The STOP-BANG questionnaire improves the detection of epilepsy patients at risk for obstructive sleep apnea.

Patients with epilepsy and obstructive sleep apnea (OSA) are at risk for worsened seizure control and quality of life. We performed a quality improvement project, evaluating for improvements in the screening of OSA in epilepsy patients using the STOP-BANG questionnaire. The electronic medical records of patients seen in our epilepsy clinic were screened for 4 months prior to the intervention. We subsequently implemented the STOP-BANG questionnaire for 3 months. Only 22/664 patients (3.3%) had their sleeping habits explored during the pre-intervention period; 11 (1.7%) were referred to sleep medicine. Following implementation of the STOP-BANG questionnaire, the percentage of patients screened for OSA increased to 41.6% (269/647, Chi-square Fisher's Exact test 2-sided p<0.001). Of the 269 patients screened, 84 (31.2%) met criteria for elevated OSA risk. Forty-one patients were referred to sleep medicine during the subsequent 3 month period, including 33 who met STOP-BANG criteria for OSA. This represented 6.3% and 5.1% (respectively) of all 647 patients, a significant improvement over the percentage referred prior to the intervention (Chi-square Fisher's Exact test 2-sided p<0.001). Twelve of the 33 patients referred based on the STOP-BANG questionnaire saw sleep medicine; 11 (91.7%) were referred for polysomnography (PSG). Of the 10 patients who underwent PSG, 9 (90%) were diagnosed with OSA and offered treatment with continuous positive airway pressure (CPAP).

Improving the prescription of folate to women receiving antiepileptic drugs.

In women of childbearing potential (WCP) on antiepileptic drugs (AEDs), there is an increased risk of teratogenicity. This can potentially be reduced with folate supplementation. We evaluated the rate of co-prescription of AEDs and folate to WCP by non-epileptologist Neurology attendings and residents before and after an educational intervention. During the initial 3 month survey, 54 WCP were prescribed ≥1 AEDs. Prior to the intervention, the rate of co-prescription of AEDs and folate was 20.4%. This was higher when neurologists were prescribing AEDs for epilepsy (34.4%) versus other disorders (0%, p=0.02). In the 3 months following the intervention, 48 WCP received AEDs. The rate of co-prescribing folate increased to 64.6% (p<0.001). Neurologists treating epilepsy continued to be more likely to prescribe folate (86.4%) than neurologists treating other conditions (46.2%, p=0.006).