Proportion of Surgical Patients With Undiagnosed Obstructive Sleep Apnoea

Abstract

† Obstructive sleep apnoea (OSA) is associated with perioperative morbidity but is under-diagnosed in the community. † In this study of Canadian surgical patients, both anaesthetists and surgeons often failed to diagnose OSA. † Preoperative diagnosis was poor, even in patients with symptoms of moderate-to-severe OSA. Background. Obstructive sleep apnoea (OSA) affects 9-24% of the general population, and 90% remain undiagnosed. Those patients with undiagnosed moderate-to-severe OSA may be associated with an increased risk of perioperative complications. Our objective was to evaluate the proportion of surgical patients with undiagnosed moderate-to-severe OSA. Methods. After research ethics board approval, patients visiting preoperative clinics were recruited over 4 yr and screened with the STOP-BANG questionnaire. The 1085 patients, who consented, subsequently underwent polysomnography (PSG) (laboratory or portable) before operation. Chart review was conducted in this historical cohort to ascertain the clinical diagnosis of OSA by surgeons and anaesthetists, blinded to the PSG results. The PSG study-identified OSA patients were further classified based on severity using the apnoea-hypopnoea index (AHI) cutoffs. Results. Of 819 patients, 111 patients had pre-existing OSA and 58% (64/111) were not diagnosed by the surgeons and 15% (17/111) were not diagnosed by the anaesthetists. Among the 708 study patients, PSG showed that 233 (31%) had no OSA, 218 (31%) patients had mild OSA (AHI: 5-15); 148 (21%) had moderate OSA (AHI: 15-30), and 119 (17%) had severe OSA (AHI.30). Before operation, of the 267 patients with moderateto-severe OSA, 92% (n¼245) and 60% (n¼159) were not diagnosed by the surgeons and the anaesthetists, respectively. Conclusions. We found that anaesthetists and surgeons failed to identify a significant number of patients with pre-existing OSA and symptomatic undiagnosed OSA, before operation. This study may provide an impetus for more diligent case finding of OSA before operation.

The importance of obstructive sleep apnoea management in peri-operative medicine

“…Whilst sleep physicians are keen to identify and treat OSA patients, the prospect of a five-fold increase in workload is daunting. As anaesthetists, we are already looking after a significant number of undiagnosed OSA patients [48]. We could make a major contribution to the health care system in the diagnosis and treatment of this condition as well as improving peri-operative safety.…”

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

“…Retrospective analyses have shown that a diagnosis of OSA is often missed in many bariatric surgical patients [216] and this subset of patients is at high risk to develop postoperative complications [217]. In patients with BMI [35 kg/m 2 the use of nasal CPAP postoperatively might be an alternative due to higher tolerance/compliance, however its therapeutic efficacy may be limited by oral air leaks [218].…”

Obstructive sleep apnoea in patients undergoing cardiac surgery: Screening, postoperative outcomes and perioperative care

“…OSA is common 1 and the reported prevalence has increased in the last two decades 1 with the new data reported mainly in European population of adults 40-85 years old showing that at least mild OSA (apnoea-hypopnoea index ≥5) was present in 84% of men and 61% of women and at least moderate disease (apnoea-hypopnoea index ≥15) was present in 50% of men and 23 % of women 2 . OSA and cardiac disease share some common risk factors and in patients undergoing coronary artery bypass graft (CABG) procedures reported prevalence is high, ranging between 41 and 87% [3][4][5] .High proportions of patients may present for surgery without a previous diagnosis of OSA 6,7 and may be at risk of worse postoperative outcomes 8 . In patients with moderate to severe OSA syndrome Continuous Positive Airway Pressure (CPAP) is the conventional treatment with established clinical and cost effectiveness 9 but its effect on cardiovascular outcomes has not been confirmed.…”