Screening for obstructive sleep apnea before surgery: why is it important?

Relationship between sleep bruxism and obstructive sleep apnoea: A population-based survey

OBJECTIVE

Sleep bruxism (SB) and obstructive sleep apnoea (OSA) seem to be mutually associated. This study investigates the relationship between current SB and OSA-related symptoms and the difference in OSA-related symptoms between groups based on a history of SB.

METHODS

An online survey was drafted to report the presence of SB and OSA in sample of 243 individuals (M = 129;F = 114;mean(SD)age = 42.4 ± 14.4 years). The Subject-Based Assessment strategy recommended in the 'Standardized Tool for the Assessment of Bruxism' (STAB) was adopted to assess SB. To evaluate OSA-related symptoms, Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaires were adopted. Correlations between current SB and OSA-related symptoms were evaluated by Spearman test. ESS and STOP-BANG scores were compared by Mann-Whitney U test in individuals with and a without positive SB history.

RESULTS

Current SB and SB history were reported by 45.7% and 39.1% of the sample, respectively. 73.7%, 21% and 5.3% of the responders showed a low, intermediate and high risk of OSA, respectively. Neither significant correlations between current SB and OSA nor significant differences between SB groups emerged.

CONCLUSIONS

This study did neither find any significant correlation between self-report of current SB and OSA nor significant differences in ESS and STOP-BANG scores between groups based on SB history.

Standardised Tool for the Assessment of Bruxism

OBJECTIVE

This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences.

METHODS

The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications.

RESULTS

The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration.

CONCLUSIONS

The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields.

Machine learning-based risk prediction of hypoxemia for outpatients undergoing sedation colonoscopy: a practical clinical tool

OBJECTIVES

Hypoxemia as a common complication in colonoscopy under sedation and may result in serious consequences. Unfortunately, a hypoxemia prediction model for outpatient colonoscopy has not been developed. Consequently, the objective of our study was to develop a practical and accurate model to predict the risk of hypoxemia in outpatient colonoscopy under sedation.

METHODS

In this study, we included patients who received colonoscopy with anesthesia in Nanjing First Hospital from July to September 2021. Risk factors were selected through the least absolute shrinkage and selection operator (LASSO). Prediction models based on logistic regression (LR), random forest classifier (RFC), extreme gradient boosting (XGBoost), support vector machine (SVM), and stacking classifier (SCLF) model were implemented and assessed by standard metrics such as the area under the receiver operating characteristic curve (AUROC), sensitivity and specificity. Then choose the best model to develop an online tool for clinical use.

RESULTS

We ultimately included 839 patients. After LASSO, body mass index (BMI) (coefficient = 0.36), obstructive sleep apnea-hypopnea syndrome (OSAHS) (coefficient = 1.32), basal oxygen saturation (coefficient = -0.14), and remifentanil dosage (coefficient = 0.04) were independent risk factors for hypoxemia. The XGBoost model with an AUROC of 0.913 showed the best performance among the five models.

CONCLUSION

Our study selected the XGBoost as the first model especially for colonoscopy, with over 95% accuracy and excellent specificity. The XGBoost includes four variables that can be quickly obtained. Moreover, an online prediction practical tool has been provided, which helps screen high-risk outpatients with hypoxemia swiftly and conveniently.

[Evaluation of the risk of obstructive sleep apnea in patients awaiting general anesthesia in Burkina Faso]

INTRODUCTION

General anaesthesia and surgery increase morbidity and mortality in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who are not known to have OSAHS and therefore not treated before surgery. The objective of this study is to evaluate the risk of OSAHS using the STOP-BANG questionnaire (SBQ) in patients undergoing general anaesthesia in Burkina Faso.

MATERIAL AND METHOD

This is a cross-sectional study concerning patients having received pre-anaesthetic consultation from 1st July 2020 to 30th June 2021. Risk of OSAHS is considered "medium to high" when the risk of obstructive sleep apnea is medium or high on SBQ.

RESULTS

Our population consisted in 599 persons. A medium to high risk of OSAHS was found in 11.18%. The ASA score and the Mallampati scale were independently associated with moderate to high risk of OSAHS (P<0.001; P<0.001). ASA score of I and Mallampati class of I decreased the risk of OSAHS by 17 and 45% respectively (P=0.012; P=0.031).

CONCLUSION

The risk of OSAHS in this population is comparable to that of the general population. Confirmation of OSAHS by ventilatory polygraphy or polysomnography would help to achieve further precision.

Analysis of the relationship between sleep-related disorder and systemic immune-inflammation index in the US population

BACKGROUND

The association between sleep-related disorders and inflammation has been demonstrated in previous studies. The systemic immune-inflammation index (SII) is a novel inflammatory index based on leukocytes, but its relationship with sleep-related disorder is unclear. We aimed to investigate the relationship between sleep-related disorder and SII in a nationally representative nonhospitalized sample.

METHODS

Data were obtained from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Exposure variables included self-reported sleep-related disorders, such as sleep duration, sleep problems, high risk of OSA, and daytime sleepiness. SII and other traditional markers of inflammation were considered as outcome variables, including platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). Multiple linear regression models were employed to examine the correlation between sleep-related disorders and inflammatory markers. Subgroup interactions were analyzed using likelihood ratio tests, and nonlinear relationships were explored by fitting restricted cubic splines.

RESULTS

A total of 8,505 participants were enrolled in this study. Overall, sleep-related disorders were found to have a stronger association with SII compared to the PLR and NLR. The results of multiple linear regression analysis revealed that participants who experienced sleep problems (β: 21.421; 95% CI 1.484, 41.358), had symptoms of OSA (β: 23.088; 95% CI 0.441, 45.735), and reported daytime sleepiness (β: 30.320; 95% CI 5.851, 54.789) exhibited a positive association with higher SII. For the analysis of other inflammatory markers, we only found that daytime sleepiness was associated with increased NLR levels (β: 0.081; 95% CI 0.002, 0.159).

