Development and Validation of a Morphologic Obstructive Sleep Apnea Prediction Score

Deflandre, Eric; Degey, Stéphanie; Brichant, Jean-François; Poirrier, Robert; Bonhomme, Vincent

doi:10.1213/ane.0000000000001089

Cited by 30 publications

(34 citation statements)

References 46 publications

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“…We recently reported the results of a study (EudraCT: 2006-006558-92) that outlined the development of the DES-OSA score (the DES part of the acronym being derived from the initials of the investigators involved in its development) in 139 patients. 4 The Figure shows the relation between the ODI and the AHI from that study. Clearly, some, but not all, patients with severe OSA (AHI [ 30) experienced nocturnal hypoxia.…”

mentioning

confidence: 92%

What mediates postoperative risk in obstructive sleep apnea: airway obstruction, nocturnal hypoxia, or both?

Deflandre

Bonhomme

Brichant

et al. 2016

Can J Anesth/J Can Anesth

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Obstructive sleep apnea (OSA) is known to be an independent risk factor for postoperative complications. 1,2The apnea-hypopnea index (AHI) -i.e., the number of apnea and hypopnea events per hour of sleep during overnight polysomnographic (PSG) monitoring -has typically served to classify the severity of OSA (with severe OSA defined by an AHI [ 30).2 A recently reported matched cohort study by Mutter et al. that measured the severity of OSA by AHI during PSG monitoring appears to constitute a landmark for identifying OSA patients at risk of postoperative complications. In that study, increased severity of OSA was associated with increased risk of complications, although only the data for the severe OSA group reached statistical significance. 2Hypoxic events in OSA patients may have significant pathophysiological consequences.3 Although confirmatory prospective studies are lacking, we hypothesize that these hypoxia-mediated inflammatory modifications could increase the risk of postoperative complications, acting cumulatively with the AHI or even mediating its effects entirely.An oxygen desaturation index (ODI) can also be derived from the PSG analysis and can be used as an independent measure of hypoxia. The ODI represents the number of times per hour that the capillary blood oxygen saturation drops by C4% from baseline during overnight PSG monitoring. We recently reported the results of a study (EudraCT: 2006-006558-92) that outlined the development of the DES-OSA score (the DES part of the acronym being derived from the initials of the investigators involved in its development) in 139 patients. 4 The Figure shows the relation between the ODI and the AHI from that study. Clearly, some, but not all, patients with severe OSA (AHI [ 30) experienced nocturnal hypoxia. In the patients with severe OSA and hypoxia, the ODI varied considerably, with minimum and maximum values of 2 and 92 events per hour, respectively, although the median [interquartile range] was only 25 [10-37] events per hour. Among patients with severe OSA, 33% encountered no (ODI \ 5 events per hour) or mild (ODI 5-15) nocturnal hypoxia; 29% had moderate nocturnal hypoxia (ODI 15-30); and 38% had severe nocturnal hypoxia (ODI[ 30). Wide variation in the preoperative and postoperative ODIs among surgical patients with and without OSA has also been noted, but the relation of the ODI to the AHI and postoperative complications was not assessed. Mutter et al. found that only severe OSA patients were at a significantly increased risk of postoperative complications.2 Whether hypoxemic and non-hypoxemic severe OSA patients share the same risk or only patients with both severe OSA and hypoxia are at risk is unknown. Our preliminary data suggest that future studies investigating postoperative complications in OSA patients

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mentioning

confidence: 92%

What mediates postoperative risk in obstructive sleep apnea: airway obstruction, nocturnal hypoxia, or both?

Deflandre

Bonhomme

Brichant

et al. 2016

Can J Anesth/J Can Anesth

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“…For example, Marrone et al demonstrated in a cohort of patients (from the European Sleep Apnea Database) that the combination of severe OSA and nocturnal hypoxemia might be an important risk factor for kidney dysfunction. 5 We have read with great interest the letter of Chung et al 6 wherein they highlighted the deleterious influence of nocturnal hypoxemia on the postoperative complication rate. Their letter confirmed to us that future studies must be specifically designed to recognize the possible influence of the nocturnal hypoxemia/severe OSA combination vs nocturnal hypoxemia alone or severe OSA alone.…”

Section: To the Editormentioning

confidence: 99%

“…In future studies, special attention should also be directed to identifying patients with thisnocturnal hypoxemia/severe OSA combination in a surgical population (e.g., using screening tools such as STOP-Bang and DES-OSA). 6 …”

