Sleep Disorders |

Preoperative Screening for Obstructive Sleep Apnea FREE TO VIEW

Dhaval Raval, MD; Ala Alkhatib; Katherine Hendra, MD; Gary Robelen, MD
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Saint Elizabeth's Medical Center, Boston, MA

Chest. 2015;148(4_MeetingAbstracts):1037A. doi:10.1378/chest.2269686
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SESSION TITLE: Sleep Disorders Poster Discussions

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM

PURPOSE: Patients with undiagnosed obstructive sleep apnea (OSA) are at increased risk for peri-operative complications. The role for pre-operative OSA screening, testing and treatment with positive airway pressure therapy is unclear. STOP BANG questionnaire is an 8 question tool used to identify patients at risk for OSA, which has been validated in the pre-operative population. A score of > 5 predicts high risk for moderate/severe OSA.

METHODS: Patients undergoing elective surgery were screened for OSA using the STOP BANG tool from 8/2013 through 6/2014. Those with a prior diagnosis of sleep apnea were excluded. Patients with scores > 5 had a green arm band placed prior to surgery, indicating increased risk for undiagnosed OSA, but no other changes in management were made. Post operative course and complications were compared in those with STOP > 5 to age and surgery category matched controls from the STOP BANG < 5 group.

RESULTS: 2044 patients were screened during the study period; 229 (11%) had known OSA, 1563 (81%) had STOP BANG < 5 and 129 (6%) had STOP BANG > 5. Data was missing on 33 screening questionnaires. One hundred high risk patients were compared with 200 low risk control patients. Baseline characteristics were similar in both groups, as were PACU time and hospital length of stay. Planned post operative hospital admission rate and unplanned hospital admission rate were higher in the STOP BANG > 5 cohort (60% vs. 38%, 8% vs. 3%, respectively). Post-operative respiratory failure also occurred more often in the high risk group (4% vs.1%) There were no reported cardiac or neurologic complications reported in either group.

CONCLUSIONS: In this large cohort of patients screened for OSA with the STOP BANG questionnaire, only 6% were categorized as high risk group. However, this group was more likely to be admitted to the hospital following surgery, and had a higher rate of respiratory failure. The occurrence of additional serious post-operative events in both groups was low. The only intervention at this time was placement of a green arm band, alerting health care providers to an increased risk for OSA.

CLINICAL IMPLICATIONS: Identifying patients at increased risk for moderate/severe OSA prior to surgery using screening tools such as the STOP BANG, in conjunction with peri-operative management protocols may be adequate to decrease the risk of major complications. However, additional information regarding unplanned admissions in the high risk group is required.

DISCLOSURE: The following authors have nothing to disclose: Dhaval Raval, Ala Alkhatib, Katherine Hendra, Gary Robelen

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