CONCLUSION

Sleep problems, symptoms of OSA, and daytime sleepiness were found to have a positive association with the SII in US adults. However, further prospective studies are necessary to establish whether there is a causal relationship between these factors.

Pre-operative screening for sleep disordered breathing: obstructive sleep apnoea and beyond

Sleep disordered breathing describes an important group of conditions that causes abnormal nocturnal gas exchange, with important implications in the peri-operative management plan. An understanding of the pathophysiology behind obstructive sleep apnoea and other disorders that may lead to hypoventilation can help to prevent complications. Patients with these disorders may be minimally symptomatic and it requires careful screening in the pre-operative assessment process for a diagnosis to be made. Decisions regarding initiation of therapy, such as positive airway pressure, and delay of the operation need to be carefully weighed up against the urgency of the surgical intervention. Planning of the peri-operative care, including the use of positive airway pressure therapy and appropriate post-operative monitoring, can help to avoid respiratory and cardiovascular morbidities and improve clinical outcomes.

Educational aims

To review different types of sleep disordered breathing and available screening methods in pre-operative assessment.To understand the pathophysiology behind sleep disordered breathing and how it can lead to complications in the peri-operative setting.To review the planning and treatment strategies that should be considered as part of peri-operative management.

Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation

The concept of "prehabilitation" consists of screening for and identification of pre-existing disorders followed by medical optimization. This is performed for many types of surgery, but may have profound impacts on outcomes particularly in cardiac surgery given the multiple comorbidities typically carried by these patients. Components of prehabilitation include direct medical intervention by preoperative specialists as well as significant care coordination and shared decision making. In this two-part review, the authors describe existing evidence to support the optimization of various preoperative problems and present a few institutional protocols utilized by our center for cardiac presurgical care. This first installment will focus on the management of anemia, obesity, sleep apnea, diabetes, and cardiac rehabilitation prior to surgery. The second will focus on frailty, malnutrition, respiratory disease, alcohol and smoking cessation, and depression.

Sleep-Disordered Breathing Risk with Comorbid Insomnia Is Associated with Mild Cognitive Impairment

Introduction: Few studies have evaluated the combined association between SDB with comorbid insomnia and mild cognitive impairment (MCI). To test the hypothesis that SDB with comorbid insomnia is associated with greater odds of MCI than either sleep disorder independently, we used ADNI data to evaluate cross-sectional associations between SDB risk with comorbid insomnia status and MCI. Methods: Participants with normal cognition or MCI were included. Insomnia was defined by self-report. SDB risk was assessed by modified STOP-BANG. Logistic regression models evaluated associations between four sleep disorder subgroups (low risk for SDB alone, low risk for SDB with insomnia, high risk for SDB alone, and high risk for SDB with insomnia) and MCI. Models adjusted for age, sex, BMI, APOE4 genotype, race, ethnicity, education, marital status, hypertension, cardiovascular disease, stroke, alcohol abuse, and smoking. Results: The sample (n = 1391) had a mean age of 73.5 ± 7.0 years, 44.9% were female, 72.0% were at low risk for SDB alone, 13.8% at low risk for SDB with insomnia, 10.1% at high risk for SDB alone, and 4.1% at high risk for SDB with insomnia. Only high risk for SDB with comorbid insomnia was associated with higher odds of MCI (OR 3.22, 95% CI 1.57–6.60). Conclusion: Studies are needed to evaluate SDB with comorbid insomnia as a modifiable risk factor for MCI.

Effectiveness of remote monitoring and feedback on objective compliance with a mandibular advancement device for treatment of obstructive sleep apnea

Compliance with a mandibular advancement device is important for the optimal treatment of obstructive sleep apnea. Recent advances in information and communication technology-based monitoring and intervention for chronic diseases have enabled continuous monitoring and personalized management. Self-evaluation and self-regulation through objective monitoring and feedback may improve compliance. The aim of this study was to evaluate the effects of information and communication technology-based remote monitoring and feedback services, using a smartphone application, on the objective compliance with a mandibular advancement device in patients with obstructive sleep apnea. Forty individuals who were diagnosed with obstructive sleep apnea by polysomnography were randomly assigned to groups A and B. During an initial 6-week evaluation period, the mandibular advancement device-wearing time was monitored with the smartphone application in group B, but not in group A. The two groups then switched the monitoring procedures during the second 6-week period (the smartphone application was then used by group B, but not by group A). If no input data were indicated on the cloud server of the smartphone application during the monitored period, push notifications were provided twice daily. Objective compliance, monitored by a micro-recorder within the mandibular advancement device, was noted and compared based on whether the monitoring service was provided. The number of mandibular advancement device-wearing days was significantly higher in the monitored period than in the unmonitored period. The mandibular advancement device-wearing time did not differ significantly between the two groups. In conclusion, information and communication technology-based remote monitoring and feedback services demonstrated a potential to increase the objective measures of compliance with mandibular advancement devices.

Comparison of Jaw Elevation Device vs. Conventional Airway Assist during Sedation in Chronic Kidney Diseases Undergoing Arteriovenous Fistula Surgery: A Randomized Controlled Trial

Patients with chronic renal failure (CRF) are likely to have obstructive sleep apnea (OSA) underdiagnosed, and maintaining airway patency is important during sedation. This study compared Jaw elevation device (JED) with conventional airway interventions (head lateral rotation, neck extension, oral or nasal airway insertion, and jaw thrust maneuver) during sedation and hypothesized that JED may be effective to open the airway. A total of 73 patients were allocated to a conventional group (n = 39) and a JED group (n = 34). The number of additional airway interventions was the primary outcome. Percentage of patients with no need of additional interventions and apnea-hypopnea index (AHI) were secondary outcomes. The number of additional interventions was significantly less in the JED group compared to the conventional group (0 (0–0) vs. 1 (0–2); p = 0.002). The percentage of patients with no requirement for additional interventions was significantly higher in the JED group compared to the conventional group (76.5% vs. 43.6%; p = 0.004). AHI was significantly lower in the JED group compared to the conventional group (4.5 (1.5–11.9) vs. 9.3 (3.8–21.9), p = 0.015). In conclusion, JED seems to be effective in opening the airway patency during sedation in CRF patients.

