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Implementation of an obstructive sleep apnea screening tool with hypertensive patients in the primary care clinic

Showalter, Laura DNP, NP-C1; O'Keefe, Catherine DNP, APRN-NP (Adjunct Associate Professor)2

Journal of the American Association of Nurse Practitioners: March 2019 - Volume 31 - Issue 3 - p 184–188
doi: 10.1097/JXX.0000000000000124
Quality Improvement Report

Background and Purpose: Patients with severe obstructive sleep apnea (OSA) have an almost 4-fold higher odds of resistant hypertension than those with less severe OSA. Obstructive sleep apnea screening practices in primary care are deficient. Additional study is needed regarding the value of OSA screening in hypertensive adults who present to the primary care clinic.

Methods: This was a convenience sample of adults with hypertension from a rural primary care clinic in Iowa. Staff identified patients who met the inclusion criteria for the project. The STOP-Bang Questionnaire was used to screen the patients for OSA. Providers subsequently used discretion as to ordering polysomnography (PSG).

Conclusions: Thirty-two patients were screened over a 3-month time period. All of the men included in the study scored either high or intermediate risk for OSA. Forty percent of the study participants scored high risk for OSA, with 33% of those participants referred for PSG. At project conclusion, three participants had undergone PSG testing, and all were diagnosed with sleep apnea.

Implications for Practice: To ensure timely diagnosis and treatment of OSA, primary care providers should consider screening all hypertensive adults for OSA. With compulsory screening and subsequent identification and treatment of patients with OSA, nurse practitioner providers can pave the way in reducing mortality and morbidity associated with OSA, as well as resistant hypertension.

1College of Nursing, Creighton University, Hampton, Iowa

2College of Nursing, Creighton University, Omaha, Nebraska

Correspondence: Laura Showalter, DNP, NP-C, College of Nursing, Creighton University, 1644 130th Street, Hampton, IA 50441. Tel: 712-363-1424 Fax: 641-444-5688; E-mail:

Competing interests: The authors report no conflicts of interest.

Authors' contributions: Laura Showalter developed the project, collected data, wrote the initial draft of the manuscript, and revised the manuscript for final submission. Dr. Catherine O'Keefe assisted in the development of the project and performed revisions to the manuscript.

Received March 27, 2018

Accepted August 08, 2018

© 2019 American Association of Nurse Practitioners
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