Ambulatory blood pressure monitoring in the TRU Sleep Clinic: Should high blood pressure and sleep apnea be tested for and treated simultaneously?

Extensive research has demonstrated a strong correlation between obstructive sleep apnea (OSA) and high blood pressure (hypertension). Furthermore, studies have shown that treating OSA can lead to an improvement in blood pressure levels. Despite this knowledge, many sleep clinics still do not test their patients for hypertension and have yet to develop comprehensive treatment plans that aim to target both OSA and hypertension. The TRU Sleep Clinic currently sees patients referred by local physicians for overnight ambulatory blood pressure (ABP) monitoring; upon their first visit, the patients are questioned regarding their sleep habits and complete questionnaires designed to reveal the level of risk for OSA. Despite this effort, patients are not returning to the clinic for further screening and treatment for OSA. The purpose of this study was to identify ABP patients whose files had been archived, but who should have been tested for OSA, invite those patients back to the clinic for further testing, and determine how to ensure that people do return to the clinic in the future if they are identified as at risk for OSA. To do so, I reviewed 182 archived ABP patient files to identify those patients who demonstrated a risk of OSA during the initial screening process. Then, I contacted those patients and invited them back to the clinic for overnight pulse-oximetry, partly to determine how willing patients were to return to the clinic for OSA testing. I designed a script for contacting patients that emphasized the connection between hypertension and OSA and the possible benefits of treating OSA for their overall health. Finally, I developed an improved ABP patient archive form in order to ensure that when a patient demonstrates a risk of OSA, their file would not be prematurely archived. Based on their Epworth Sleepiness Scale and STOP-BANG questionnaire scores, and their self-reported sleep issues, 48 of the 182 patients should have been invited back to the clinic for overnight pulse-oximetry to test for OSA. Of those, 20 were contacted successfully and 10 agreed to return to the clinic for pulse-ox. The conclusions from this study were that more than a quarter of the patients who initially visited the clinic for overnight ABP monitoring should have returned for pulse oximetry, a substantial proportion of patients were willing to return to the clinic for further testing, and that a new “Request to Archive ABP Patient File” form was necessary in the clinic to ensure that ABP patients demonstrating a risk for OSA were being identified and not archived.