Electronic health record cue identifies epilepsy patients at risk for obstructive sleep apnea

Abstract

BackgroundPrior studies have reported that patients with epilepsy have a higher prevalence of obstructive sleep apnea (OSA) that contributes to poor seizure control. Detection and treatment of OSA can improve seizure control in some patients with epilepsy. In this study, we sought to develop, implement, and evaluate the effectiveness of an electronic health record (EHR) alert to screen for OSA in patients with epilepsy.MethodsA 3-month retrospective chart review was conducted of all patients with epilepsy >18 years of age who were evaluated in our epilepsy clinics prior to the intervention. An assessment for obstructive sleep apnea (AOSA) consisting of 12 recognized risk factors for OSA was subsequently developed and embedded in the EHR. The AOSA was utilized for a 3-month period. Patients identified with 2 or more risk factors were referred for polysomnography. A comparison was made to determine if there was a difference in the number of patients at risk for OSA detected and referred for polysomnography with and without an EHR alert to screen for OSA.ResultsThere was a significant increase in OSA patient recognition. Prior to the EHR alert, 25/346 (7.23%) patients with epilepsy were referred for a polysomnography. Postintervention, 405/414 patients were screened using an EHR alert for AOSA and 134/405 (33.1%) were referred for polysomnography (p < 0.001).ConclusionAn intervention with AOSA cued in the EHR demonstrated markedly improved identification of epilepsy patients at risk for OSA and referral for polysomnography.

What's happening in Innovations in Care Delivery

“…2 Our goal is to highlight health services research articles published in Neurology ® and Neurology ® Clinical Practice, as well as to give opinions by experts in the field. Another new addition is an article by Mulvey et al 3 about implementing and evaluating an electronic health record alert to screen for obstructive sleep apnea in patients with epilepsy. The study used 12 risk factors for obstructive sleep apnea, and patients with 2 or more risk factors were referred for polysomnography by the provider.…”

Quality improvement and practice-based research in sleep medicine using structured clinical documentation in the electronic medical record

“…Other guidelines for RLS/ WED have been published (Allen et al 2014;Picchietti et al 2015;Garcia-Borreguero et al 2016;Winkelman et al 2016). Few studies in sleep and neurology are incorporated into EMRs (Alexander et al 2016;Stubberud et al 2019;Mulvey et al 2018). A challenge to EMR documentation is that clinical data are not captured discretely, making it difficult to report performance and assess quality improvement opportunities.…”