Improving Perioperative Pathways for Undiagnosed Obstructive Sleep Apnoea

Introduction and aims

Obstructive Sleep Apnoea (OSA) is a common pathology that often goes undiagnosed. It increases the risk of a range of perioperative complications, with undiagnosed OSA being particularly dangerous.

We aimed to improve perioperative screening, diagnosis, and treatment of OSA through development of a novel perioperative pathway in a central London preassessment clinic (PAC).

Initial audit data in a focus group of patients (those undergoing major gynaecological surgery) found that just 14.3% of patients with a BMI of ≥30 had a STOPBang score + subsequent sleep study performed (17/01/22-17/02/22).

The main aims of the project were-

• Primary project aim: Achieve a 40% rate of optimal management of high-risk patients as per our novel pathway shown below

• Secondary aims: Improve referral rates for possible undiagnosed sleep apnoea from PAC

Results and future actions

Number of patients with moderate/severe OSA referred to sleep team

Novel pathway – developed Jan 2022 Audit data after one month of pathway implementation revealed 21.4% of patients managed optimally.

Across 11 months in 2022, 27 patients were referred to the sleep team with confirmed, clinically significant OSA. This was an increase from 4 patients in 2021.

In November 2022, we achieved 40% of patients being managed optimally as per the pathway. The PDSA cycle with the most significant and consistent shift in correct percentage referrals was implementation of a nursing champion.

Barriers to implementation included unfamiliarity with new technology, increased workload, and understanding of pathophysiology of OSA.

Future plans involve teaching within the PAC, funding for more WatchPAT sleep studies, utilisation of the WatchPAT direct service, changes to the PAC patient proforma and dedicated pre-operative sleep clinics.