Insomnia

Insomnia-the unwelcome experience of difficulty sleeping-is common and can be acute, intermittent, or chronic. Insomnia can be the presenting symptom for several common sleep disorders, but it also often occurs comorbidly with mental and physical health conditions. Evaluating the symptom of insomnia requires assessing-largely by history-whether an underlying condition explains it. Insomnia disorder is the diagnostic term for the symptom of insomnia that merits specific attention. Cognitive behavioral therapy for insomnia is the preferred treatment approach because of its efficacy, safety, and durability of benefit, but pharmaceutical treatments are widely used for insomnia symptoms.

[Ultrasound assessment of gastric insufflation in obese patients receiving transnasal humidified rapid-insufflation ventilatory exchange during general anesthesia induction]

OBJECTIVE

To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients.

METHODS

Ninety obese patients (BMI 30-39.9 kg/m²) undergoing laparoscopic cholecystectomy under general anesthesia were randomized into 3 groups (n=30) to receive facemask pre- oxygenation followed by face mask ventilation (FMV) after administration of anesthetics (Group M), oxygenation with THRIVE (Group T), or pre-oxygenation with facemask combined with THRIVE followed continuous oxygenation with both FMV and THRIVE after administration of anesthetics (Group M+T). The patients in the latter two groups received continuous oxygen via THRIVE during tracheal intubation. All the patients received real-time ultrasound monitoring of the gastric antrum, and positive gastric insufflation (GI⁺) was defined by the presence of comet-tail artifacts. The cross-sectional area of the gastic antrum (CSA-GA) was measured by ultrasound before and after pre-oxygenation and after intubation. The patients' SpO₂, PaO₂, and PaCO₂ at admission (T₁), 5 min after pre-oxygenation (T₂), 5 min after medication (T₃), and immediately after intubation (T₄) were recorded, and the incidence of postoperative adverse events was assessed.

RESULTS

The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (P < 0.05). The CSA-GA was significantly greater at T₄ than at T₁ in Group M and Group M+T and in their GI⁺s ubgroups. The GI⁺ subgroups in Group M and Group M+ T had significantly larger CSA-GA at T₄ than the GI^- subgroups (P < 0.05). CSA-GA did not vary significantly during anesthesia induction in Group T (P>0.05). The incidence of grade Ⅰ gastric distension was lower but grade Ⅱ gastric distention was higher in Group M and Group M+T than in Group T (P < 0.05). Group M showed significantly greater variations of PaO₂ at T₃ and T₄ than Group T and Group M+T (P < 0.05).

CONCLUSIONS

Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.

Smaller pineal gland is associated with rapid eye movement sleep behavior disorder in Alzheimer's disease

BACKGROUND

To investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer's disease (AD) patients without any feature of dementia with Lewy bodies.

METHODS

We enrolled 296 community-dwelling probable AD patients who did not meet the diagnostic criteria for possible or probable dementia with Lewy bodies. Among them, 93 were amyloid beta (Aβ) positive on ¹⁸F-florbetaben amyloid brain positron emission tomography. We measured RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as the RBDSQ of 5 or higher. We manually segmented pineal gland on 3T structural T1-weighted brain magnetic resonance imaging.

RESULTS

The participants with pRBD had smaller pineal parenchyma volume (VPP) than those without pRBD (p <  0.001). The smaller the VPP, the more severe the RBD symptoms (p <  0.001). VPP was inversely associated with risk of prevalent pRBD (odds ratio = 0.909, 95% confidence interval [CI] = 0.878-0.942, p <  0.001). Area under the receiver operator characteristic curve for pRBD of VPP was 0.80 (95% CI = 0.750-0.844, p <  0.0001). These results were not changed when we analyzed the 93 participants with Aβ-positive AD separately.

CONCLUSIONS

In AD patients, reduced pineal gland volume may be associated with RBD.

Sex differences in subjective age-associated changes in sleep: a prospective elderly cohort study

Subjective age-associated changes in sleep (AACS) and sex differences in AACS have never been prospectively investigated in elderly populations. We compared the AACS every 2 years over a total of 6 years between 4,686 community-dwelling healthy men and women aged 60 years or older who participated in the Korean Longitudinal Study on Cognitive Aging and Dementia. Sleep parameters including sleep duration, latency, and efficiency, mid-sleep time, daytime dysfunction, and overall subjective sleep quality were measured using the Pittsburgh Sleep Quality Index at baseline and at each follow-up. The effects of time and sex on subjective sleep parameters were analyzed using linear mixed-effects models. During the 6 years of follow-up, we observed that overall, sleep latency increased, while daytime dysfunction and sleep quality worsened. Significant sex differences in AACS was found, with women showing shortened sleep duration, delayed mid-sleep time, and decreased sleep efficiency over 6 years. Sleep quality worsened in both groups but a more pronounced change was observed in women. Clinicians should be cautious in determining when to treat declared sleep disturbances in this population.

Preoperative identification of children at high risk of obstructive sleep apnea

Obstructive sleep apnea is a common childhood disorder which can lead to serious health problems if left untreated. Enlarged adenoid and tonsils are the commonest causes, and adenotonsillectomy is the recommended first line of treatment. Obstructive sleep apnea poses as an anesthetic challenge, and it is a well-known risk factor for perioperative adverse events. The presence and severity of an obstructive sleep apnea diagnosis will influence anesthesia, pain management, and level of monitoring in recovery period. Preoperative obstructive sleep apnea assessment is necessary, and anesthetists are ideally placed to do so. Currently, there is no standardized approach to the best method of preoperative screening for obstructive sleep apnea. Focused history, clinical assessments, and knowledge regarding the strengths and limitations of available obstructive sleep apnea assessment tools will help recognize a child with obstructive sleep apnea in the preoperative setting.

