Background: Sleep apnea is a common health disorder that is strongly associated with many serious comorbidities. At Patel Medical Clinic located in rural southwestern Arizona, the clinic director acknowledged the need to identify individuals that may have this condition but may go undetected. Presentation of symptoms in women can be misleading for diagnosis and conceals the need for further workup. Although men are more commonly recognized for having this condition, women of 50 years of age and older are vulnerable as the risk for sleep apnea increases significantly after menopause. In this study, women 50 years of age and older were asked to volunteer to determine sleep apnea risk and to identify barriers to diagnosis.

Methods: The purpose of this quality improvement project was to evaluate the use of a validated screening tool in identifying women 50 years of age and older in a rural southwestern internal medicine practice who are at moderate to high-risk of sleep apnea using a cross-sectional quantitative survey design. The study took place at Patel Medical Clinic, a private medical establishment located in rural Arizona. All clinic patients who are female and 50 years of age and older and patients of this clinic during data collection times were able to participate in the study, regardless of sleep apnea status.

Results: Most participants were of the 60--69 and 70--79 age groups. Study subjects consisted of 54 women. Of these, (37) 68.5% of participants scored at moderate or high-risk of sleep apnea. A total of (27) 50% participants scored as "moderate-risk," (10) 18.5% scored as high-risk. Of the 54 participants, (13) 24% had a previous diagnosis of sleep apnea. Of those 13 with an established diagnosis, (7) 53% scored in the moderate-risk category, and (5) 38 % scored in the high-risk category. Out of those that were referred for sleep study but unable to participate, various barriers were identified that were unique to each individual participant.

Discussion/Recommendations: Symptoms of sleep apnea are vastly present among participants. Many participants that scored as having moderate to high-risk have not been referred for sleep study. A screening tool could potentially reduce the number of moderate-to-high-risk patients from going unrecognized. Additional long-term studies are necessary to further examine barriers for diagnostic testing and how to better ensure that these tests are completed. Women with sleep apnea often present with gender-specific symptoms and could greatly benefit from a female-focused questionnaire.