Preoperative Assessment of Obstructive Sleep Apnea in the Ambulatory Anesthesia Patient: A Survey of Oral and Maxillofacial Surgery Providers

Obstructive sleep apnea in surgical patients and its relationship with difficult intubation: two years of experience from a single center

BACKGROUND AND OBJECTIVES

In this study, we aimed to determine the risk of obstructive sleep apnea (OSA) in patients undergoing elective surgery and its relationship with difficult intubation (DI).

METHODS

This prospective, descriptive, cross-sectional study was conducted between December 2018 and February 2020 in the anesthesiology and reanimation service of a training and research hospital. The study included patients who were ASA I...II, 18 years of age, and older who underwent elective surgery under general anesthesia. A form regarding the baseline characteristics of the participants as well as STOP-Bang score, Mallampati, and Cormack-Lehane classification was used to collect the data.

RESULTS

The study included 307 patients. It was determined that 64.2% of patients had a high risk of OSA. The presence of DI (determined by repeated attempts at intubation) was 28.6% in the high-risk OSA group, while there was no DI in the low-risk OSA group. A statistically significant difference was found between the groups in terms of OSA risk according to the presence of DI according to repeated attempts, Cormack-Lehane classification, and Mallampati classification (p...<...0.001).

CONCLUSION

Due to the high rate of DI in patients with a high risk of OSA, the security of the airway in these patients is endangered. Early clinical recognition of OSA can help in designing a safer care plan.

OMS residents’ obstructive sleep apnea‐related education, knowledge, and professional behavior: A national survey

OBJECTIVES

Oral and maxillofacial surgeons (OMS) treat adult and pediatric patients with obstructive sleep apnea (OSA). Objective 1 assessed sleep apnea-related education, knowledge, and professional behavior of OMS residents in the United States. Objective 2 was to compare the responses of junior versus senior residents and residents in single- versus dual-degree programs.

METHODS

OMS residents in the United States received a recruitment email with a link to an anonymous online survey; 81 residents responded. The survey included 20 questions to assess respondents' OSA-related education, knowledge, attitudes, and professional behavior.

RESULTS

Respondents generally agreed that they had received OSA-related didactic-based education (5-point scale with "5" = agree strongly: mean = 3.62) and clinical training (mean = 3.75). Clinical and classroom educational gaps were identified in relation to treatment with oral appliances and hypoglossal nerve stimulation. The residents scored on average 10.38 out of 18 (58%) possible correct answer points for the knowledge questions. Findings about pediatric OSA suggest that only 43.8% of residents understand diagnostic criteria for pediatric OSA, with only 26.6% screening pediatric patients for OSA. A case analysis showed that only 1.5% of residents correctly identified an apnea-hypopnea index of 17 as moderate sleep apnea.

CONCLUSION(S)

This survey found knowledge gaps in several areas that can be improved upon. It identifies deficiency in objective knowledge about OSA among OMS residents and a specific lack of clinical training and confidence with hypoglossal nerve stimulation and management of pediatric patients with OSA. Junior and senior residents and single- and dual-degree residents showed no statistically significant differences in any category except senior residents in regard to surgical management of OSA, particularly with maxillomandibular advancement.

Periprocedural Management during Therapeutic Cardiac Catheterization in Patients with Sleep Apnea Syndrome: Report of Three Cases and Review of Literature

Most of the patients with sleep apnea syndrome (SAS) also known as sleep disordered breathing are not diagnosed before undergoing any cardiac interventional procedure. Many of them can safely undergo outpatient procedure under sedation or anesthesia. Few of them with moderate to severe grade of SAS, who are not optimized medically, may create problem and need special consideration. We managed three such cases in cardiac catheterization laboratory; two of them were not diagnosed before. The periprocedural problems we faced in these patients are narrated in this article along with review of literature. Some suggestions for management of such patients undergoing therapeutic cardiac catheterization are also highlighted.

Prevalence of Obstructive Sleep Apnea Risk According to the STOP-BANG Questionnaire in an Oral Surgery Office-Based Anesthesia Patient Population

PURPOSE

Patients with obstructive sleep apnea (OSA) are at an increased risk for perioperative and postoperative complications after receiving intravenous (IV) sedation or postoperative analgesia. We previously showed that most oral and maxillofacial surgery (OMS) providers do not screen for OSA using a quantifiable method. The purpose of this study was to determine the prevalence of OSA risk in the OMS office-based anesthesia patient population using the snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and gender (STOP-BANG) questionnaire.

PATIENTS AND METHODS

After deeming patients (n = 153) suitable for outpatient IV sedation using our existing institutional ambulatory preanesthesia protocol, 2 OMS providers administered the STOP-BANG questionnaire to classify patient risk for OSA. The questionnaire is a concise, validated predictor for OSA risk and consists of 8 yes or no questions.

RESULTS

Of the 153 patients, 141 (92.16%) were at a low risk for moderate to severe OSA, 11 (7.19%) were at a moderate risk, and 1 (0.65%) was at a high risk. Overall, 12 (7.84%) patients were shown to be at risk for OSA. We estimate with 95% confidence that between 5.7 and 10% of all OMS office-based anesthesia patients are at risk for OSA. The IV sedation plans for 4 (2.61%) patients were changed after including OSA risk with the existing preanesthesia protocol.

CONCLUSIONS

A statistically significant proportion (95% confidence interval, 0.0567 to 0.100) of the OMS office-based anesthesia patient population is at an increased risk for moderate to severe OSA. These results outline the importance of screening for OSA before office-based anesthesia administration. OMS providers can easily use the STOP-BANG questionnaire to assess OSA risk, modify anesthesia management, and improve patient safety.