Article Text
PDF
Abstract
Introduction Obstructive sleep apnoea (OSA) is common and significantly underdiagnosed. It increases the risk of type two diabetes, cardiovascular disease, and death, and treatment with continuous positive airways pressure (CPAP) reduces these risks.1
Patients with OSA are at significantly increased risk of perioperative complications and treatment with CPAP therapy reduces these risks.2
Opportunities to identify and treat patients with OSA should be taken whenever possible.
Methods We designed a pathway to identify high risk patients who were undergoing major surgery (figure 1). Patients underwent a home sleep study using peripheral arterial tonometry technology (WatchPAT®ONE).
Pathway for screening and diagnosis of high risk patients. BMI = body mass index (kg/m2). STOPBANG = screening questionnaire. AHI = apnoea hypopnoea index. ODI = Oxygen Desaturation Index. OSA = obstructive sleep apnoea
Project aims 1) Assess prevalence of undiagnosed OSA in high risk patients in the perioperative period
2) Identify patients for perioperative multidisciplinary team (MDT) discussion regarding surgical risk
3) Initiate long term management of OSA
Results In 14 months between 17/02/22 and 17/04/23, 91 patients were identified as high risk and underwent a home sleep study. Of these, 69 (75.8%) were newly diagnosed with OSA, with 43 (47.3%) being diagnosed with moderate or severe OSA.
Newly diagnosed patients were discussed by the MDT regarding risks of surgery. Patients with moderate or severe OSA were seen urgently in clinic for review and initiation of CPAP therapy.
Discussion Undiagnosed OSA is a significant burden in the perioperative period. The pre-operative period is an optimum time to screen, diagnose, and treat patients. As well as highlighting patients at increased surgical risk, long term management of patients can be initiated, thus reducing long term negative health outcomes.
References
Dodds S, Williams LJ, Roguski A, Vennelle M, Douglas NJ, Kotoulas SC, et al. Mortality and morbidity in obstructive sleep apnoea-hypopnoea syndrome: results from a 30-year prospective cohort study. ERJ Open Res [Internet]. 2020 Jul;6(3). Available from: http://dx.doi.org/10.1183/23120541.00057-2020
Berezin L, Nagappa M, Poorzargar K, Saripella A, Ariaratnam J, Butris N, et al. The effectiveness of positive airway pressure therapy in reducing postoperative adverse outcomes in surgical patients with obstructive sleep apnea: A systematic review and meta-analysis. J Clin Anesth. 2023 Feb;84:110993.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.