Outcomes and Safety Among Patients With Obstructive Sleep Apnea Undergoing Cancer Surgery Procedures in a Freestanding Ambulatory Surgical Facility

BACKGROUND

Patients with obstructive sleep apnea (OSA) may be at increased risk for serious perioperative complications. The suitability of ambulatory surgery for patients with OSA remains controversial, and several national guidelines call for more evidence that assesses clinically significant outcomes. In this study, we investigate the association between OSA status (STOP-BANG risk, or previously diagnosed) and short-term outcomes and safety for patients undergoing cancer surgery at a freestanding ambulatory surgery facility.

METHODS

We conducted a retrospective analysis of all patients having surgery at the Josie Robertson Surgery Center, a freestanding ambulatory surgery facility of the Memorial Sloan Kettering Cancer Center. Surgeries included more complex ambulatory extended recovery procedures for which patients typically stay overnight, such as mastectomy, thyroidectomy, and minimally invasive hysterectomy, prostatectomy, and nephrectomy, as well as typical outpatient surgeries. Both univariate and multivariable analyses were used to assess the association between OSA risk and transfer to the main hospital, urgent care center visit, and hospital readmission within 30 days postoperatively (primary outcomes) and length of stay and discharge time (secondary outcomes). Multivariable models were adjusted for age, American Society of Anesthesiologists score, robotic surgery, and type of anesthesia (general or monitored anesthesia care) and also adjusted for surgery start time for length of stay and discharge time outcomes. χ tests were used to assess the association between OSA risk and respiratory events and device use.

RESULTS

Of the 5721 patients included in the analysis, 526 (9.2%) were diagnosed or at moderate or high risk for OSA. We found no evidence of a difference in length of stay when comparing high-risk or diagnosed patients with OSA to low- or moderate-risk patients whether they underwent outpatient (P = .2) or ambulatory extended recovery procedures (P = .3). Though a greater frequency of postoperative respiratory events were reported in high-risk or diagnosed patients with OSA compared to moderate risk (P = .004), the rate of hospital transfer was not significantly different between the groups (risk difference, 0.78%; 95% CI, -0.43% to 2%; P = .2). On multivariable analysis, there was no evidence of increased rate of urgent care center visits (adjusted risk difference, 1.4%; 95% CI, -0.68% to 3.4%; P = .15) or readmissions within 30 days (adjusted risk difference, 1.2%; 95% CI, -0.40% to 2.8%; P = .077) when comparing high-risk or diagnosed OSA to low- or moderate-risk patients. Based on the upper bounds of the CIs, a clinically relevant increase in transfers, readmissions, and urgent care center visits is unlikely.

CONCLUSIONS

Our results contribute to the body of evidence supporting that patients with moderate-risk, high-risk, or diagnosed OSA can safely undergo outpatient and advanced ambulatory oncology surgery without increased health care burden of extended stay or hospital admission and avoiding adverse postoperative outcomes. Our results support the adoption of several national OSA guidelines focusing on preoperative identification of patients with OSA and clinical pathways for perioperative management and postoperative monitoring.

A Case of Complex and Abnormal Behaviors at Night: The Role of the Epilepsy Monitoring Unit in Diagnosis

Complex nocturnal behaviors associated with sleep have many potential causes, including parasomnias and epilepsy. Although the type of event and description can frequently lead to a diagnosis, sometimes it is challenging clinically to determine the cause of the behaviors, requiring a more in-depth investigation. We report the case of a 29-year-old woman with a long history of complex abnormal behaviors and visual hallucinations at night. An extensive clinical evaluation failed to reveal a definitive cause of these episodes, prompting a 3-day epilepsy monitoring unit admission. During the stay, several events were captured on video electroencephalography, leading to a conclusive final diagnosis. This case highlights the challenging task of finding a definitive diagnosis in cases of complex nocturnal behaviors and the potential role of an admission to an epilepsy monitoring unit to help diagnose the cause of these behaviors.

Pineal gland volume is associated with prevalent and incident isolated rapid eye movement sleep behavior disorder

We aimed to investigate the association of pineal gland volume with the risk of isolated rapid eye movement (REM) sleep behavior disorder (RBD). We enrolled 245 community-dwelling cognitively normal elderly individuals without major psychiatric or neurological disorders at the baseline evaluation, of whom 146 completed the 2-year follow-up evaluation. We assessed RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as an RBDSQ score of ≥ 5. We manually segmented the pineal gland on 3T T1-weighted brain magnetic resonance imaging and estimated its volume. The smaller the baseline pineal gland volume, the more severe the RBD symptoms at baseline. The individuals with isolated pRBD showed smaller pineal gland volumes than those without isolated pRBD. The larger the baseline pineal gland volume, the lower the risks of prevalent isolated pRBD at the baseline evaluation and incident isolated pRBD at the 2-year follow-up evaluation. Pineal gland volume showed good diagnostic accuracy for prevalent isolated pRBD and predictive accuracy for incident isolated pRBD in the receiver operator characteristic analysis. Our findings suggest that pineal gland volume may be associated with the severity of RBD symptoms and the risk of isolated RBD in cognitively normal elderly individuals.

Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice

PURPOSE

This article describes the implementation and maintenance of obstructive sleep apnea (OSA) screening and capnography monitoring.

DESIGN

A quality improvement project.

METHODS

A multidisciplinary team provided staff education to three perianesthesia care units. Using the STOP-Bang screening tool, five or more positive responses indicated high risk for OSA. A postanesthesia care unit audit tool tracked STOP-Bang scores, capnography use, hypoventilation events, nursing interventions, and respiratory complications.

FINDINGS

Among 314 patients with OSA, 36% were identified as high risk. Nurses used capnography on 76% of OSA patients and were able to readily identify hypoventilation and intervene. Respiratory complications occurred in 10.8% (n = 34) requiring a higher level of care. Postimplementation, all six postanesthesia care units employ this best practice.

