Safety of Gastrointestinal Endoscopy With Conscious Sedation in Patients With and Without Obstructive Sleep Apnea

Andrade, Christian; Patel, Brijesh; Gill, Jeffrey; Amodeo, Donald; Kulkarni, Prasad; Goldsmith, Susan; Bachman, Barbara; Geerken, Reynaldo; Klein, Malcolm; Anderson, William; Miladinović, Branko; Fernandez, Ileana; Kumar, Amit; Richter, J. P.; Vidyarthi, Gitanjali

doi:10.1097/mcg.0000000000000305

Cited by 18 publications

(12 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In short, significant differences between OSA patients and controls were not identified among any of the study variables: Incidence of hypoxia, hypotension, tachycardia or bradycardia. This is in correlation with regards to the recent publication from our institution highlighting the cardiopulmonary parameters in the OSA and non-OSA patients[ 8 ]. OSA patients are perceived as high risk for endoscopy and are offered monitored anesthesia care routinely although this meta-analysis suggests otherwise.…”

Section: Discussionsupporting

confidence: 83%

“…Non-significant variations in cardiopulmonary parameters are usually noted during routine endoscopy and have been well studied[ 5 - 7 ]. Several published studies, including a recently reported prospective study evaluating the risk of cardiopulmonary complications in patients with OSA undergoing endoscopy with conscious sedation have not supported the need for extra precaution[ 8 ]. We recently published a prospective analysis in the veteran population undergoing upper and lower endoscopy which did not find any significant cardio-pulmonary variation in control and OSA patients[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea

Andrade

Patel

Vellanki

et al. 2017

WJGE

Self Cite

View full text Add to dashboard Cite

AIMTo perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea (OSA).METHODSA comprehensive electronic search of MEDLINE and EMBASE was performed from inception until March 1, 2015. In an effort to include unpublished data, abstracts from prior gastroenterological society meetings as well as other reference sources were interrogated. After study selection, two authors utilizing a standardized data extraction form collected the data independently. Any disagreements between authors were resolved by consensus among four authors. The methodological quality was assessed using the Newcastle Ottawa tool for observational studies. The primary variables of interest included incidence of hypoxia, hypotension, tachycardia, and bradycardia. Continuous data were summarized as odds ratio (OR) and 95%CI and pooled using generic inverse variance under the random-effects model. Heterogeneity between pooled studies was assessed using the I2 statistic.RESULTSInitial search of MEDLINE and EMBASE identified 357 citations. A search of meeting abstracts did not yield any relevant citations. After systematic review and exclusion consensus meetings, seven studies met the a priori determined inclusion criteria. The overall methodological quality of included studies ranged from moderate to low. No significant differences between OSA patients and controls were identified among any of the study variables: Incidence of hypoxia (7 studies, 3005 patients; OR = 1.11; 95%CI: 0.73-1.11; P = 0.47; I2 = 0%), incidence of hypotension (4 studies, 2125 patients; OR = 1.10; 95%CI: 0.75-1.60; P = 0.63; I2 = 0%), incidence of tachycardia (3 studies, 2030 patients; OR = 0.94; 95%CI: 0.53-1.65; P = 0.28; I2 = 21%), and incidence of bradycardia (3 studies, 2030 patients; OR = 0.88; 95%CI: 0.63-1.22; P = 0.59; I2 = 0%).CONCLUSIONOSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures with conscious sedation.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea

Andrade

Patel

Vellanki

et al. 2017

WJGE

Self Cite

View full text Add to dashboard Cite

show abstract

“…Previous studies on the risk of adverse events have focused on populations undergoing gastrointestinal endoscopy. Patients at high risk of OSA had increased cardiopulmonary events when they underwent advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasound15 but not when they underwent routine esophagogastroduodenoscopy and colonoscopy2728303132. Differences in the duration and depth of sedation as well as in patient positioning during procedures may account for the different rates of cardiopulmonary events.…”

