(046) Addressing Sleep Disorders in Psychiatry: A Collaborative Care Model

Abstract: Background/Significance:
Obstructive Sleep Apnea (OSA) significantly complicates the management of psychiatric disorders, yet remains underdiagnosed in psychiatric settings. Our initiative at BronxCare Hospital's Adult Outpatient Psychiatry Department (AOPD2) addresses this critical gap by implementing standardized OSA screening for our diverse patient population of 1500 outpatients, aiming to improve outcomes and care processes.

Methods:
Launched in April 2024, this initiative targets comprehensive OSA screening using the STOP-Bang questionnaire, available in both English and Spanish, to ensure inclusivity. We plan to screen 100% of patients by June 2024, identifying those at high risk for OSA. The top 100 identified patients will undergo further evaluation with WatchPAT disposable Home Sleep Apnea Testing (HSAT) devices. This process is designed to be financially sustainable for the hospital, with a fast-track referral system to the Sleep Medicine Department for patients with positive HSAT results, thereby enhancing efficiency in patient care management.

Results:
While in the preliminary phase of data collection, we have integrated the STOP-Bang questionnaire into patient assessments and distributed HSAT devices for at-home sleep studies. The initiative is expected to identify a significant number of patients with undiagnosed OSA, with detailed results and analysis to be completed by October 2024.

Discussion:
Early data suggest that our strategy to incorporate OSA screening into psychiatric care is both feasible and beneficial. By identifying at-risk individuals early and providing accessible diagnostic tools, we aim to mitigate the adverse effects of OSA on psychiatric conditions. Addressing compliance issues unique to psychiatric patients, such as challenges with attending in-lab sleep studies, the at-home HSAT devices and streamlined referral process aim to mitigate these barriers, enhancing patient participation and follow-through with sleep disorder treatments. Our hypothesis posits that a significant portion of our psychiatric outpatient population, previously unscreened for OSA, will be diagnosed with varying levels of OSA severity. 

Conclusion/Implications:
By integrating OSA screening into psychiatric outpatient care, this initiative promises to significantly improve patient outcomes while emphasizing the importance of interdisciplinary collaboration in the complex interplay between sleep and psychiatric health. The financial sustainability of the project, coupled with the strategic referral system and the consideration of unique compliance challenges faced by psychiatric patients, underscores its potential as a scalable model for comprehensive patient care.

References:
Nikolakaros, G., Virtanen, I., Markkula, J., Vahlberg, T., & Saaresranta, T. (2015). Obstructive sleep apnea in psychiatric outpatients. A clinic-based study. Journal of Psychiatric Research, 69, 126-134.

Tamayo Martínez, N., & Rosselli Cock, D. (2017). Obstructive sleep apnea syndrome in patients attending a psychiatry outpatient service: A case series. Revista Colombiana de Psiquiatría (English ed.), 46(4), 243-246.

Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: Our project, centered in a Bronx hospital serving an impoverished community, advances DEI by addressing OSA in psychiatric outpatients, a condition often overlooked in diverse and underserved populations. Recognizing the disproportionate impact of sleep disorders on mental health in these groups, we've implemented the screening questionnaire in both English and Spanish for inclusivity, and provided WatchPAT HSAT devices for comprehensive, accessible care. This initiative not only aims to improve psychiatric and sleep-related outcomes but also embodies our commitment to equitable health practices, ensuring all patients, regardless of socio-economic status or background, receive the necessary screenings and interventions for OSA.