Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome

Bhargavi Gali, Francis X. Whalen, Peter C. Gay, Eric J. Olson, Darrell R. Schroeder, David J. Plevak, Timothy Ian Morgenthaler

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Study Objectives: Obstructive sleep apnea (OSA) has been associated with increased perioperative morbidity and mortality. We initiated a protocol designed to screen patients preoperatively and monitor them postoperatively. The goal was to identify patients who were at risk for oxygen desaturation after discharge from the postanesthesia recovery room (PACU). Methods: Patients without previously diagnosed OSA presenting to the preoperative evaluation clinic were assessed over a 10.5-month period using a validated prediction rule to identify patients thought to be at high risk of OSA (sleep apnea clinical score, SACS ≥ 15). Following surgery, patients were monitored in the PACU for significant respiratory events: apnea, increased FiO2 requirement, pain-sedation mismatch, or episodes of desaturation. Patients were placed in 3 groups based on their SACS and the presence or absence of recurrent PACU respiratory events (group 1: SACS < 15, no recurrent events; group 2: SACS ≥15, no recurrent events; and group 3: SACS ≥ 15, recurrent events.) The number of oxygen desaturations ≥ 4% per hour, the oxygen desaturation index (ODI), was calculated for each patient for 24 to 48 hours after PACU discharge. An ODI > 10 was the threshold chosen to indicate a high frequency of oxygen desaturation. Results: The percentage of patients with ODI > 10 differed significantly across the 3 study groups (12%, 37%, and 57%, for groups 1-3, p = 0.005). Mean ODI in group 1 was significantly different from groups 2 and 3 (5.8 compared to 10.0 group 2 and 11.4 group 3 with p = 0.001). Conclusions: We have shown that combining preoperative screening is useful for identifying patients at risk for oxygen desaturation after PACU discharge.

Original languageEnglish (US)
Pages (from-to)582-588
Number of pages7
JournalJournal of Clinical Sleep Medicine
Volume3
Issue number6
StatePublished - Oct 15 2007

Fingerprint

Perioperative Care
Obstructive Sleep Apnea
Oxygen
Recovery Room
Sleep Apnea Syndromes
Apnea
Morbidity
Pain
Mortality

Keywords

  • Hypoventilation
  • Obstructive
  • Oximetry
  • Postoperative complications
  • Preoperative evaluation
  • Recovery room
  • Sedation
  • Sleep apnea
  • Sleep-disordered breathing

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. / Gali, Bhargavi; Whalen, Francis X.; Gay, Peter C.; Olson, Eric J.; Schroeder, Darrell R.; Plevak, David J.; Morgenthaler, Timothy Ian.

In: Journal of Clinical Sleep Medicine, Vol. 3, No. 6, 15.10.2007, p. 582-588.

Research output: Contribution to journalArticle

Gali, Bhargavi ; Whalen, Francis X. ; Gay, Peter C. ; Olson, Eric J. ; Schroeder, Darrell R. ; Plevak, David J. ; Morgenthaler, Timothy Ian. / Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. In: Journal of Clinical Sleep Medicine. 2007 ; Vol. 3, No. 6. pp. 582-588.
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abstract = "Study Objectives: Obstructive sleep apnea (OSA) has been associated with increased perioperative morbidity and mortality. We initiated a protocol designed to screen patients preoperatively and monitor them postoperatively. The goal was to identify patients who were at risk for oxygen desaturation after discharge from the postanesthesia recovery room (PACU). Methods: Patients without previously diagnosed OSA presenting to the preoperative evaluation clinic were assessed over a 10.5-month period using a validated prediction rule to identify patients thought to be at high risk of OSA (sleep apnea clinical score, SACS ≥ 15). Following surgery, patients were monitored in the PACU for significant respiratory events: apnea, increased FiO2 requirement, pain-sedation mismatch, or episodes of desaturation. Patients were placed in 3 groups based on their SACS and the presence or absence of recurrent PACU respiratory events (group 1: SACS < 15, no recurrent events; group 2: SACS ≥15, no recurrent events; and group 3: SACS ≥ 15, recurrent events.) The number of oxygen desaturations ≥ 4{\%} per hour, the oxygen desaturation index (ODI), was calculated for each patient for 24 to 48 hours after PACU discharge. An ODI > 10 was the threshold chosen to indicate a high frequency of oxygen desaturation. Results: The percentage of patients with ODI > 10 differed significantly across the 3 study groups (12{\%}, 37{\%}, and 57{\%}, for groups 1-3, p = 0.005). Mean ODI in group 1 was significantly different from groups 2 and 3 (5.8 compared to 10.0 group 2 and 11.4 group 3 with p = 0.001). Conclusions: We have shown that combining preoperative screening is useful for identifying patients at risk for oxygen desaturation after PACU discharge.",
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AU - Schroeder, Darrell R.

AU - Plevak, David J.

AU - Morgenthaler, Timothy Ian

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KW - Recovery room

KW - Sedation

KW - Sleep apnea

KW - Sleep-disordered breathing

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