Section: Discussionmentioning

confidence: 99%

Snoring during Bronchoscopy with Moderate Sedation Is a Predictor of Obstructive Sleep Apnea

et al. 2019

View full text Add to dashboard Cite

BackgroundSnoring is the cardinal symptom of obstructive sleep apnea (OSA). Snoring and upper airway obstruction associated with major oxygen desaturation may occur in populations undergoing flexible bronchoscopy.MethodsTo evaluate the prevalence of patients at a high risk of having OSA among patients undergoing bronchoscopy with sedation and to investigate whether snoring during the procedure predicts patients who are at risk of OSA, we prospectively enrolled 517 consecutive patients who underwent the procedure with moderate sedation. Patients exhibiting audible snoring for any duration during the procedure were considered snorers. The STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, Age, Neck circumference and Gender) questionnaire was used to identify patients at high (score ≥3 out of 8) or low risk (score <3) of OSA.ResultsOf the 517 patients, 165 (31.9%) snored during bronchoscopy under sedation. The prevalence of a STOP-Bang score ≥3 was 61.9% (320/517), whereas 200 of the 352 nonsnorers (56.8%) and 120 of the 165 snorers (72.7%) had a STOP-Bang score ≥3 (p=0.001). In multivariable analysis, snoring during bronchoscopy was significantly associated with a STOP-Bang score ≥3 after adjustment for the presence of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and stroke (adjusted odds ratio, 1.91; 95% confidence interval, 1.26–2.89; p=0.002).ConclusionTwo-thirds of patients undergoing bronchoscopy with moderate sedation were at risk of OSA based on the screening questionnaire. Snoring during bronchoscopy was highly predictive of patients at high risk of OSA.

show abstract

“…However, we consider the nature of recovery from apneas and hypopneas was well characterized in the non-obese elderly patients under deep sedation even without previous OSA diagnosis. It would be an interesting future study to explore the differences of the nature of respiratory disturbances during propofol sedation between patients with and without obstructive sleep apnea [23].…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Cortical Arousal at Recovery from Respiratory Disturbances during Deep Propofol Sedation

Urahama

Uesato

Aikawa

et al. 2019

IJERPH

View full text Add to dashboard Cite

Recent evidences suggest that non-arousal mechanisms can restore and stabilize breathing in sleeping patients with obstructive sleep apnea. This possibility can be examined under deep sedation which increases the cortical arousal threshold. We examined incidences of cortical arousal at termination of apneas and hypopneas in elderly patients receiving propofol sedation which increases the cortical arousal threshold. Ten elderly patients undergoing advanced endoscopic procedures under propofol-sedation were recruited. Standard polysomnographic measurements were performed to assess nature of breathing, consciousness, and occurrence of arousal at recovery from apneas and hypopneas. A total of 245 periodic apneas and hypopneas were identified during propofol-induced sleep state. Cortical arousal only occurred in 55 apneas and hypopneas (22.5%), and apneas and hypopneas without arousal and desaturation were most commonly observed (65.7%) regardless of the types of disordered breathing. Chi-square test indicated that incidence of no cortical arousal was significantly associated with occurrence of no desaturation. Higher dose of propofol was associated with a higher apnea hypopnea index (r = 0.673, p = 0.033). In conclusion, even under deep propofol sedation, apneas and hypopneas can be terminated without cortical arousal. However, extensive suppression of the arousal threshold can lead to critical hypoxemia suggesting careful respiratory monitoring.

show abstract

Safety of Gastrointestinal Endoscopy With Conscious Sedation in Patients With and Without Obstructive Sleep Apnea

Cited by 18 publications

References 28 publications

Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea

Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea

Snoring during Bronchoscopy with Moderate Sedation Is a Predictor of Obstructive Sleep Apnea

Occurrence of Cortical Arousal at Recovery from Respiratory Disturbances during Deep Propofol Sedation

Contact Info

Product

Resources

About