CONCLUSIONS

Perianesthesia nurses found OSA screening and capnography easy to incorporate into nursing practice. This process can reduce respiratory complications in the surgical patient with OSA. An Evidence-Based Practice Fellowship Program facilitated this practice change.

A Novel Decision Making Procedure during Wakefulness for Screening Obstructive Sleep Apnea using Anthropometric Information and Tracheal Breathing Sounds

Obstructive sleep apnea (OSA) is an underdiagnosed common disorder. Undiagnosed OSA, in particular, increases the perioperative morbidity and mortality risks for OSA patients undergoing surgery requiring full anesthesia. OSA screening using the gold standard, Polysomnography (PSG), is expensive and time-consuming. This study offers an objective and accurate tool for screening OSA during wakefulness by a few minutes of breathing sounds recording. Our proposed algorithm (AWakeOSA) extracts an optimized set (3-4) of breathing sound features specific to each anthropometric feature (i.e. age, sex, etc.) for each subject. These personalized group (e.g. age) classification features are then used to determine OSA severity in the test subject for that anthropomorphic parameter. Each of the anthropomorphic parameter classifications is weighted and summed to produce a final OSA severity classification. The tracheal breathing sounds of 199 individuals (109 with apnea/hypopnea index (AHI) < 15 as non-OSA and 90 with AHI ≥ 15 as moderate/severe-OSA) were recorded during wakefulness in the supine position. The sound features sensitive to OSA were extracted from a training set (n = 100). The rest were used as a blind test dataset. Using Random-Forest classification, the training dataset was shuffled 1200-6000 times to avoid any training bias. This routine resulted in 81.4%, 80.9%, and 82.1% classification accuracy, sensitivity, and specificity, respectively, on the blind-test dataset which was similar to the results for the out-of-bag-validation applied to the training dataset. These results provide a proof of concept for AWakeOSA algorithm as an accurate, reliable and quick OSA screening tool that can be done in less than 10 minutes during wakefulness.

Performance of the STOP-Bang in the Detection of OSA, a Brazilian study

OBJECTIVES

Assess the performance of the Stop-Bang questionnaire in Brazilian patients for the screening of OSA.

METHODS

A cross-sectional study with historical and consecutive analysis of all patients who underwent polysomnography tests in the Sleeping Sector of the Ear, Nose, and Throat, and Cardiopulmonary (LabSono) Departments of the Gaffrée and Guinle University Hospital (HUGG), from 10/17/2011 to 04/16/2015. The variables relating to the SB questionnaire were collected by direct research from the medical records of patients.

RESULTS

In a series of 83 patients, we found that our sample were similar to other studies conducted in specialized centers of Sleep Medicine, and the population presented characteristics similar to those found by studies in Latin America. Men and women only behaved similarly in relation to the presence of Observed Apnea and body mass index, with a predominance of women who had systemic hypertension over men. In our study, the discriminatory value of 4 or more positive answers to the questionnaire had the best performance in identifying patients with an hourly Apnea-Hypopnea Index greater than 15/h, with a sensitivity of 72.97% (55.9% - 86.2%) and specificity of 67.39% (52.0% - 80.5%).

CONCLUSIONS

The Stop-Bang questionnaire proved to be, in our sample, a good screening instrument for diagnosing OSA Syndrome.

Prevalence of obstructive sleep apnea in male patients with surgically treated maxillary and zygomatic fractures

Background

Midface fractures can cause airway obstruction and breathing disturbances. The purpose of the present study was to determine the prevalence of undiagnosed obstructive sleep apnea (OSA) among patients with surgically treated maxillary and zygomatic fractures.

Methods

We retrospectively analyzed the medical records of 44 patients who had undergone surgical treatment of maxillary or zygomatic fractures between Jan. 1, 2003, and Dec. 31, 2013 at a single centre. All participants underwent polygraphy testing and were asked to complete the STOP (snoring, tiredness, observed apnea and high blood pressure) questionnaire, Nasal Obstruction Symptom Evaluation (NOSE) scale and Epworth Sleepiness Scale.

Results

There were 27 participants (61%) with maxillary fracture and 17 (39%) with zygomatic fracture. Obstructive sleep apnea was diagnosed in 24 (54%) of the 44 participants, of whom 15 (62%) had maxillary fractures and 9 (38%) had zygomatic fractures. Participants with OSA had a mean Apnea–Hypopnea Index (AHI) of 15.5 (standard deviation [SD] 9.7) events/h, compared to 2.4 (SD 1.5) events/h for those without OSA (p < 0.001). Of the 30 participants with nose obstruction, 18 (60%) had an AHI of 5 or greater.

Conclusion

The results suggest that the prevalence of OSA was higher in surgical patients with midface fractures, independent of the type of fracture, than in the general population. The NOSE scale results showed significant correlation with the presence of OSA.

Sleep Disorders

Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.

Effects of continuous positive airway pressure in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia

In patients with obstructive sleep apnea, short-term use of a continuous positive airway pressure mask improves oxygenation, decreases the apnea-hypopnea index, and reduces hemodynamic instability. In this study, we investigated the effects of use of a continuous positive airway pressure mask in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia. Forty patients who underwent propofol sedation after spinal anesthesia for transurethral bladder or prostate resection with a STOP-Bang score of 3 or more were enrolled in this study. Patients were randomly divided into two groups: a simple oxygen mask group (n = 20) and a continuous positive airway pressure mask group (n = 20). After spinal anesthesia, propofol was injected at a target concentration of 1.3 mcg/ml via a target concentration control injector. ApneaLink™ was applied to all patients. Patients in the simple oxygen mask group were administered oxygen at a rate of 6 L/min through a simple facial mask. Patients in the CPAP mask group were connected to a pressurizer, and oxygen (6 L/min, 5-15 cm H₂O) was administered. Blood pressure, heart rate, respiratory rate, and oxygen saturation were recorded preoperatively, after spinal anesthesia, and every 5 min after the injection of propofol to observe hemodynamic changes. Apnea-hypopnea index was estimated using ApneaLink™. There were no significant differences in hemodynamic changes between the two groups. Apnea-hypopnea index was significantly reduced in the continuous positive airway pressure mask group compared to the simple facial mask group. Application of a continuous positive airway pressure mask in a patient at high risk of obstructive sleep apnea can lower the incidence of obstructive sleep apnea during sedation without a significant effect on hemodynamic stability.

