Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea

Bachenberg, Kenneth L.; Benumof, Jonathan L.; Caplan, Robert A.; Connis, Richard T.; Coté, Charles J.; Nickinovich, David G.; Prachand, Vivek N.; Ward, Denham S.; Weaver, Edward M.; Ydens, Lawrence; Yu, Song

doi:10.1097/00000542-200605000-00026

Cited by 824 publications

(103 citation statements)

References 61 publications

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“…Physicians should judge the probability of OSA based on the presence of risk factors and validated questionnaires. Major risk factors for OSA include male gender, obesity (body mass index >35 kg/m 2 ), wide neck (neck circumference > 40 cm), crowded oropharynx, and craniofacial abnormalities affecting the upper airway [62]. A four-question questionnaire known as “STOP” has been validated in screening perioperative patients for OSA [63].…”

Section: Risk Factors For Ppcsmentioning

confidence: 99%

“…Continuous positive airway pressure (CPAP), the mainstay treatment for OSA, may be considered during the perioperative period, and elective polysomnography should be arranged later on [64]. For those with known OSA prior to hip fracture, adequate treatment, such as CPAP, mandibular advancement device, or oral appliances, should be provided as recommended by the guidelines from the American Society of Anaesthesiologists [62]. …”

Section: Risk Factors For Ppcsmentioning

confidence: 99%

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Pre-operative pulmonary assessment for patients with hip fracture

Siu

Tse

et al. 2010

Osteoporos Int

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Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis, pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and mortality. This review aims to provide evidence-based recommendations for preoperative assessment and perioperative strategies to reduce the risk of pulmonary complications after hip fracture surgery. Clinical assessment and basic laboratory results are sufficient to stratify the risk of postoperative pulmonary complications. Well-documented risk factors for pulmonary complications include advanced age, poor general health status, current infections, pre-existing cardiopulmonary diseases, hypoalbuminemia, and impaired renal function. Apart from optimizing the patient's medical conditions, interventions such as lung expansion maneuvers and thromboprophylaxis have been proven to be effective in reducing the risk of pulmonary complications after hip fracture surgery.

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Section: Risk Factors For Ppcsmentioning

confidence: 99%

Section: Risk Factors For Ppcsmentioning

confidence: 99%

Pre-operative pulmonary assessment for patients with hip fracture

Siu

Tse

et al. 2010

Osteoporos Int

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“…[[6,34]] As also noted by Memtsoudis et al,[[20]] there was no increase in the rate of pulmonary embolism, and found that sleep apnoea is associated with an increased risk of admission to the intensive care unit and the need for transfusion and ventilation. While some patients with sleep apnoea might have received intensive care treatment, especially after high-risk procedures including upper airway surgery,[[35]] sleep apnoea is known as a risk factor for unplanned post-operative admission to the intensive care unit. [[36]] Hang et al[[37]] identified cardiovascular, respiratory and cerebrovascular events as the most common indications for intensive care admission in non-surgical patients with sleep apnoea.…”

Section: Discussionmentioning

confidence: 99%

“…The individual peri-operative risk has previously been described both as a function of the severity of sleep apnoea and also the type of surgery. [[35]] This applies to smoking, which is a predisposing factor for sleep apnoea and a risk factor for cardiovascular disease. [[40]] Nor was there information on body mass index (BMI) of individual patients, thus the authors were unable to adjust for BMI as a continuous rather than a binary variable (‘morbid obesity’).…”

Section: Discussionmentioning

confidence: 99%

Sleep apnoea adversely affects the outcome in patients who undergo posterior lumbar fusion

Stundner

Chiu

Sun

et al. 2014

The Bone & Joint Journal

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Despite the increasing prevalence of sleep apnoea, little information is available regarding its impact on the peri-operative outcome of patients undergoing posterior lumbar fusion. Using a national database, patients who underwent lumbar fusion between 2006 and 2010 were identified, sub-grouped by diagnosis of sleep apnoea and compared. The impact of sleep apnoea on various outcome measures was assessed by regression analysis. The records of 84 655 patients undergoing posterior lumbar fusion were identified and 7.28% also had a diagnostic code for sleep apnoea. Compared with patients without sleep apnoea, these patients were older, more frequently female, had a higher comorbidity burden and higher rates of peri-operative complications, post-operative mechanical ventilation, blood transfusion, and intensive care. Patients with sleep apnoea also had longer and more costly periods of hospitalisation. In the regression analysis, sleep apnoea emerged as an independent risk factor for the development of peri-operative complications (Odds Ratio (OR) 1.50, Confidence Interval (CI) 1.38;1.62), blood transfusions (OR 1.12, CI 1.03;1.23), mechanical ventilation (OR 6.97, CI 5.90;8.23), critical care services (OR 1.86, CI 1.71;2.03), prolonged hospitalisation and increased cost (OR 1.28, CI 1.19;1.37; OR 1.10, CI 1.03;1.18). Patients with sleep apnoea who undergo posterior lumbar fusion pose significant challenges to clinicians.

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“…The American Society of Anesthesiologists (ASA) addressed OSA in 2006 with practice guidelines which included assessment of patients for possible OSA before surgery and careful postoperative monitoring for those suspected to be at high risk. The ASA guidelines also included recommendations to evaluate patients who may be at high risk based on clinical suspicion preoperatively (Gross et al, 2006). …”

Section: Literature Reviewmentioning

confidence: 99%

Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire

Davies

Patrick

Gerard

2016

IJANS

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Background: Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term "STOP-BANG" is an acronym for eight independent elements predictive of OSAthree are OSA-related symptoms, three are physiological measurements, and two are patient characteristics. Methods: This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey. Results: This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool. Conclusions:The results suggest that programs targeted at raising CRNAs' and SRNAs' PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.

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Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea

Cited by 824 publications

References 61 publications

Pre-operative pulmonary assessment for patients with hip fracture

Pre-operative pulmonary assessment for patients with hip fracture

Sleep apnoea adversely affects the outcome in patients who undergo posterior lumbar fusion

Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire

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