Perioperative Management of Obstructive Sleep Apnea

Abdullah, Hairil Rizal; Chung, Frances

doi:10.1007/s40140-013-0039-0

Cited by 5 publications

(6 citation statements)

References 69 publications

(59 reference statements)

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“…The increasing prevalence of obesity in the general population gives cause for concern that OSA is on the rise (Peppard & Hagen, 2017). According to Abdullah and Chung (2014), mounting evidence suggests that OSA may be an “independent risk factor for perioperative complications” (Abdullah & Chung, 2014, p. 20).…”

Section: Prescreening For Obstructive Sleep Apnea In Procedural Consc...mentioning

confidence: 99%

“…Each of the eight dichotomous (yes/no) questions scores 1 point for a “yes” answer, allowing for a total STOP-Bang score ranging from 0 to 8. A STOP-Bang score of greater than 3 is considered “at risk” or “intermediate risk” for OSA, and a score of 5 or greater is considered at “high risk” for OSA (Abdullah & Chung, 2014, p. 21). The STOP-Bang screening questionnaire (University of Toronto, 2012) has been correlated to PSG testing for sleep apnea in predicting moderate to severe sleep apnea.…”

Section: Prescreening For Obstructive Sleep Apnea In Procedural Consc...mentioning

confidence: 99%

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Identifying Predictors of Airway Complications During Conscious Sedation Procedures

Bray

Knapp

2021

Gastroenterology Nursing

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Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea screening questionnaire used as a preprocedure evaluation tool to assess a patient's risk for obstructive sleep apnea. The purpose of this study was to determine whether risk factors for obstructive sleep apnea, using the STOP-Bang questionnaire, could predict procedural airway complications in 152 endoscopy patients following conscious sedation. Logistic regression analysis revealed that a STOP-Bang score of greater than 5 (high risk) predicted a 10% change in heart rate (p = .021), apnea (p = .038), and arousal-relieved airway obstruction (p = .023). Every point of increase in body mass index predicted a 10% change in heart rate (p = .046), a drop in oxygen saturation (p = .002), apnea (p = .003), and 1.212 times the odds of requiring arousal-relieved airway obstruction (p = .002). An intermediate-risk STOP-Bang score (3-4) positively correlated to abnormal carbon dioxide values during the procedure (p = .015). These findings concur with existing literature on the topic and translate to clinical considerations of procedural monitoring protocols for patients with a high probability for airway complications during conscious sedation.

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Section: Prescreening For Obstructive Sleep Apnea In Procedural Consc...mentioning

confidence: 99%

Section: Prescreening For Obstructive Sleep Apnea In Procedural Consc...mentioning

confidence: 99%

Identifying Predictors of Airway Complications During Conscious Sedation Procedures

Bray

Knapp

2021

Gastroenterology Nursing

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“…OSA patients have been gaining a number of attention from health care providers, particularly in the last decades, as current evidence associate it with a number of chronic illness that are physically serious and economically draining consequences [6] .…”

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confidence: 99%

Incidence of difficult airway among adult patients of undiagnosed obstructive sleep apnea who are undergoing elective surgery: a prospective cohort study

Muzien¹,

Gelgelo²,

Woldeyohans³

2022

International Journal of Surgery: Global Health

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Introduction: Obstructive sleep apnea (OSA) is a dangerous medical disorder marked by obstruction of the upper airway during sleep that is frequently undiagnosed before surgery. Preoperative identification of suspected OSA patients necessitates appropriate preparation and prevents unfavorable outcomes. The incidence of difficult airway in adult patients with OSA who are undergoing elective surgery is significantly increased. Materials and method: The study population was separated into high and low-risk groups based on STOP-BANG scores of ≥ 3 and <3, respectively. The rate of occurrence was compared between the study groups. SPSS version 23 was used for statistical analysis. P-values <0.05 are considered significant. To find characteristics that predict problematic airway, researchers used logistic regression.Result: A total of 113 participants was enrolled. Based on STOP-BANG 77 patients and 36 patients were grouped in to low risk OSA and high risk OSA, respectively, the incidence of difficult intubation (DI) was significantly higher (22.2%) in high risk OSA group versus 5.2% in low risk OSA group, relative risk of 4.278 (95% confidence interval: 1.378-13.2). Mask ventilation was significantly more problematic for the high-risk group (P = 0.011) (25% against 6.5%). Male sex, neck circumference > 40 cm, Mallampati class 3, and 12.5 cm stern mental distance were all linked to DI. Age above 50 years, snoring history, and a neck circumference of > 40 cm were all found to be predictors. Conclusion: Patients who scored ≥ 3 on the STOP-BANG had a significantly higher rate of DI and difficult mask ventilation. As a result, the STOP-BANG questionnaire should be used to screen every adult patient undergoing elective surgery for OSA.

