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What Is the Proportion of Undiagnosed Obstructive Sleep Apnea in a Surgical Population? FREE TO VIEW

Frances Chung, MD; Pu Liao, MD; Mandeep Singh, MBBS; Saif Kobah, MD; Hisham Elsaid, MD
Author and Funding Information

University Health Network, University of Toronto, Toronto, ON, Canada

Chest. 2010;138(4_MeetingAbstracts):781A. doi:10.1378/chest.9993
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PURPOSE: Obstructive sleep apnea (OSA) affects 2-26% of general population, with 90% remaining undiagnosed. This study aims to evaluate the proportion of undiagnosed OSA in surgical patients.

METHODS: Following REB approvals, the recruited patients from preoperative clinics underwent an 8-hour sleep study with standard polysomnography(PSG) in laboratory or a 10-channel portable PSG device (Embletta X100) at home. A total of 819 patients completed the study, 234 with laboratory PSG and 585 with portable PSG. PSG recordings were scored by certified PSG technologists. Surgeons and anesthesiologists were not informed of PSG results. Through chart review, clinical diagnosis of OSA by surgeons and anesthesiologists were classified as documented OSA when diagnosis of OSA was based on the results of previously performed PSG, and as suspected OSA when a clinical diagnosis of OSA was only based on symptoms.

RESULTS: Of 819 patients, 428( 52%) were female, age:59 ±13, BMI:31±7, and 49% were orthopedic patients. 536 (65%) patients had AHI>5 (OSA). Notably, 84% of them had at least one symptom of snoring, daytime sleepiness or observed apnea. Surgeons diagnosed 48 (8.9%) OSA patients, 42 (7.8%) as documented OSA and 6 (1.1%) as suspected OSA. Documented OSA was identified by surgeons in 5.0% (12/240), 8.2% (13/158) and 12.3% (17/138) patients having mild, moderate and severe OSA, respectively. On the contrary, anesthesiologists diagnosed 204 (38%) with OSA, 102 (19%) as documented OSA and 102 (19%) as suspected OSA. Anesthesiologists identified documented OSA in 14.6% (35/240), 15.8% (25/158) and 30.4% (42/138) patients having mild, moderate and severe OSA, respectively. Overall, 91% (488/536) of patients with OSA (AHI>5) and 85.5% (118/138) patients with severe OSA ( AHI>30) were not diagnosed by surgeons, and 61.9% (332/536) of OSA and 47.1% (65/138) of severe OSA were not diagnosed by anesthesiologists.

CONCLUSION: Undiagnosed OSA remains high in a surgical population, 47.1% and 85.5% patients with severe OSA were not diagnosed by anesthesiologists and surgeons respectively.

CLINICAL IMPLICATIONS: Implementation of OSA screening would significantly reduce the proportion of undiagnosed OSA among surgical patients.

DISCLOSURE: Frances Chung, No Financial Disclosure Information; No Product/Research Disclosure Information

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