Co-morbid sleep disorders and epilepsy: A narrative review and case examples

Co-morbid sleep disorders, including sleep apnea, insomnia, restless legs syndrome, and the parasomnias, occur frequently in people with epilepsy. This article reviews the cardinal presenting symptoms and diagnostic features of each of these disorders to enable epileptologists to readily screen and identify sleep co-morbidities in their patients. It summarizes current evidence concerning the reciprocal relationship between sleep disturbances and epilepsy and available treatment options for common sleep disorders in people with epilepsy. Several illustrative cases demonstrate the practical consequences of co-morbid sleep disorders in epilepsy patients and suggest diagnostic and treatment approaches that may improve daytime functioning, alertness, quality of life, and seizure burden.

Anesthesia Preoperative Clinic Evaluation of Obstructive Sleep Apnea Using Nasal Fiberoptic Videoendoscopy: A Pilot Study Comparison with Polysomnography

Background

Nasal fiberoptic videoendoscopy is an established technique to assess upper airway pathology in conscious and sedated patients.

Objectives

The authors conducted a prospective proof-of-concept pilot study to evaluate whether airway narrowing detected using nasal fiberoptic videoendoscopy in the anesthesia preoperative clinic was capable of defining the severity of obstructive sleep apnea (OSA) in patients scheduled for elective surgery.

Methods

After application of topical local anesthesia (4% lidocaine with phenylephrine), sixteen patients (ASA physical status 2 or 3) underwent nasal fiberoptic videoendoscopy in sitting position. The magnitudes of retropalatal and retrolingual luminal narrowing were assessed as predictors of OSA. Patients also underwent polysomnography and completed STOP-Bang questionnaires. The endoscopist's clinical impression of OSA severity based on the history and airway examination was quantified.

Results

Retropalatal luminal narrowing and STOP-Bang score ≥ 4 predicted OSA severity as either "none or mild" or "moderate to severe" in 13 (81%) and 9 (56%) of 16 patients who underwent polysomnography, respectively. OSA severity was significantly (Spearman's rank correlation coefficient) associated with retropalatal airway narrowing (P = 0.0048), STOP-BANG score (P = 0.0072), and body mass index (P = 0.0091), whereas clinical impression and retrolingual pharyngeal narrowing were not (P=0.093 and P = 0.11, respectively).

Conclusions

The current results suggest that nasal fiberoptic videoendoscopy quantification of retropalatal airway narrowing may be a useful tool for assessing the severity of OSA in the anesthesia preoperative clinic. The current findings document a proof-of-concept feasibility of nasal fiberoptic videoendoscopy as a screening tool for OSA in conscious patients during preoperative evaluation that may justify further prospective clinical trials of this technique.

STOP-Bang Assessment and Postoperative Outcomes

PURPOSE

Obstructive sleep apnea (OSA) is a common cause of intraoperative and postoperative complications in the surgical setting.

DESIGN

Retrospective chart analysis.

METHODS

Complete review of 150 patient charts over a 3-month period.

FINDING

Findings indicated that of the 150 charts reviewed, 87 (58%) screened high (STOP-Bang score of 3 or greater) for OSA. Patients at a high risk for OSA preoperatively had a higher rate of postoperative complications compared with patients at low risk (79.49% vs 20.51%; χ² = 18.94, P = .004). Postoperative complications included events such as hypoxemia and acute hypercapnia.

CONCLUSIONS

There is a relationship between scores of the STOP-Bang Screening Questionnaire and postoperative complications among surgical patients.

Sleep and cognitive decline: A prospective nondemented elderly cohort study

OBJECTIVE

To investigate sleep disturbances that induce cognitive changes over 4 years in nondemented elderlies.

METHODS

Data were acquired from a nationwide, population-based, prospective cohort of Korean elderlies (2,238 normal cognition [NC] and 655 mild cognitive impairment [MCI]). At baseline and 4-year follow-up assessments, sleep-related parameters (midsleep time, sleep duration, sleep latency, subjective sleep quality, sleep efficiency, and daytime dysfunction) and cognitive status were measured using the Pittsburgh Sleep Quality Index and Consortium to Establish a Registry for Alzheimer's Disease Assessment, respectively. We used logistic regression models adjusted for covariates including age, sex, education, apolipoprotein E genotype, Geriatric Depression Scale, Cumulative Illness Rating Scale, and physical activity.

RESULTS

In participants with NC, long sleep latency (>30 minutes), long sleep duration (≥7.95 hours), and late midsleep time (after 3:00 am) at baseline were related to the risk of cognitive decline at 4-year follow-up assessment; odds ratio (OR) was 1.40 for long sleep latency, 1.67 for long sleep duration, and 0.61 for late midsleep time. These relationships remained significant when these variables maintained their status throughout the follow-up period. Newly developed long sleep latency also doubled the risk of cognitive decline. In those with MCI, however, only long sleep latency reduced the chance of reversion to NC (OR = 0.69).

INTERPRETATION

As early markers of cognitive decline, long sleep latency can be used for elderlies with NC or MCI, whereas long sleep duration and relatively early sleep time might be used for cognitively normal elderlies only. Ann Neurol 2018;83:472-482.

Pre-anesthetic assessment with three core questions for the detection of obstructive sleep apnea in childhood: An observational study

Background

Children with obstructive sleep apnea are at high risk for perioperative airway obstruction. Many “at risk” children may remain unrecognized. The aim of this study is to find a clinically practicable test to identify obstructive sleep apnea in childhood.

