in advance.
Since the sleep center opened in August 2005 and was accredited in February 2008, the number of adult patients has doubled. But what is more surprising, says Andre L. Smith, RPSGT, director of the sleep center, is that the number of pediatric patients also has doubled. Each patient usually stays at the sleep center for seven or eight hours. The children who are diagnosed with sleep apnea “have sleep apnea issues just like the adults,” he says. Often sleep apnea is not immediately diagnosed in children. Hyperactivity, inattentiveness, mood swings—all could signal sleep apnea, he says.
OSA in children is usually due to large tonsils and adenoids, but obesity in children also is a significant factor, Smith says. OSA has been estimated to occur in 1% to 3% of otherwise healthy preschool children, with the peak prevalence at 2 to 6 years of age. The prevailing estimates do not reflect the occurrence of sleep apnea in children or adults, Smith says. “Both populations are underdiagnosed,” he says.
Pediatricians and ear, nose, and throat doctors are among the physicians who make referrals of patients to the Swedish Covenant sleep program. Pediatric physicians are becoming aware of a link between attention deficit hyperactivity disorder and sleep disorders, Smith says, noting they may have similar symptoms, such as inattentiveness, overactivity, and restlessness.
“We are seeing a lot of new business,” Smith says. “We don’t have the beds in the city to cover all the patients in need,” he adds. The hospital is considering expanding its program.