The STOP-BANG Test:Changing the Sleep Apnea Discussion Health & Welfare Practice Update

February 2016 • Lockton® Companies

L O C K T O N C O M P A N I E S

SHANE JACOBSENVice President, Producer

Omaha Health & Welfare Practice402.970.6102

sjacobsen@lockton.com

Lockton prides itself on implementing effective health management programs. One of the reasons our strategies work is our ability to recognize the importance of personal attention and it’s role in managing risk and reducing gaps in care among your employees.

This month, we will focus on one major health concern frequently seen by our nurses when delivering this personalized support – sleep apnea.

Obstructive sleep apnea (OSA) is a common disorder in which one experiences paused or decreased breathing during sleep. OSA is the most prevalent of the sleep-breathing disturbances, and affects 24% of men and 9% of women in the general population. Sleep apnea increases the risk for conditions like high blood pressure and heart disease, and increases the risk for poor work performance and even accidents and injuries. It can be a fearful diagnosis if the patient does not have a good understanding of their treatment options or a strong support system.

Many individuals suffering from OSA don’t know that they have it because their disordered breathing only occurs during sleep. The person with OSA experiences chronically poor sleep and reports excessive daytime sleepiness and fatigue, but a bed partner may notice the signs of sleep apnea such as gaps in breathing and snoring. Since this condition can be diffi cult to detect, but has a huge impact on an individual’s daily life, it is vital to know the risks and discuss them with a physician when indicated.

Q: Why do you recommend the STOP-BANG test?

A: The STOP-BANG test is a comprehensive

questionnaire used to screen for the presence

of Obstructive Sleep Apnea (OSA). The score

from this screening test, especially when considered

along with evidence of a Body Mass Index (BMI)

>35, is highly predictive of the presence of OSA.

The STOP-BANG screening can eliminate the need

for a referral to a sleep center. When the STOP-

BANG is used, instead of relying primarily on

BMI and neck circumference as predictors of OSA,

many individuals are spared the inconvenience (and

possible high co-pays) of a sleep study.

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Typically, when sleep apnea is a potential concern, doctors or Department of Transportation (DOT) examiners will automatically request that a patient undergo a sleep study. Sleep studies can be expensive and time consuming. In the trucking industry, where OSA is common, drivers are often given a very limited time frame in which to complete their sleep study.

One way our nurses address sleep apnea with our participants is the STOP-BANG test. This test includes questions related to sleep habits and general health that can help assess an individual’s risk for OSA and serve as a pre-cursor to further discussion and testing.

In order to help prevent participants from undergoing unnecessary and costly testing, especially when they may not present with all of the risk factors for sleep apnea, our nurses suggest that doctors and DOT examiners screen using the STOP-BANG test prior to referral to a sleep study center.

The test can help keep the focus on a participant’s health issues – before jumping to conclusions – and better prepare them for a sleep apnea discussion with a physician or examiner. The nurse advocates also use this

as an opportunity to point out the support available to individuals before and after their DOT exams, further testing, and possible treatment for OSA.

Most OSA sufferers are treated with Continuous Positive Airway Pressure therapy, or CPAP, which provides constant, steady air flow while sleeping. There are many different masks and machines available, and our nurses note that most people immediately love them or hate them – but most patients quickly learn to love CPAP once they experience the profound effect a good night’s rest can have on their daily lives.

Sleep apnea is becoming a more widespread problem in our society, especially among truck drivers. It is often feared, under-diagnosed and over-tested, but it doesn’t have to be. Our nurses can help to improve the understanding of sleep apnea and its treatments by educating and supporting participants. By doing so, we can begin to develop a population where sleep apnea is seen as a manageable condition with a strong support system available to those affected. We believe the STOP-BANG test is one small step in that direction.

STOP-BANG Questionnaire• Snoring: Do you snore loudly?

• Tired: Do you often feel tired, fatigued, or sleepy during the daytime?

• Observed: Has anyone observed you stop breathing or choking/gasping during your sleep?

• Pressure: Do you have, or are you being treated for, high blood pressure?

• Body Mass Index: More than 35 kg/m2?

• Age: Older than 50?

• Neck Size: Larger than 17 inches/43 cm for men? Larger than 16 inches/41 cm for women?

• Gender: Male?

Scoring: Yes to 5-8 questions = High Risk of Obstructive Sleep Apnea (OSA)

February 2016 • Lockton Companies

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Our nurses can help to improve the understanding of sleep apnea and its treatments by

educating and supporting

participants.

References:

Toronto Western Hospital, University Health Network. 2012. www.stopbang.ca

Many individuals with sleep apnea attempt to deny

the problem entirely. Lockton nurses fulfi ll multiple

roles, including assessing a driver’s risk for OSA

before their DOT testing, helping to improve their

health and risk factors when possible, assisting

drivers with results of their DOT exam, and providing

participants with a better understanding of sleep

apnea and its treatment.

Our nurses have received numerous testimonials

from participants using CPAP machines, often stating

they’ve “never felt better” and can’t imagine living

without the machine. One truck driver is so grateful

for his device, that in order to never be without one,

he has acquired three! He has also become very

knowledgeable about machines and masks, even

reaching out to other drivers who are new to using

CPAP. His peers are very receptive to the support from

our nurses and their fellow driver, and have come to

appreciate the CPAP systems.

Nurse Advocates in Action

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