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Obstructive sleep apnea in general surgery patients: is it more common than we think?
Joshua Eberhardt
The American Journal of Surgery, 2014
BACKGROUND: To determine the risk of obstructive sleep apnea (OSA) in preoperative surgical patients.
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Obstructive Sleep Apnea in General Surgery Patients: Is Screening Required Preoperatively?
National Journal of Health Sciences
Research Article, 2021
Abstract: Aim: To screen cases who are at high risk and low risk for obstructive sleep apnea in general surgery patients. Materials & Methods: It is a cross-sectional study. It was done in Liaquat National Hospital from January 2019 to June 2019. After institutional approval, 335 patients were included in this study, who presented to general surgery OPD. STOP-BANG questionnaire was used to screen cases who are at high risk and low risk for obstructive sleep apnea in general surgery patients. Results: 335 patients were screened and 38.5% of individuals in population had age of more than 50 years. In this population 149(44.5%) of patients were male. Out of 335 patients, 135(40.3%) of them were found to have high risk of obstructive sleep apnea while the remaining 199(59.7%) were classified in low risk group. All of the parameters of STOP-bang questionnaire including age (p<0.001), gender (p=0.026), BMI (p<0.001), snoring (p<0.001), tiredness (p<0.001), sleep apnea (p=0.001), diastolic blood pressure (p<0.001) and neck circumference (p<0.001) were significantly different between high risk and low risk patients. Conclusion: This study can provide a catalyst for more meticulous screening for OSA preoperatively to diagnose high risk group. Keywords: Sleep Apnea, Obstructive, Care, Preoperative, Surgery, General, Operative Procedures.
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Unrecognized Sleep Apnea in the Surgical Patient
Amir Jaffer
Chest, 2006
Anesthesia and surgery both affect the architecture of sleep. Aside from the postoperative effects of anesthesia and surgery, sleep deprivation and fragmentation have been shown to produce apneas or desaturations even in patients without presumed sleep apnea. Recent epidemiologic data have placed the prevalence of obstructive sleep apnea syndrome (OSAS) at about 5% among Western countries. The problem is further hindered by the difficulty in diagnosing OSAS, as patients with OSAS may present for surgery without a prior diagnosis. Clinical suspicion for OSAS may first be recognized intraoperatively. Adverse surgical outcomes appear to be more frequent in OSAS patients. Immediate postoperative complications may intuitively be attributed to the negative effects of sedative, analgesic, and anesthetic agents, which can worsen OSAS by decreasing pharyngeal tone, and the arousal responses to hypoxia, hypercarbia, and obstruction. Later events are, however, more likely to be related to postoperative rapid eye movement (REM) sleep rebound. In the severe OSAS patient, REM sleep rebound could conceivably act in conjunction with opioid administration and supine posture to aggravate sleep-disordered breathing. REM sleep rebound has also been suggested to contribute to mental confusion and postoperative delirium, myocardial ischemia/infarction, stroke, and wound breakdown. Although the data to guide the perioperative management of patients with moderate-to-severe OSAS is scarce, heightened awareness is recommended. The selected use of therapy with nasal continuous positive airway pressure before surgery and after extubation may be beneficial. Learning Objectives: 1. Identify common sleep architectures affected by anesthesia and surgery in the perioperative period. 2. State a perioperative complication in Obstructive Sleep Apnea Syndrome patients. 3. Identify perioperative interventions and management techniques that best facilitate improved obstructive sleep apnea syndrome patient care.
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Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients
Sharon Chung
Anesthesiology, 2008
Background Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review. Results Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwen...
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The Management of Surgical Patients with Obstructive Sleep Apnea
sanjeev chhangani
Lung
Obstructive sleep apnea (OSA) is a leading public health problem in both developed and developing nations. However, awareness regarding diagnostic options, management, and consequences of untreated OSA remains inadequate in the perioperative period. Adverse surgical outcomes appear to be more frequent in OSA patients. Immediate postoperative complications may be partially attributed to the negative effects of sedative, analgesic, and anesthetic agents that can worsen OSA by decreasing pharyngeal tone and the arousal responses to hypoxia, hypercarbia, and obstruction. Rebound rapid eye movement sleep after anesthesia and the use of opioids may contribute to adverse events in the postoperative period. Even though data to guide clinicians in the perioperative period is scarce, heightened awareness is recommended.
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Perioperative implications and prevalence of Obstructive Sleep Apnea risk in a surgical population using the updated STOP-Bang questionnaire
Amela Fayed
Trends in Anaesthesia and Critical Care, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Patient Unrecognized Sleep Apnea in the Surgical
Roop Kaw
2006
2006;129;198-205 Chest Auckley and Joseph Golish Roop Kaw, Franklin Michota, Amir Jaffer, Shekhar Ghamande, Dennis * Patient Unrecognized Sleep Apnea in the Surgical http://www.chestjournal.org/content/129/1/198.full.html and services can be found online on the World Wide Web at: The online version of this article, along with updated information ) ISSN:0012-3692 http://www.chestjournal.org/site/misc/reprints.xhtml ( of the copyright holder. may be reproduced or distributed without the prior written permission Northbrook IL 60062. All rights reserved. No part of this article or PDF by the American College of Chest Physicians, 3300 Dundee Road, 2007 Physicians. It has been published monthly since 1935. Copyright CHEST is the official journal of the American College of Chest
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The use of practice guidelines by the American Society of Anesthesiologists for the identification of surgical patients at high risk of sleep apnea
J. Porhomayon, Nader Nader
Chronic Respiratory Disease, 2012
American Society of Anesthesiologists (ASA) has introduced a simple tool to assess the perioperative risk of surgery/anesthesia in patients with obstructive sleep apnea (OSA). We compared the surgical outcomes in patients at high risk of OSA with the matched controls. This was a case-control study conducted on 3593 surgical patients receiving a general anesthesia at a single institution. On the basis of a preoperative OSA scoring system using the ASA checklist, patients were classified as high-risk OSA (HR-OSA) or low-risk OSA (LR-OSA) groups. Apnea/hypopnea index of >5 h À1 during a formal preoperative sleep study was used to confirm or rule out the diagnosis of OSA. Receiver operating characteristic curves were plotted to determine the predictive values as well as sensitivity and specificity of the ASA tool in predicting HR-OSA. The HR-OSA group was matched with the patients in LR-OSA using the propensity scoring and logistic regression. Patients were analyzed for premorbid conditions, intraoperative course and postoperative events using cross tabulation, logistic regression model and paired t test. The development of a composite respiratory complication in the postoperative period was considered as the primary end point. The ASA risk tool was found to have 95.1% sensitivity and 52.2% specificity. At a prevalence of 10%, the negative predictive value was 98.5%. Of the 3593 patients, 306 were identified as HR-OSA. The HR-OSA group was found to have a higher incidence of hypertension and diabetes preoperatively when compared with LR-OSA. Postoperatively, the HR-OSA group had higher incidence of hypoxia, reintubation, postoperative use of continuous positive airway pressure and a longer stay in the recovery room. The ASA checklist offers a highly sensitive tool to identify the patients at a higher risk of OSA during the perioperative period. Patients at HR-OSA have a higher incidence of adverse events in the postoperative period when compared with those with LR-OSA.
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Routine preoperative obstructive sleep apnea screening of elective surgical patients: a single-centre three-month experience
Lisa Jin
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2019
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Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care
Tony Solomonides
Journal of the American Board of Family Medicine : JABFM
The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed. For adults, preoperative screening using the STOP or STOP-Bang questionnaires can help to identify adult patients at increased risk of OSA. In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous posit...
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