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Literature

The information below provides a sampling of information on sleep apnea in the preoperative period.

Please read the interview with Carla Lickteig, RN, BSN, and CPAN to learn about her experiences.

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Grigg P, Lickteig C.2002 Preoperative screening for obstructive sleep apnea. Am Fam Physician.Sep 15;66(6):958, 963-4

Richards R, Morganthayler T, Lickteig C, Carr B.  RT’s Role in Preoperative Management of OSA. Respiratory Therapy.  2007: June

Lickteig CA, Grigg P. Risks of OSA and Anesthesia. Sleep Review. 2003: Jan/Feb.

Bolden N, Smith CE, Auckley D Avoiding adverse outcomes in patients with obstructive sleep apnea (OSA): development and implementation of a preoperative OSA protocol J Clin Anesth. 2009 Jun;21(4):286-93. Epub 2009 Jun 6. Obstructive sleep apnea (OSA) is associated with postoperative airway obstruction, hypoxemia, cardiac arrhythmias, cardio respiratory arrest, hypoxic encephalopathy, and death. Three cases highlighting important issues in patients with OSA are presented that occurred prior to and after implementation of an OSA protocol.

Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ.(2009) Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and post anesthesia care assessment Anesthesiology.Apr;110(4):869-77

BACKGROUND: Patients with obstructive sleep apnea are at risk for preoperative morbidity. The authors used a screening prediction model for obstructive sleep apnea to generate a sleep apnea clinical score (SACS) that identified patients at high or low risk for obstructive sleep apnea. This was combined with post anesthesia care unit (PACU) monitoring with the aim of identifying patients at high risk of postoperative oxygen desideration and respiratory complications. METHODS: In this prospective cohort study, surgical patients with a hospital stay longer than 48 h who consented were enrolled. The SACS (high or low risk) was calculated; all patients were monitored in the PACU for recurrent episodes of bradypnea, apnea, desaturations, and pain-sedation mismatch. All patients underwent pulse oximetry postoperatively; complications were documented. Chi-square, two-sample t test, and logistic regression were used for analysis. The oxygen desideration index (number of desaturations per hour) was calculated. Oxygen desideration index and incidence of postoperative cardio respiratory complications were primary endpoints. RESULTS: Six hundred ninety-three patients were enrolled. From multivariable logistic regression analysis, the likelihood of a postoperative oxygen desideration index greater than 10 was increased with a high SACS (odds ratio = 1.9, P < 0.001) and recurrent PACU events (odds ratio = 1.5, P = 0.036). Postoperative respiratory events were also associated with a high SACS (odds ratio = 3.5, P < 0.001) and recurrent PACU events (odds ratio = 21.0, P < 0.001).

CONCLUSIONS: Combination of an obstructive sleep apnea screening tool preoperatively (SACS) and recurrent PACU respiratory events was associated with a higher oxygen desideration index and postoperative respiratory complications. A two-phase process to identify patients at higher risk for preoperative respiratory desaturations and complications may be useful to stratify and manage surgical patients postoperatively.

Ead H.(2009) Meeting the challenge of obstructive sleep apnea: developing a protocol that guides per anesthesia patient care. J Perianesth Nurs.Apr;24(2):103-10; quiz 111-13

Caring for a patient postoperatively with a medical history of diagnosed or suspected obstructive sleep apnea (OSA) is not uncommon. OSA is estimated to be present in 2%-26% of the general population, and the National Sleep Foundation proposes that one in four Americans are at high risk for OSA. Also of concern is that the incidence of OSA may increase as our population ages. Despite published guidelines, it can be difficult to implement recommendations that include increased monitoring of patients in critical care settings, particularly when these resources are already stretched. Although health care professionals want to provide a high level of care, it is recognized that patients with OSA can place a strain on health care systems. This article reviews the impact OSA can have on the patient in the preoperative phase and the implications to care providers. Also outlined are the challenges of initiating an OSA screening tool and management protocol. Although updating an institution's policies around preoperative management of the patient with OSA is vital, it can appear to be an overwhelming task to comply with all evidence-based recommendations.

Accessed via Pub Med