Evolving concepts in the perioperative management of obstructive sleep apnea after endoscopic skull base surgery

Rabinowitz, Mindy; Chaskes, Mark B.; Choby, Garret; Wang, Eric; Thorp, Brian D.; Toskala, Elina; Nyquist, Gurston; Rosen, Marc; Evans, James J.

doi:10.1002/alr.22905

Cited by 6 publications

(10 citation statements)

References 25 publications

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“…The prevalence of OSA within the general population is about 22%, and patients with CRS are at an increased risk of OSA 5,11 . Patients with CRS report diminished sleep quality and 15% of these patients have formally diagnosed comorbid OSA 12,13 .…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that untreated OSA leads to cardiovascular, pulmonary, and endocrinologic sequelae 13 . In the perioperative setting, patients with pre‐diagnosed OSA face increased risk for acute complications including difficulty with intubation, postoperative hypoxemia, and ICU admission 3–5 . While perioperative teams are able to anticipate advanced care needs for patients with known OSA, same‐day screening can reveal a high percentage of additional patients at risk 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Obstructive sleep apnea (OSA) results from episodes of partial or full collapse of upper airway musculature 1,2 . 20% of men and 10% of women in the United States suffer from moderate‐to‐severe OSA, and approximately 60%–90% of surgical patients with moderate‐to‐severe disease are undiagnosed preoperatively 3–5 . The sequelae of untreated OSA include diabetes, congestive heart failure, stroke, and increased all‐cause mortality 2 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 20% of men and 10% of women in the United States suffer from moderate-to-severe OSA, and approximately 60%-90% of surgical patients with moderate-to-severe disease are undiagnosed preoperatively. [3][4][5] The sequelae of untreated OSA include diabetes, congestive heart failure, stroke, and increased all-cause mortality. 2 Perioperatively, patients with known OSA are at increased risk for difficulty with intubation, postoperative hypoxemia, and ICU admission; additionally, OSA patients without a formal diagnosis face even higher risk.…”

Section: Introductionmentioning

confidence: 99%

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Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis

et al. 2023

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Objectives: Approximately 20% of patients with chronic rhinosinusitis (CRS) have comorbid obstructive sleep apnea (OSA). Patients with undiagnosed OSA are at high risk for perioperative complications. The Sinonasal Outcomes Test (SNOT-22) Questionnaire is commonly administered to CRS patients, whereas OSA screening tools are less routinely employed. This study compared SNOT-22 sleep subdomain (Sleep-SNOT) scores among non-OSA CRS versus OSA-CRS patients undergoing ESS, and assessed sensitivity, specificity, and diagnostic accuracy of the Sleep-SNOT for OSA screening.Methods: Retrospective review of patients that underwent endoscopic sinus surgery (ESS) for CRS from 2012 to 2021. Patients either carried a reported OSA diagnosis and completed the SNOT-22, or had undocumented OSA status and completed both STOP-BANG and SNOT-22. Demographics, questionnaire scores, and OSA status were collected. A receiver operating characteristic (ROC) curve assessed cutoff scores, sensitivity, and specificity of the Sleep-SNOT for OSA screening.Results: Of 600 patients reviewed, 109 were included. 41% had comorbid OSA. OSA patients had a higher BMI (32.1

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis

et al. 2023

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“…Future studies are warranted to determine if and how long PPV restrictions are necessary after ESBS in OSA patients with and without intraoperative CSF leaks. The need for further investigations on this topic has been increasingly recognized, and additional studies may already be underway 118 …”

Section: Discussionmentioning

confidence: 99%

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

Abiri

Patel

Nguyen

et al. 2022

Int Forum Allergy Rhinol

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Background Postoperative management strategies for endoscopic skull base surgery (ESBS) vary widely because of limited evidence‐based guidance. Methods The PubMed, EMBASE, and Cochrane databases were systematically reviewed from January 1990 through February 2022 to examine 18 postoperative considerations for ESBS. Nonhuman studies, articles written in a language other than English, and case reports were excluded. Studies were assessed for levels of evidence, and each topic's aggregate grade of evidence was evaluated. Results A total of 74 studies reporting on 18 postoperative practices were reviewed. Postoperative pain management, prophylactic antibiotics, and lumbar drain use had the highest grades of evidence (B). The literature currently lacks high quality evidence for a majority of the reviewed ESBS precautions. There were no relevant studies to address postoperative urinary catheter use and medical intracranial pressure reduction. Conclusion The evidence for postoperative ESBS precautions is heterogeneous, scarce, and generally of low quality. Although this review identified the best evidence available in the literature, it suggests the urgent need for more robust evidence. Therefore, additional high‐quality studies are needed in order to devise optimal postoperative ESBS protocols.

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American Rhinologic Society expert practice statement part 2: Postoperative precautions and management principles following endoscopic skull base surgery

Douglas,

Adappa,

Choby

et al. 2024

Int Forum Allergy Rhinol

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The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence regarding postoperative precautions for patients following endoscopic skull base surgery for intradural pathology. These topics include the administration of postoperative nasal hygiene; patient mobilization and activity level; the resumption of continuous positive airway pressure in patients with obstructive sleep apnea; and the timing and capacity with which a patient may be subjected to barotrauma, such as air travel postoperatively. This EPS was developed following the recommended methodology and approval process as previously outlined. Given the diverse practices and limited agreement on the accepted principles regarding postoperative precautions for patients following skull base surgery, this EPS seeks to summarize the existing literature and provide clinically relevant guidance to bring clarity to these differing practice patterns. Following a modified Delphi approach, four statements were developed, all of which reached consensus. Because of the paucity of literature on these topics, these statements represent a summation of the limited literature and the experts’ opinions. These statements and the accompanying evidence are summarized below, along with an assessment of future needs.

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Evolving concepts in the perioperative management of obstructive sleep apnea after endoscopic skull base surgery

Cited by 6 publications

References 25 publications

Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis

Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

American Rhinologic Society expert practice statement part 2: Postoperative precautions and management principles following endoscopic skull base surgery

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