A Screening Instrument for Sleep Apnea Predicts Airway Maneuvers in Patients Undergoing Advanced Endoscopic Procedures

Background & Aims

Among patients undergoing advanced endoscopy, unrecognized obstructive sleep apnea (OSA) could predict sedation-related complications (SRCs) and the need for airway maneuvers (AMs). By using an OSA screening tool, we sought to define the prevalence of patients at high risk for OSA and to correlate OSA with the frequency of AMs and SRCs.

Methods

We enrolled 231 consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) (n = 176) and endoscopic ultrasound (n = 55). Propofol-based sedation and patient monitoring were performed by a nurse anesthetist and an anesthesiologist. A previously validated screening tool for OSA (STOP-BANG) was used to identify patients at high risk for OSA (score, ≥3 of 8; SB+) or low risk (SB−). AMs were defined as a chin lift, modified mask ventilation, nasal airway, bag-mask ventilation, and endotracheal intubation. SRCs were defined as any duration of pulse oximetry less than 90%, systolic blood pressure less than 90 mm Hg, apnea, or early procedure termination.

Results

The prevalence of SB+ was 43.3%. The frequency of hypoxemia was significantly higher among patients with SB+ than SB− (12.0% vs 5.2%; relative risk [RR], 1.83; 95% confidence interval [CI], 1.32–2.54). The rate of AMs was also significantly higher among SB+ (20.0%) compared with SB− (6.1%) patients (RR, 1.8; 95% CI, 1.3–2.4). These rates remained significant after adjusting for American Society of Anesthesiologists class 3 or higher (RR, 1.70; 95% CI, 1.28–2.2 for AMs; RR, 1.63; 95% CI, 1.19–2.25 for hypoxemia). Each element of the STOP-BANG was reported more commonly in SB+ patients (P < .0001 for each comparison).

Conclusions

A significant number of patients undergoing advanced endoscopic procedures are at risk for OSA. AMs and hypoxemia occur at an increased frequency in these patients.

Keywords: ERCP, EUS, Monitored Anesthesia Care, Interventional Endoscopy

Abbreviations used in this paper: AM, airway maneuver, ASA, American Society of Anesthesiologists, BMI, body mass index, CI, confidence interval, CRNA, certified registered nurse anesthetist, ERCP, endoscopic retrograde cholangiopancreatography, EUS, endoscopic ultrasound, MOAA/S, Modified Observer's Assessment of Alertness and Sedation, OSA, obstructive sleep apnea, RR, relative risk, SRC, sedation-related complication