Role of Preoperative Screening for Adult Patients for Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is a chronic disease with increasing prevalence. Underdiagnosed in the surgical population, OSA can reach a prevalence of up to 70% in bariatric surgery, and be associated with difficult airways and postoperative cardiopulmonary adverse events. Despite its association with escalation of care, increased health care resource utilization, and length of hospital stay, < 25% of health care institutions in the United States have OSA perioperative protocols to improve patient safety. This is explained in part by a lack of studies that support a widely accepted systematic approach to preoperative screening and risk stratification. This review evaluates the role of preoperative screening tools for adult patients with suspected OSA.

Pre-operative evaluation in obstructive sleep apnea patients undergoing bariatric surgery: sleep laboratory limitations

“…The literature indicates that there is a bidirectional association between obstructive sleep apnea (OSA) and systemic arterial hypertension (SAH). ( 2 ) With regard to the role of SAH and OSA as risk factors for the development of OSA and SAH, respectively, some data merit special attention: OSA as a causal risk factor for the development of SAH has been more extensively studied than has the reverse; in addition, the treatment of OSA with continuous positive airway pressure usually improves blood pressure levels in patients with hypertension. ( 2 ) In contrast, the treatment of SAH with antihypertensives in order to improve OSA yields conflicting results; except, perhaps, for the treatment of SAH with diuretics, especially spironolactone, because it reduces parapharyngeal edema and secondary airway obstruction.…”

“…( 2 ) In contrast, the treatment of SAH with antihypertensives in order to improve OSA yields conflicting results; except, perhaps, for the treatment of SAH with diuretics, especially spironolactone, because it reduces parapharyngeal edema and secondary airway obstruction. ( 2 )…”

“…Obesity ( 1 , 2 ) is a proven risk factor for obstructive sleep apnea (OSA), and it is predictable that various patients who will undergo bariatric surgery (BS) might have the disease.…”

“…However, most frequently, patients are not diagnosed with the disease whether they are symptomatic or not. Surgeons ( 2 ) usually examine those patients in order to evaluate the risk of OSA before performing BS and might refer such patients for proper study and treatment.…”

Perioperative screening for obstructive sleep apnoea and treatment outcomes: where are the data?

“…OSA carries several short-and long-term health consequences. These may range from perioperative complications to the risk of having uncontrolled hypertension, stroke, coronary artery disease and dysrhythmias, to name a few [3][4][5][6][7][8]. …”