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“…This information has application in the clinical consideration of monitoring protocols, medication administration, equipment availability, and staffing for patients with a high probability for airway obstruction. Total n 180 (Aurora et al, 2015;Abdullah et al, 2014;Choi et al, 2010) *Minimum sample size (n) required to run logistic regression analysis:…”

Section: Resultsmentioning

confidence: 99%

“…The advantages of preoperative screening apply to pre-procedural patient evaluation to mitigate risk and optimize patient safety. Polysomnography claims to be the gold standard for the confirming the diagnosis of sleep apnea and is able to differentiate between central sleep apnea and OSA (Abdullah et al, 2014).…”

Section: Preoperative Patient Evaluation and Evidence-based Practice mentioning

confidence: 99%

Identifying Predictors of Airway Complications in Conscious Sedation Procedures

Bray

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Problem: Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea (OSA) screening questionnaire used as a pre-procedure evaluation tool to assess a patient's risk for OSA. There are four verifiable, objective questions and four subjective questions. This study examines to what extent the STOP-Bang score question variables reliably predict airway complications during conscious sedation procedures. Method: The method was a retrospective review of data from the electronic medical record (EMR) of patients who had conscious sedation for endoscopy procedures. The individual questions of the STOP-Bang questionnaire were manually collected as independent predictor variables. Physiologic signs of airway compromise and documented airway maneuvers to relieve airway obstruction were collected as dependent outcome variables. Logistic regression analysis was preformed to predict outcome severity based on individual and total STOP-Bang questionnaire scores. Results: A STOP-Bang threshold score of greater than 5, indicating a high risk for OSA, was determined to be predictive of a heart rate change greater than 10% from baseline during the procedure (p =.021) and periods of apnea of (respiratory rate less than or equal to 8 seconds) (p = .038), indicating airway compromise. The STOP-Bang threshold score of greater than 5 was statistically significantly when correlated to the patient requiring arousal-relieved airway obstruction by verbal or tactile stimulation (p = .023). For the predictor variable of every point of increase in Body Mass Index (BMI), there was a statistically significant correlation with an increase in heart rate during the procedure by 10%, (p = .046), a drop in oxygen saturation as measured by pulse oximetry (SpO 2) (p = .002), and periods of apnea (respiratory rate less than or equal to 8) (p = .003). Additionally, for every point of increase in BMI there was 1.212 times the odds of requiring verbal or tactile stimulation to relieve airway obstruction (p = .002). The predictor variable of an STOP-Bang score between 3 and 4, indicating intermediate risk for OSA, was correlated to the development of abnormal CO 2 values during the procedure (p = 0.15). Conclusion: With these findings, proactive safety measures can be instituted for additional airway management for identified at-risk patients. This information has application in the clinical consideration of monitoring protocols, medication administration, equipment availability, and staffing for patients with a high probability for airway obstruction during conscious sedation.

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Perioperative Management of Obstructive Sleep Apnea

Cited by 5 publications

References 69 publications

Identifying Predictors of Airway Complications During Conscious Sedation Procedures

Identifying Predictors of Airway Complications During Conscious Sedation Procedures

Incidence of difficult airway among adult patients of undiagnosed obstructive sleep apnea who are undergoing elective surgery: a prospective cohort study

Identifying Predictors of Airway Complications in Conscious Sedation Procedures

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