Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. www.jcrpjournal.com Obstructive Sleep Apnea Screening in CR / 1 ORIGINAL INVESTIGATION Author Affiliations: Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada. All authors have read and approved the article. The authors declare no conflicts of interest. Correspondence: Susan Marzolini, PhD, Toronto Rehabilitation Institute, 347 Rumsey Rd, Toronto, ON M4G1R7, Canada (Susan.marzolini@uhn.ca). K E Y W O R D S cardiac rehabilitation obstructive sleep apnea ■ PURPOSE: Obstructive sleep apnea (OSA) is prevalent in patients with car- diovascular disease and is often undiagnosed. The purpose of this study was to determine the utility of communicating OSA risk with the patients in a diabetes and cardiac rehabilitation program (CRP) and primary care physicians. ■ METHODS: Following an OSA education session, 295 patients in diabetes and CRPs were screened for OSA and daytime sleepiness by STOP- BANG and Epworth Sleepiness Scale questionnaires. Letters were sent to patients at high risk or noncompliant with continuous positive air- way pressure (CPAP) treatment and their physicians. Follow-up ques- tionnaires were sent to patients 6 months later. ■ RESULTS: Of the 295 patients screened, 16.6% (n = 49) had an OSA diag- nosis and had been prescribed CPAP. A smaller proportion patients in the diabetes program than in the CRP had discontinued CPAP (22.2% vs 45.2%; P = .03) with discomfort being the greatest barrier. Three of the 7 patients (42.9%) who had contact with their physician resumed CPAP. Of the remaining 246 patients who scored high on ≥1 ques- tionnaire (77.6%; n = 191) and returned the 6-month questionnaire (53.9%; n = 103), communication of risk assessment resulted in 49.5% (n = 51) of patients consulting with their physician. Of those, half were referred for polysomnography. All were diagnosed with OSA. ■ CONCLUSION: More than three quarters of patients in diabetes and CRPs scored high on ≥1 questionnaire suggesting signs/symptoms of OSA. However, only 16.6% were prescribed CPAP and compliance to treat- ment was poor (63.3%). Education and communication of OSA risk with patients and physicians resulted in a de novo diagnosis in at least 1 of 10 patients screened and 16.7% restarted CPAP. Utility of Screening for Obstructive Sleep Apnea in Cardiac Rehabilitation Susan Marzolini, PhD; Michael Sarin, MD; Jaan Reitav, PhD; Monique Mendelson, PhD; Paul Oh, MD Obstructive sleep apnea (OSA) is characterized by repetitive periods of breathing cessation (apnea) or partial collapse of the upper airway and significant reductions of airflow (hypopnea), resulting in arousal and hypoxia during sleep. 1,2 Symptoms associated with OSA may include excessive daytime sleepiness, witnessed apneas, snoring, morning headaches, dry mouth, nocturia, as well as impaired concentration and mood. There is increasing awareness of the asso- ciation between OSA, cardiovascular disease (CVD), DOI: 10.1097/HCR.0000000000000186 and diabetes, both in terms of its role as a risk factor and the beneficial effects of treatment with continuous positive airway pressure (CPAP). 3-5 However, although there is a high prevalence of coexisting OSA in people with CVD and diabetes, it often goes undiagnosed. 6-13 This is of clinical significance as observational and cross-sectional cohort studies have shown that there is an association between the severity of untreated OSA and hypertension, coronary artery disease, stroke, and poor glycemic control. 13-16