Preoperative Evaluation of Adults With or Suspected of Having Obstructive Sleep Apnea

Terry Shaneyfelt, MD, MPHAssoc. Professor, UAB Department of Medicine

• Estimated 7% prevalence in presurgical patients (Anesth Analg 2010;110:1007)

• Over 50% of patients with OSA who present for surgery are undiagnosed

• OSA increases perioperative complications

Background

Factors contributing to perioperative aggravation of OSA

PERIOPERATIVE AGGRAVATIONOF OSA

• All patients should be screened but especially:• Obese patients (BMI ≥ 30kg/m2)• Bariatric surgery• Medical conditions in which OSA is prevalent (HTN, DM)• h/o difficult intubation• Upper airway characteristics that predict difficult

intubation

• STOP-Bang, Berlin, Sleep apnea clinical score

ASA recommends screening for OSA(Practice Guidelines for the Perioperative Management of Patients with OSA

Anesthesiology 2014;120:268-86)

Low risk of ASA: Yes on 0-2Intermediate: Yes on 3-4High risk: Yes on 5-8 + HCO3 ≥ 28 MMOL/L

(15.7 inches)

• Severity• Current symptoms• Sleep study

• Adequacy of current treatment• Residual symptoms• adherence

Assessment of patients with known OSA

Who needs further evaluation prior to surgery?

HIGH RISK SURGICAL PROCEDURE

HIGH RISK FOR SEVERE, INADEQUATELY TREATED OSA

Majority of patients can proceed to surgery without additional testing or treatment

• OSA increases risk of a variety of postoperative complications

• Patients should be screening for OSA esp if they are obese or have medical problems associated with OSA

• No further evaluation is needed in low risk patients undergoing low risk procedures

• No further evaluation is needed in patients with OSA who are well controlled and adherent to therapy

Summary