Interpretation of sleep studies for patients with sleep-disordered breathing: What the anesthesiologist needs to know

Abstract

There is increased interest in the perioperative management of patients with sleep-disordered breathing (SDB). Anesthesiologists must distill information from clinical reports to make key decisions for optimizing perioperative care. A patient with SDB may present with a sleep study report at the time of surgery. Knowledge of the essential components of such a report can help the anesthesiologist evaluate the patient and optimize the perioperative management. In this narrative review, we describe how level I (i.e., laboratory-based) polysomnography (PSG) data are collected and scored using the recommended scoring guidelines, as well as the basic information and salient features of a typical PSG report relevant to the anesthesiologist. In addition, we briefly review the indications for sleep studies, including the types of laboratory-based studies, as well as the role and limitations of portable monitors (level II-IV studies) and examples of PSG reports in the clinical context.

Sleep Study and Oximetry Parameters for Predicting Postoperative Complications in Patients With OSA

“…Evidence from a network-based cluster analysis suggests that populations with OSA are much more diverse than traditionally conceived because there are clusters of nonobese, thin-necked, normotensive individuals with OSA. 60 Certain phenotypes of OSA, such as those with high arousal threshold 44 or high loop gain, 61 are underrecognized and may not be apparent immediately from the results of conventional PSG. Those with the phenotype with high arousal threshold have a low propensity to wake with obstructive events, which may predispose them to a greater magnitude of hypoxemia and hypercarbia within a respiratory event vs those in a patient with a similar AHI.…”

“…Those with the phenotype with high loop gain, characterized by an oversensitive ventilatory response to hypercapnia, may be predisposed to hyperventilation and hypocapnia leading to decreased respiratory drive and central sleep apnea. 61 This cycle of overcompensation leads to unstable and perpetual cycles of hypoxia, which may predispose the patient to cardiac and pulmonary complications. In clinical practice, these parameters are not routinely used in PSGs and require further validation studies.…”

Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

“…Type 3 involved portable monitoring (minimum of 4 channels: respiratory movement, airflow, heart rate, SpO2). Type 4 involved portable monitoring with 1 or 2 channels, including pulse oximetry [44].…”

Preoperative identification of children at high risk of obstructive sleep apnea

“…A commonly stated limitation of home PSG studies is a relatively higher rate of technical issues and poor quality of signals due to unattended nature of the study compared with in‐lab PSGs . However, a recent report suggests that such studies can be performed with >95% technically acceptable recordings, indicating that technologist skill and experience are important factors in study success.…”