Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

Abstract

Background The relationship between body mass index (BMI) and cardiopulmonary adverse events (CAEs) for ambulatory colonoscopy is unclear. Aim To assess the association of BMI and CAEs associated with ambulatory colonoscopy. Methods This is a retrospective cohort analysis of 418 patients who underwent outpatient colonoscopy at the Durham Veterans Affairs Medical Center categorized as normal/overweight (BMI < 30), obese (BMI 30–34), or morbidly obese (BMI ≥ 35). Adjusted logistic regression analyses were performed. Results At least one CAE occurred in 46.4% of patients (220 events, 72.7% were hypoxia). The rate of CAEs (BMI < 30: 43.8%, BMI 30–34: 48.0%, BMI ≥ 35: 50.6%, p = 0.53) and rate of hypoxia (BMI < 30: 34.8%, BMI 30–34: 40.9%, BMI ≥ 35: 43.2%, p = 0.32) were numerically higher for obese and morbidly obese patients, but not statistically significant. Obese (OR 1.10, 95% CI 0.70–1.73) and morbidly obese (OR 1.07, 95% CI 0.61–1.85) patients did not have an increased risk of CAEs after adjusting for age, ASA class, obstructive sleep apnea (OSA), and type of sedation. OSA was independently associated with an increased risk of CAEs (OR 1.71, 95% CI 1.09–2.74, p = 0.02) after adjusting for BMI, age, ASA class, and type of sedation. Conclusion OSA confers a higher risk of CAEs independent of BMI and sedation type. Consideration of undiagnosed OSA is recommended for appropriate pre-procedure risk stratification. While not statistically significant in this study, there may be clinically significant increased risks of CAEs and hypoxia for patient with BMI > 30 that require further evaluation with larger studies.

Impact of intravenous and topical lidocaine on clinical outcomes in patients receiving propofol for gastrointestinal endoscopic procedures: a meta-analysis of randomised controlled trials

“…Since snoring is suggestive of an increased upper airway resistance and pharyngeal collapsibility associated with the development of obstructive sleep apnoea (OSA), 54 a higher risk of cardiopulmonary adverse events (e.g. hypoxia) in those with OSA receiving colonoscopy independent of BMI and sedation type 55 may contribute to bias in our study outcomes.…”

Evaluation of Propofol-Sparing Effect of Intravenous Lignocaine in Patients Undergoing Daycare Upper Gastrointestinal Endoscopic Procedures

“…Respiratory complications like hypoventilation and apnea are major concerns in older patients with multiple comorbidities [ 10 ]. Obese patients and history of obstructive sleep apnea (OSA) are significant risk factors for the development of hypoxia in a patient undergoing sedation for endoscopic procedures [ 23 , 24 ]. We didn’t observe any major respiratory adverse events in our study.…”

Prevention of pulmonary complications in sedated patients undergoing interventional procedures in the nonoperating room anesthesia setting

“…Claims for adverse respiratory events (e.g., inadequate oxygenation or ventilation) are reportedly more common in the NORA setting than in the OR (53 vs. 23%); other respiratory-related complications (e.g., hypoxemia, aspiration, difficult intubation, esophageal intubation) are five times more common than in the OR [9]. Up to 54% of all NORA patients, regardless of American Society of Anesthesiologists (ASA) classification, suffer episodes of severe hypoxemia secondary to sedation-related upper airway obstruction (UAO) and respiratory depression despite supplemental oxygen and continuous monitoring of oxygenation [10,11]. Claims for death in NORA settings are reported to be higher than OR claims: 61% vs. 30% in one study and 54% vs. 29% in another [9,12].…”

“…Although the prevalence of obstructive sleep apnea (OSA) in the general population is estimated to be between 3% and 24%, it is much higher in the surgical population (24–41%), and it can be as high as 70% in high-risk populations such as the morbidly obese [16,17]. OSA is an independent risk factor for adverse perioperative cardiopulmonary events [11]. Obese patients with OSA are predisposed to episodes of desaturation in the perioperative period due to alterations in their respiratory physiology.…”