Preoperatively Screened Obstructive Sleep Apnea Is Associated With Worse Postoperative Outcomes Than Previously Diagnosed Obstructive Sleep Apnea

Fernandez-Bustamante, Ana; Bartels, Karsten; Clavijo, Claudia F.; Scott, Benjamin; Kacmar, Rachel M.; Bullard, Kenneth; Moss, Angela; Henderson, William G.; Juaréz-Colunga, Elizabeth; Jameson, Leslie C.

doi:10.1213/ane.0000000000002241

Cited by 48 publications

(38 citation statements)

References 39 publications

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“…17 It must be noted that significant heterogeneity existed among the studies included in this analysis; it may be plausible that the association of STOP-BANG with respiratory complications was driving the pooled effect observed. More robust associations of STOP-BANG with respiratory complications have also since been exhibited, 29 although a recent prospective study found no predictive ability for postoperative hypoxaemia. 30 Our study, including only cardiac complications, did not find a significant adjusted association in these complications between the STOP-BANG risk strata.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery

Sankar

Beattie

Wijeysundera

2019

British Journal of Anaesthesia

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Background: The STOP-BANG questionnaire screens for obstructive sleep apnoea (OSA) in surgical patients. In prior research, the association of STOP-BANG scores with comorbidities and outcomes was inconsistent. The objective of this study was to evaluate the validity of the STOP-BANG score. Methods: We conducted a retrospective cohort study of patients undergoing major elective noncardiac surgery at the University Health Network (Toronto, ON, Canada) between 2011 and 2015. Cross-sectional construct validity was evaluated based on proportions with diagnosed OSA across STOP-BANG strata. Concurrent construct validity was assessed based on the correlation of STOP-BANG with ASA Physical Status (ASA-PS), the Revised Cardiac Risk Index, and the Charlson Comorbidity Index. Predictive validity was assessed based on the adjusted associations of STOP-BANG risk with 30-day mortality (logistic regression), cardiac complications (logistic regression), and length-of-stay (negative binomial regression). Results: Of 26 068 patients in the cohort, 58% were in the low-risk STOP-BANG stratum, 23% in the intermediate-risk stratum, and 19% in the high-risk stratum. The proportion with previously diagnosed OSA was 4% (n¼615) in the low-risk stratum, 12% (n¼740) in the intermediate-risk stratum, and 44% (n¼2142) in the high-risk stratum. The correlations of STOP-BANG with ASA-PS (Spearman r¼0.28), Revised Cardiac Risk Index (r¼0.24), and Charlson Comorbidity Index (r¼0.10) were weak, albeit statistically significant (P<0.001). After risk-adjustment, STOP-BANG risk strata were not associated with 30-day mortality, cardiac complications, or length-of-stay. Conclusions: The STOP-BANG questionnaire has modest construct validity but did not predict postoperative mortality, hospital length-of-stay, or cardiac complications.

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Section: Discussionmentioning

confidence: 99%

Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery

Sankar

Beattie

Wijeysundera

2019

British Journal of Anaesthesia

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“…Obstructive sleep apnea (Category B). Obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) are highly associated with OIUAS and OIRD (Fernandez-Bustamante et al, 2017;Gupta et al, 2018;Kaw et al, 2012;Nagappa et al, 2017;Shin et al, 2016;Weingarten, Herasevich, et al, 2015). Patients diagnosed with OSA or those who screen positive for OSA using the STOP-BANG questionnaire (Table 3) and experience an opioidrelated respiratory arrest are more likely to experience a serious consequence such as anoxic brain injury and death (Fernandez-Bustamante et al, 2017;Fouladpour et al, 2016).…”

Section: Rationalementioning

confidence: 99%

“…ASA classification (Category B). When more than one comorbid condition exists, the likelihood of developing postoperative complication such as OIUAS and OIRD is increased (Fernandez-Bustamante et al, 2017;Gupta et al, 2018;Khelemsky et al, 2015;Lee et al, 2015;Pawasauskas et al, 2014;Rosenfeld et al, 2016;Schug, Palmer, Scott, Halliwell, & Trinca, 2016). For 50 years, anesthesia providers have used the American Society of Anesthesiologists (ASA) Physical Status Classifications system to rate a patient's risk of undergoing anesthesia (Hurwitz et al, 2017).…”

Section: Rationalementioning

confidence: 99%

“…Specific diseases (Category B). There is strong evidence supporting the use of the ASA classification score as a predictor of risk for OIUAS and OIRD (Fernandez-Bustamante et al, 2017;Nadpara, Joyce, Carroll, Carroll, Barnard, & Zedler, 2018;Pawasauskas et al, 2014;Ramachandran et al, 2017;Weingarten et al, 2016;Yung, Lee, Hsu, Furnish, & Atayee, 2017;Zedler, Saunders, Joyce, Vick, & Murrelle, 2018). Additionally, there is substantial evidence to indicate that patients with diabetes mellitus (Fernandez-Bustamante et al, 2017;Gupta et al, 2018;Nadpara et al, 2018;Ramachandran et al, 2017;Weingarten et al, 2016;Zedler et al, 2018), renal impairment (Dahan, Overdyk, Smith, Aarts, & Niesters, 2013;Fernandez-Bustamante et al, 2017;Khanna et al, 2019;Nadpara et al, 2018;Pawasauskas et al, 2014;Yung et al, 2017;Zedler et al, 2018), and heart failure (Khanna et al, 2019;Nadpara et al, 2018;Pawasauskas et al, 2014;Ramachandran et al, 2017;Yung et al, 2017;Zedler et al, 2018) could be at high risk for OIUAS and OIRD.…”

Section: Rationalementioning

confidence: 99%

“…Although the evidence is weak, other individual risk factors potentially increase the likelihood for OIUAS and OIRD. These include age (Gupta et al, 2018;Khanna et al, 2019;Lee et al, 2015); liver disease (Fernandez-Bustamante et al, 2017;Ramachandran et al, 2017;Zedler et al, 2018); obesity (Fernandez-Bustamante et al, 2017;Overdyk et al, 2014;Yung et al, 2017); presence of substance use disorder, including opioid use disorder (Menendez, Ring, & Bateman, 2015;Nadpara et al, 2018;Zedler et al, 2018); being a smoker (Fernandez-Bustamante et al, 2017;Pawasauskas et al, 2014;Ramachandran et al, 2017); presence of genetic variations in opioids pharmacokinetics (Madadi et al, 2013;Manini, Jacobs, Vlahov, & Hurd, 2013); and opioid tolerance (Khanna et al, 2019;Lee et al, 2015). In the past, opioid tolerance has been subject to varying definitions.…”

Section: Rationalementioning

confidence: 99%

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American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

Jungquist

Quinlan-Colwell

Vallerand

et al. 2020

Pain Management Nursing

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a b s t r a c tObjectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics. Design: Systematic review of the literature. Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews. Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated. Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Preoperatively Screened Obstructive Sleep Apnea Is Associated With Worse Postoperative Outcomes Than Previously Diagnosed Obstructive Sleep Apnea

Cited by 48 publications

References 39 publications

Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery

Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

International Consensus Statement on Obstructive Sleep Apnea

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