Methods

In this pilot study, we prospectively compared four parental questionnaires with the respective findings of subsequent sleep laboratory testing in children. Right before sleep laboratory testing, children’s parents answered both the Pediatric Sleep Questionnaire, a subscale of the Sleep Related Breathing Disorder questionnaire (PSQ-SRBD-Subscale), and an eight-item questionnaire derived from it. Finally, we condensed the eight-item questionnaire to three core issues: Does your child regularly snore at night? Does your child demonstrate labored breathing during sleep? Does your child have breathing pauses during sleep? With it, two similar questionnaires were generated that differed in the formation of the resulting score. One questionnaire was built by a quotient comparable to the abovementioned questionnaires and a second as quick test that functioned as a simple sum score. Both sensitivity and specificity were determined by using a Receiver Operating Characteristic analysis.

Results

In total, 53 children were included in the study. Both the PSQ-SRBD-questionnaire and self-derived eight-item questionnaire failed to reach statistically significant results in detecting obstructive sleep apnea. The set of three core questions with a score built by a quotient was statistically significant and provided sensitivity and a moderate specificity of 0.944 and 0.543, respectively. This could be slightly optimized by creating a simple sum-score (specificity of 0.571).

Conclusions

The use of three core-questions may facilitate the detection of pediatric obstructive sleep apnea within the scope of the anesthesia survey. While the study has some limitations, future studies with both unselective collectives and older children might prove this ultra-short questionnaire to be advantageous in detecting pediatric OSA in clinical practices.

Trial registration

German Clinical Trial Register (DRKS00010408, https://www.drks.de); date of registration 26.07.2016

A pilot randomized controlled trial of on-line interventions to improve sleep quality in adults after mild or moderate traumatic brain injury

Objective:

To explore feasibility and potential efficacy of on-line interventions for sleep quality following a traumatic brain injury (TBI).

Design:

A two parallel-group, randomized controlled pilot study.

Setting:

Community-based.

Subjects:

In all, 24 participants (mean age: 35.9 ± 11.8 years) who reported experiencing sleep difficulties between 3 and 36 months after a mild or moderate TBI.

Interventions:

Participants were randomized to receive either a cognitive behaviour therapy or an education intervention on-line. Both interventions were self-completed for 20–30 minutes per week over a six-week period.

Main measures:

The Pittsburgh Sleep Quality Index assessed self-reported sleep quality with actigraphy used as an objective measure of sleep quality. The CNS Vital Signs on-line neuropsychological test assessed cognitive functioning and the Rivermead Post-concussion Symptoms and Quality of Life after Brain Injury questionnaires were completed pre and post intervention.

Results:

Both programmes demonstrated feasibility for use post TBI, with 83.3% of participants completing the interventions. The cognitive behaviour therapy group experienced significant reductions ( F = 5.47, p = 0.04) in sleep disturbance (mean individual change = −4.00) in comparison to controls post intervention (mean individual change = −1.50) with a moderate effect size of 1.17. There were no significant group differences on objective sleep quality, cognitive functioning, post-concussion symptoms or quality of life.

Conclusion:

On-line programmes designed to improve sleep are feasible for use for adults following mild-to-moderate TBI. Based on the effect size identified in this pilot study, 128 people (64 per group) would be needed to determine clinical effectiveness.

Are the Epworth Sleepiness Scale and Stop-Bang model effective at predicting the severity of obstructive sleep apnoea (OSA); in particular OSA requiring treatment?

Obstructive sleep apnoea (OSA) is a condition characterised by repetitive upper airway collapse during sleep. The condition carries a range of health sequelae that can prove fatal in cases with co-existing risk factors for the condition, such as obesity and hypertension. Utilisation of a high-performance screening tool for OSA is thus important. A retrospective audit using the ESS and Stop-Bang scores, alongside Apnoea-Hypopnea Index values, for patients who underwent polysomnography over 1 year. Multinomial logistic regression was used to compare the predictive abilities of ESS, SBM, and body mass index (BMI) for the patient outcome groups, "None" (No OSA), "Notreat" (OSA not requiring treatment) and "treat" (OSA requiring treatment). The influences of age, gender and BMI on outcome group were also assessed. 126 bariatric and 66 non-bariatric patients were included. Multinomial logistic regression failed to demonstrate predictive ability of ESS. A higher Stop-Bang score significantly increases the risk being in the "treat" group. In addition, male gender, greater age and a higher BMI each individually increase the risk of OSA requiring treatment. Stop-Bang failed to demonstrate predictive significance when age and gender were controlled for. ESS is not an appropriate screening tool for OSA. Stop-Bang, however, remains a useful screening tool, with the ability to detect patient with OSA in need of treatment. Further study may benefit the development and implementation of a concise and more specific screening tool that considers high evidence-based risk factors for OSA, including male gender, greater age and raised BMI.

Manejo perioperatorio del paciente con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS)

Los pacientes con diagnóstico de síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) pueden ser llevados de forma segura a cualquier procedimiento quirúrgico, incluso de manera ambulatoria si tienen control adecuado de sus otras comorbilidades. El tratamiento con presión positiva continúa en vía aérea (CPAP) en pacientes con diagnóstico confirmado disminuye el riesgo de presentar complicaciones cardiovasculares a largo plazo. La sedación debe ser hecha por un anestesiólogo, quien, además, debe vigilar al paciente y disponer del equipo adecuado para atender complicaciones respiratorias emergentes. Se sugiere que, en estos pacientes, los procedimientos sean hechos en el ámbito hospitalario, donde se tenga disponibilidad en la unidad de cuidados post-anestésicos y personal para monitoreo por al menos una hora tras finalizar el procedimiento. El tratamiento con CPAP debe continuar según sea ordenado por el médico tratante. Es importante que desde la valoración preanestésica se identifique a los pacientes con riesgo de SAHOS para lograr trazar un plan anestésico que disminuya las complicaciones a nivel respiratorio y del manejo de la vía área.

