Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Candice Falls

Clinical Mentor

Dr. Joy Coles

Committee Member

Dr. Holly Chitwood

Committee Member

Dr. Brittany Kellum


Background: Obstructive sleep apnea (OSA) is the most common sleep-breathing disorder. Undiagnosed OSA is highly prevalent in the population, especially in those with heart failure. OSA and heart failure combined create a negative feedback loop that can lead to poor clinical outcomes. Unfortunately, many cardiac patients are never screened for OSA.

Purpose: The purpose of this project is to improve screening rates for OSA via the STOP-Bang questionnaire and establish an efficient and effective process for referrals to sleep medicine for heart failure patients screening high-risk.

Methods: The design was a quality improvement project with pre- and post-testing and a retrospective and prospective chart review of patient data. The study took place in the cardiovascular intensive care unit (CVICU) at UK HealthCare over three 30-day phases. The intervention of the study was a nursing education session on the STOP-Bang questionnaire and an automatic warning for a sleep medicine referral for those screening high-risk.

Results: There was no positive effect on screening rates following the education session despite nurses reporting increased knowledge and confidence in administering the tool. The intervention of the discharge warning had no significant effect on referrals to sleep medicine.

Conclusion: There is still more work to be done to address undiagnosed OSA in heart failure patients. Although reported knowledge and confidence increased following the education session, screening rates were not positively affected. Addressing the barriers to screening for OSA needs to be done to get as close as possible to all patients being screened. The automatic discharge warning did not improve referral rates despite many patients screening high-risk. Future interventions should incorporate provider involvement, address screening barriers, and expand the automatic warning to more patient populations within the hospital setting.

CMitchell DNP paper FINAL May 2024.pdf (2211 kB)
Revised paper