Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care

Wolfe, Robert M.; Pomerantz, Jonathan; Miller, Deborah E.; Weiss-Coleman, Rebecca; Solomonides, Tony

doi:10.3122/jabfm.2016.02.150085

Cited by 52 publications

(33 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these numbers may underestimate the true prevalence of the disease, as studies have shown that a significant proportion of OSA patients are undiagnosed [13–16]. …”

Section: Introductionmentioning

confidence: 99%

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

et al. 2017

View full text Add to dashboard Cite

BackgroundPostoperative respiratory complications (PRCs) are associated with significant morbidity, mortality, and hospital costs. Obstructive sleep apnea (OSA), often undiagnosed in the surgical population, may be a contributing factor. Thus, we aimed to develop and validate a score for preoperative prediction of OSA (SPOSA) based on data available in electronic medical records preoperatively.MethodsOSA was defined as the occurrence of an OSA diagnostic code preceded by a polysomnography procedure. A priori defined variables were analyzed by multivariable logistic regression analysis to develop our score. Score validity was assessed by investigating the score’s ability to predict non-invasive ventilation. We then assessed the effect of high OSA risk, as defined by SPOSA, on PRCs within seven postoperative days and in-hospital mortality.ResultsA total of 108,781 surgical patients at Partners HealthCare hospitals (2007–2014) were studied. Predictors of OSA included BMI >25 kg*m−2 and comorbidities, including pulmonary hypertension, hypertension, and diabetes. The score yielded an area under the curve of 0.82. Non-invasive ventilation was significantly associated with high OSA risk (OR 1.44, 95% CI 1.22–1.69). Using a dichotomized endpoint, 26,968 (24.8%) patients were identified as high risk for OSA and 7.9% of these patients experienced PRCs. OSA risk was significantly associated with PRCs (OR 1.30, 95% CI 1.19–1.43).ConclusionSPOSA identifies patients at high risk for OSA using electronic medical record-derived data. High risk of OSA is associated with the occurrence of PRCs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0361-z) contains supplementary material, which is available to authorized users.

show abstract

“…However, these numbers may underestimate the true prevalence of the disease, as studies have shown that a significant proportion of OSA patients are undiagnosed [13–16]. …”

Section: Introductionmentioning

confidence: 99%

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

et al. 2017

View full text Add to dashboard Cite

show abstract

“…For this reason, several screening tools, such as the STOP-Bang, ASA checklist, sleep apnea clinical score, and Berlin questionnaire, were developed to assess the possible existence of an undiagnosed OSA and to provide risk stratification of OSA in surgical patients (10–12). A recent study showed that high-risk OSA patients had nearly fourfold increase in developing airway events in postanesthesia care unit (PACU) compared with low-risk OSA patients (13).…”

Section: Introductionmentioning

confidence: 99%

“…However, on postoperative night 1 and 3, they found out that 31 of those patients had apnea hypopnea index (AHI) >15, which defines the cutoff level of moderate OSA (26). That was implicated by the fact that surgery may have an impact on the incidence of OSA by altering sleep architecture, which possibly contributes to a greater degree of postoperative risk in OSA patients (10). The postsurgical period is characterized by disturbances in rapid eye movement phase of sleep, during which there are more occurrences of apneic episodes and desaturations (27).…”

Section: Introductionmentioning

confidence: 99%

A Brief Review of Non-invasive Monitoring of Respiratory Condition for Extubated Patients with or at Risk for Obstructive Sleep Apnea after Surgery

et al. 2017

View full text Add to dashboard Cite

Obstructive sleep apnea (OSA) is one of the important risk factors contributing to postoperative airway complications. OSA alters the respiratory physiology and increases the sensitivity of muscle tone of the upper airway after surgery to residual anesthetic medication. In addition, the prevalence of OSA was reported to be much higher among surgical patients than the general population. Therefore, appropriate monitoring to detect early respiratory impairment in postoperative extubated patients with possible OSA is challenging. Based on the comprehensive clinical observation, several equipment have been used for monitoring the respiratory conditions of OSA patients after surgery, including the continuous pulse oximetry, capnography, photoplethysmography (PPG), and respiratory volume monitor (RVM). To date, there has been no consensus on the most suitable device as a recommended standard of care. In this review, we describe the advantages and disadvantages of some possible monitoring strategies under certain clinical conditions. According to the literature, the continuous pulse oximetry, with its high sensitivity, is still the most widely used device. It is also cost-effective and convenient to use but has low specificity and does not reflect ventilation. Capnography is the most widely used device for detection of hypoventilation, but it may not provide reliable data for extubated patients. Even normal capnography cannot exclude the existence of hypoxia. PPG shows the state of both ventilation and oxygenation, but its sensitivity needs further improvement. RVM provides real-time detection of hypoventilation, quantitative precise demonstration of respiratory rate, tidal volume, and MV for extubated patients, but no reflection of oxygenation. Altogether, the sole use of any of these devices is not ideal for monitoring of extubated patients with or at risk for OSA after surgery. However, we expect that the combined use of continuous pulse oximetry and RVM may be promising for these patients due to their complementary function, which need further study.

show abstract

“…Sleep apnea is a commonly recognized medical problem in the United States, yet an estimated 70 -80% of patients with the condition remain undiagnosed. [1][2][3][4] Because sleep apnea is associated with a variety of poor patient outcomes, 5,6 awareness of the importance of diagnosing sleep apnea has become much more common in recent years, with referrals for polysomnography, the accepted standard method for diagnosing sleep apnea, increasing 12-fold worldwide over the past decade. 1 Sleep laboratory capacity has not accompanied the dramatic increase in demand, contributing to widespread underdiagnosis and undertreatment of sleep apnea.…”

Section: Introductionmentioning

confidence: 99%

Economic Assessment of 4 Approaches to the Diagnosis and Initial Treatment of Sleep Apnea

Bravata¹,

Lightner²,

Yaggi

et al. 2017

Respir Care

View full text Add to dashboard Cite

show abstract

Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care

Cited by 52 publications

References 74 publications

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

A Brief Review of Non-invasive Monitoring of Respiratory Condition for Extubated Patients with or at Risk for Obstructive Sleep Apnea after Surgery

Economic Assessment of 4 Approaches to the Diagnosis and Initial Treatment of Sleep Apnea

Contact Info

Product

Resources

About