Section: To the Editormentioning

confidence: 99%

In reply: Perioperative nocturnal hypoxemia matters in surgical patients with obstructive sleep apnea

Deflandre

2016

Can J Anesth/J Can Anesth

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“…Besides the effort to reduce the number of undiagnosed cases of OSA, it is of general interest among surgeons and anesthesiologists to estimate the postoperative outcome ofpatients with OSA [2]. Therefore, scientists developed a clinical screening in a sleep center, in a population with a high incidence of OSA.…”

Section: Predictors Of Obstructive Sleep Apnea Anthropometric Measurementioning

confidence: 99%

“…Therefore, scientists developed a clinical screening in a sleep center, in a population with a high incidence of OSA. The test ought to define the severity of OSA and contains Mallampati Index, the distance between thyroid and chin (cm), neck circumference (cm), BMI (kg/m 2 ), and gender [2]. Despite all these approaches there is still an intense debate on the significance and hierarchy of all possible predictors of OSA.…”

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confidence: 99%

Predictors of obstructive sleep apnea

2016

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Obstructive sleep apnea (OSA) is a disorder with a high prevalence not only in western societies. OSA is defined as an apnea-hypopnea index(AHI)> 5/hsleep, whereas OSA syndrome (OSAS) includes the symptoms associated with OSA. The current prevalence of OSA approximately amounts to 26 % (AHI ≥ 5) of the population in the US aged 30-70 years [13]. Worse sleep-disordered breathing (AHI ≥ 15) has a prevalence of 10 %. The prevalence varies depending on age, body mass index (BMI), and gender: Among 30-49-year-old men, the number of patients affected (AHI ≥ 15) is much higher (10 %) than among women of the same age (3 %). Reaching older ages (50-70 years), the numbers are higher, with prevalences of 17 % of men and 9 % of women with an AHI ≥ 15 [13]. These epidemiological estimations represent the increase of OSA over the last two decades, which is likely a result of the progressing obesity epidemic in the US [13].This gives an impression of how huge the number of people with OSAS really is. In many cases it is never diagnosed, due to a lack of symptoms such as daytime sleepiness or neurocognitive disorders. The situation is equivalent in European countries, where many cases of OSAS remain undetected. A recent populationbased study in Lausanne collected data of 2121 participants and found a prevalence of 83.8 % among men and 60.8 % among women with an AHI ≥ 5, whereas 49.7 % of the male and 23.4 % of the female participants actually had an AHI ≥ 15 [7].It has to be taken into consideration that only some affected persons have symptoms of OSAS that would help to detect it.The gold standard of OSAS diagnostics is polysomnography (PSG), but this is also very complex and expensive. Capacity is mostly limited and waiting periods extend to 6 months and longer. There is a discussion on the guidelines' recommendation to use polygraphy instead, in order to prescreen patients with suspected OSAS [14]. In the recent past, researchers took the initiative to simplify the diagnostic process, considering the fact that approximately 80 % of the people with OSA remain undiagnosed [5]. A recent pilot study analyzed the inability to fit hands around the neck as a predictor of OSA. This screening procedure has a positive predictive power of 100 %, but a negative predictive power of only 31.6 % for an AHI ≥ 5/h [5].Consequences of OSAS include worsening of cardiovascular disease with a negative impact on the general health condition of the patient, neurocognitive disorders, and a much higher risk for car accidents because of daytime sleepiness and inattentiveness [10,16]. Besides the effort to reduce the number of undiagnosed cases of OSA, it is of general interest among surgeons and anesthesiologists to estimate the postoperative outcome ofpatients with OSA [2]. Therefore, scientists developed a clinical screening in a sleep center, in a population with a high incidence of OSA. The test ought to define the severity of OSA and contains Mallampati Index, the distance between thyroid and chin (cm), neck circumference (cm), BMI (kg/m 2 ), and...

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Development and Validation of a Morphologic Obstructive Sleep Apnea Prediction Score

Cited by 30 publications

References 46 publications

What mediates postoperative risk in obstructive sleep apnea: airway obstruction, nocturnal hypoxia, or both?

What mediates postoperative risk in obstructive sleep apnea: airway obstruction, nocturnal hypoxia, or both?

In reply: Perioperative nocturnal hypoxemia matters in surgical patients with obstructive sleep apnea

Predictors of obstructive sleep apnea

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