Can a validated sleep apnea scoring system predict cardiopulmonary events using propofol sedation for routine EGD or colonoscopy? A prospective cohort study

Mehta, Paresh P.; Kochhar, Gursimran; Kalra, Saminder; Mäurer, W; Tetzlaff, John; Singh, Gurshawn; López, Rocío; Sanaka, Madhusudhan R.; Vargo, John J.

doi:10.1016/j.gie.2013.09.022

Cited by 55 publications

(48 citation statements)

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“…Our overall CAE rate (46.4%) was high, but comparable to other studies [13, 22] based on varying definitions of the outcome. Of note, studies have found that the most common unplanned cardiopulmonary event during endoscopic procedures is hypoxemia, and it occurs in up to 10–70% of patients depending on the definition of hypoxemia, level and type of sedation, type of endoscopy, and patient population [4, 17].…”

Section: Discussionsupporting

confidence: 88%

“…The rate of adverse events has varied between 13.9 and 44.4% in prior studies. BMI has been shown to be a risk factor for adverse events, with OR ranging between 1.02 and 2.0 [13, 22]. A minimum sample size for a multiple logistic regression model for this study was calculated to be 396 patients using an estimate of 12% for event proportion and odds ratio 1.5, with a type I error rate of 0.05 and 80% power [23].…”

Section: Methodsmentioning

confidence: 99%

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Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

et al. 2017

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Background The relationship between body mass index (BMI) and cardiopulmonary adverse events (CAEs) for ambulatory colonoscopy is unclear. Aim To assess the association of BMI and CAEs associated with ambulatory colonoscopy. Methods This is a retrospective cohort analysis of 418 patients who underwent outpatient colonoscopy at the Durham Veterans Affairs Medical Center categorized as normal/overweight (BMI < 30), obese (BMI 30–34), or morbidly obese (BMI ≥ 35). Adjusted logistic regression analyses were performed. Results At least one CAE occurred in 46.4% of patients (220 events, 72.7% were hypoxia). The rate of CAEs (BMI < 30: 43.8%, BMI 30–34: 48.0%, BMI ≥ 35: 50.6%, p = 0.53) and rate of hypoxia (BMI < 30: 34.8%, BMI 30–34: 40.9%, BMI ≥ 35: 43.2%, p = 0.32) were numerically higher for obese and morbidly obese patients, but not statistically significant. Obese (OR 1.10, 95% CI 0.70–1.73) and morbidly obese (OR 1.07, 95% CI 0.61–1.85) patients did not have an increased risk of CAEs after adjusting for age, ASA class, obstructive sleep apnea (OSA), and type of sedation. OSA was independently associated with an increased risk of CAEs (OR 1.71, 95% CI 1.09–2.74, p = 0.02) after adjusting for BMI, age, ASA class, and type of sedation. Conclusion OSA confers a higher risk of CAEs independent of BMI and sedation type. Consideration of undiagnosed OSA is recommended for appropriate pre-procedure risk stratification. While not statistically significant in this study, there may be clinically significant increased risks of CAEs and hypoxia for patient with BMI > 30 that require further evaluation with larger studies.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

et al. 2017

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“…Cote’s study showed that patients with a positive SB score had a higher incidence of hypoxemia and the need for airway maneuvers such as a chin lift or placement of a nasopharyngeal airway [39]. In contradistinction, Mehta and colleagues reported that a higher STOP-BANG score was not associated with an increased incidence of sedation-related adverse events or with airway intervention in their study cohort of 243 patients undergoing upper endoscopy or colonoscopy under anesthesiologist-directed propofol sedation [40]. A higher BMI, however, was associated with an increased incidence of both outcomes.…”

Section: Obstructive Sleep Apnea and Sedationmentioning

confidence: 99%

Sedation Challenges

Jirapinyo

Thompson

2016

Gastrointestinal Endoscopy Clinics of North America

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“…OSA is defined by a pause in breathing that lasts at least 10 seconds and a decrease in oxygen saturation by 4% from the patient's baseline oxygen saturation (Henrichs & Walsh, 2012;Mehta et al, 2014;Singh et al, 2013). The obstructive breathing pattern characteristic of OSA occurs when the muscles that typically support an open airway during sleep, relax in tone causing the airway to collapse and airflow to decrease or cease altogether (Henrichs & Walsh, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that more than 18 million Americans suffer from OSA. More than 92% of women and 82% of men who suffer from moderate to severe sleep apnea are undiagnosed (Henrichs & Walsh, 2012;Mehta et al, 2014;Singh et al, 2013). The prevalence of OSA in surgical candidates is higher than the general population, and varies by surgery type, with the highest prevalence in patients presenting for bariatric surgery Singh et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire

Davies

Patrick

Gerard

2016

IJANS

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Background: Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term "STOP-BANG" is an acronym for eight independent elements predictive of OSAthree are OSA-related symptoms, three are physiological measurements, and two are patient characteristics. Methods: This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey. Results: This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool. Conclusions:The results suggest that programs targeted at raising CRNAs' and SRNAs' PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.

show abstract

Can a validated sleep apnea scoring system predict cardiopulmonary events using propofol sedation for routine EGD or colonoscopy? A prospective cohort study

Cited by 55 publications

References 20 publications

Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

Sedation Challenges

Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire

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