Evaluación del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) mediante instrumentos de medición como escalas y fórmulas matemáticas

La psicometría del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) se puede proporcionar con el uso de variados métodos de evaluación como entrevistas clínicas, escalas, cuestionarios de sueño, autoregistros y registros psicofisiológicos. La prueba de oro para el diagnóstico de esta enfermedad sigue siendo la polisomnografía, la cual puede llegar a tener altos costos y dificultades para acceder al estudio. Debido a la alta morbimortalidad asociada a este síndrome, se requieren instrumentos que permitan la identificación rápida de individuos que puedan estar en riesgo de padecerlo. Por tales motivos, se han desarrollado herramientas que permiten detectar los pacientes en riesgo de presentar SAHOS, tales como el Cuestionario de Berlín, el STOP-Bang y la Escala de Somnolencia de Epworth. Es importante tener en cuenta los alcances y limitaciones de estas herramientas para escoger el instrumento indicado según lo que se desee evaluar.

STOP-Bang questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil

Objective:

To translate and perform a cross-cultural adaptation of the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-Bang) questionnaire so that it can be used as a screening tool for the diagnosis of obstructive sleep apnea in Brazil.

Methods:

Based on the principles of good practice for the translation and cross-cultural adaptation of such instruments, the protocol included the following steps: acquisition of authorization from the lead author of the original questionnaire; translation of the instrument to Brazilian Portuguese, carried out by two translators; reconciliation; back-translation to English, carried out by two English teachers who are fluent in Portuguese; review of the back-translation; harmonization; review and approval of the questionnaire by the original author; cognitive debriefing involving 14 patients who completed the questionnaire; analysis of the results; and review and preparation of the final version of the instrument approved by the review committee.

Results:

The final version of the STOP-Bang questionnaire for use in Brazil showed a clarity score > 9 (on a scale of 1-10) for all of the questions. The Cronbach's alpha coefficient was 0.62, demonstrating the internal consistency of the instrument. The means and standard deviations of the age, body mass index, and neck circumference of the patients studied were 46.8 ± 11.2 years, 43.7 ± 8.5 kg/m², and 41.3 ± 3.6 cm, respectively.

Conclusions:

The STOP-Bang questionnaire proved to be understandable, clear, and applicable. The original instrument and the translated version, cross-culturally adapted for use in Brazil, were consistently equivalent. Therefore, it can become a widely used screening tool for patients with suspected obstructive sleep apnea.

Correlational Study of Sleep Apnea Patient Characteristics With Discharge Locations

PURPOSE

To determine if a correlation exists between OSA patient characteristics and the PACU discharge location; and the characteristics of the patients at-risk for low saturation levels, increased number of desaturations, and longer length of stay in the PACU.

DESIGN

Retrospective, correlational study design.

METHOD

Chart review of OSA patients ≥ 18 years old. Correlational analysis was performed between 15 high risk patient variables and the PACU discharge disposition: home or monitored bed. Complications resulting in monitored bed admission were reviewed.

FINDINGS

153 patients' charts were reviewed. The results showed that age>60, ASA classification, anesthesia type and narcotics use in the PACU were significantly correlated (p≤.05) with a patient's discharge disposition.

DISCUSSION

The findings are consistent with other OSA research except BMI was not significant in this study.

CONCLUSION

The results highlighted areas for future research and implications for clinical practice that would enable the perioperative care team to deliver safe care based on evidence.

A Quality Improvement Project: Using the STOP-BANG Tool in a Military Population to Improve Equity in Preoperative Screening

BACKGROUND

The lack of a preoperative screening tool to detect obstructive sleep apnea (OSA) may lead to an increase in postoperative complications.

AIM

The aim of the study was to implement a prescreening tool to identify diagnosed or undiagnosed OSA before a surgical procedure.

SETTING

The study was conducted in the surgical admission center and postanesthesia care unit at a military treatment facility in Hawaii.

PARTICIPANTS

Participants of the study included military personnel, military family members, veterans, and veteran beneficiaries.

METHODS

The STOP-BANG (snore/tired/obstruction/pressure-body mass index/age/neck/gender) tool was used between April and June 2013 to identify and stratify 1,625 patients into low-risk, intermediate-risk, high-risk, and known OSA categories.

RESULTS

The STOP-BANG tool confirmed the diagnosed OSA rate to be 13.48%, and increased at-risk OSA detection by 24.69%. Hawaiians/Pacific Islanders were more frequently found to be at risk with known OSA, likely to have complications, and be transferred to PACU 23-hour extended stay compared to other races and intermediate-risk and high-risk categories.

CONCLUSION

The STOP-BANG tool identified and stratified surgical patients at risk for OSA and standardized OSA assessments.

Can Screening Tools for Obstructive Sleep Apnea Predict Postoperative Complications? A Systematic Review of the Literature

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is a common, underdiagnosed condition that is associated with significant morbidity and mortality in the perioperative setting. Increasing evidence suggests that the utility of preoperative screening tools may go beyond identification of OSA, to the prediction of perioperative complications. The primary objective of this study was to systematically review the literature on all studies assessing whether high risk scores on the STOP-Bang questionnaire, American Society of Anesthesiologists (ASA) checklist, and the Berlin Questionnaire (BQ) are associated with higher rates of postoperative complications.

METHODS

A systematic review of English language records was performed using Medline, EMBASE, and PsychInfo with additional studies identified by manual search through reference lists. Only studies that evaluated the ability of the STOP-Bang, the BQ, and ASA checklist to predict postoperative complications in adults were included.

RESULTS

Twelve studies were included in the final review. Eight studies looked at STOP-Bang, 3 at the Berlin Questionnaire, and 2 at the ASA Checklist. Significant differences across study characteristics prevented a meta-analysis and the studies were evaluated qualitatively.

CONCLUSIONS

The ASA checklist, Berlin Questionnaire, and STOP-Bang questionnaire may be able to risk stratify patients for perioperative and postoperative complications. Further research is required, with a particular focus on specific surgery types and adjustment of potentially confounding factors in the analysis.