Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort

Abstract

Objective A recent investigation at Barnes-Jewish Hospital located in St. Louis, Missouri, found that an estimated 22% of adults presenting for inpatient surgery screened as high risk for obstructive sleep apnea (OSA). Surgical patients with OSA have multiple comorbidities and are at increased risk for perioperative complications. Our objective was to determine whether a prior diagnosis of OSA, or a positive screen for OSA is associated with increased risk for 30 days and one year mortality. Methods B-J APNEAS (Barnes-Jewish Apnea Prevalence in Every Admission Study) was a prospective cohort study. Unselected adult surgical patients at Barnes Jewish Hospital were prospectively enrolled between February 2006 and April 2010. All patients completed preoperative OSA screening and those who were at risk for OSA according to a combination of the Berlin and Flemons screening tools received targeted postoperative interventions. STOP and STOP-BANG scores were also obtained. Results Overall, the sample included 14,962 patients, of whom 1,939 (12.9%) reported a history of OSA. All four screening tools identified a high prevalence of undiagnosed patients at risk for OSA (9.5% to 41.6%), but agreement among screens was not strong with Kappa ranging from 0.225 to 0.611. There was no significant difference in 30 day postoperative mortality between patients with possible OSA (based on their history or on a positive OSA screen with any of the four instruments) and the rest of the surgical population. Significant differences in one-year mortality were noted between the low and high-risk groups as identified by the Flemons’ (4.96% versus 6.91%; p <0.0001), STOP (5.28% versus 7.57%; p <0.0001) and STOP-BANG (4.13% versus 7.45%; p <0.0001) screens. After adjusting for risk factors, none of the OSA screening tools independently predicted mortality rate up to one year postoperatively. Conclusion Neither a prior diagnosis of OSA, or a positive screen for OSA risk was associated with increased 30 day or one year postoperative mortality. It is possible that incorporating OSA screening and patient safety measures into routine care mitigated the early postoperative complications in this patient cohort. The results of this study highlight uncertainties and research priorities for the medical community.

Risk of Sleep Apnea in Hospitalized Older Patients

“…Interestingly, compared to one of these studies of surgical patients by Lockhart et al, our study found twice as many general medicine inpatients screening at high risk as surgical patients. 34 Given the potentially high rates of undiagnosed OSA on medical wards, hospital staff should be trained to routinely screen patients who are at high risk for OSA and refer them for diagnosis and treatment.…”

Perioperative Complications in Obstructive Sleep Apnea Patients

“…A variety of screening questionnaires have been used to identify patients at high risk for OSA and used as surrogates for diagnosing OSA in some perioperative studies [21][22][23][24][25][26][27][28][29]. The accuracy of screening questionnaires has been assessed in recent reviews [30,31] and is highly variable, reflecting different testing populations (i.e., high versus low prevalence of disease) and different diagnostic criteria used for defining OSA.…”

In Terms Of Thoracıc Surgery: Approaches To Lung Cancer Coexıstıng Wıth Sleep Dısordered Breathıng

“…Tahmini olarak her 4 erkekten birinin ve her 10 kadından birinin hafif OSA; her 9 erkekten birinin ve her 20 kadından 1'inin orta şiddette OSA olduğu düşünül-mektedir (1,2). Herhangi bir cerrahi işleme aday olan hastaların yaklaşık yarısında toplumda görülme sıklığı nedeniyle, tanı konulmamış OSA olma olasılığı vardır (3,4). OSA hastalarında perioperatif komplikasyonların daha sık görülmesi nedeniyle Amerikan Anesteziyoloji Birliği (ASA) ve Amerikan Uyku Tıbbı Akademisi (AASM) OSA hastalarının perioperatif yönetimine dair rehberler ve protokoller geliştirmiştir (5).…”