Skip to main content
SpringerLink
Log in

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

  • Original Research
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136–43.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? Curr Opin Anaesthesiol. 2009;22:405–11.

    Article  PubMed  Google Scholar 

  3. Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107:1543–63.

    Article  PubMed  Google Scholar 

  4. Parati G, Di Rienzo M, Bonsignore MR, Insalaco G, Marrone O, Castiglioni P, et al. Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep. J Hypertens. 1997;15:1621–6.

    Article  CAS  PubMed  Google Scholar 

  5. Bonsignore MR, Parati G, Insalaco G, Castiglioni P, Marrone O, Romano S, et al. Baroreflex control of heart rate during sleep in severe obstructive sleep apnoea: effects of acute CPAP. Eur Respir J. 2006;27:128–35.

    Article  CAS  PubMed  Google Scholar 

  6. Sogol J, Shahrokh J, Ali J. Sleep apnea, heart failure, and pulmonary hypertension. Curr Heart Fail Rep. 2013;10(4):315–20.

    Article  Google Scholar 

  7. Hillman DR, Loadsman JA, Platt PR, Eastwood PR. Obstructive sleep apnoea and anaesthesia. Sleep Med Rev. 2004;8:459–71.

    Article  PubMed  Google Scholar 

  8. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2006;104:1081–93. (quiz 117–118).

    Article  PubMed  Google Scholar 

  9. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812–21.

    Article  PubMed  Google Scholar 

  10. Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108(5):768–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 2016;149(3):631–8.

    Article  PubMed  Google Scholar 

  12. Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 2005;103:470–7.

    Article  CAS  PubMed  Google Scholar 

  13. Kim GH, Lee JJ, Choi SJ, Shin BS, Lee AR, Lee SH, et al. Clinical predictors of apnoea-hypopnoea during propofol sedation in patients undergoing spinal anaesthesia. Anaesthesia 2012;67:755–9.

    Article  CAS  PubMed  Google Scholar 

  14. McDaid C, Duree KH, Griffin SC, Weatherly HL, Stradling JR, Davies RJ, et al. A systematic review of continuous positive airway pressure for obstructive sleep apnoea-hypopnoea syndrome. Sleep Med Rev. 2009;13:427–36.

    Article  PubMed  Google Scholar 

  15. Kakkar RK, Berry RB. Positive airway pressure treatment for obstructive sleep apnea. Chest 2007;132:1057–72.

    Article  PubMed  Google Scholar 

  16. Dursunoglu N, Dursunoglu D, Cuhadaroglu C, Kilicaslan Z. Acute effects of automated continuous positive airway pressure on blood pressure in patients with sleep apnea and hypertension. Respiration 2005;72:150–5.

    Article  PubMed  Google Scholar 

  17. Ruehland WR, Rochford PD, O’Donoghue FJ, Pierce RJ, Singh P, Thornton AT. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 2009;32(2):150–7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nathaniel S, Marshall PhD, Keith KH, Wong, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton health study. Sleep 2008;31(8):1079–85.

    Google Scholar 

  19. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109(6):897–906.

    Article  CAS  PubMed  Google Scholar 

  20. D’Apuzzo MR, Browne JA. Obstructive sleep apnea as a risk factor for postoperative complications after revision joint arthroplasty. J Arthroplasty. 2012;27(8):95–8.

    Article  PubMed  Google Scholar 

  21. Vold M, Aasebo U, Wilsgaard T, Melbye H. Low oxygen saturation and mortality in an adult cohort: the Tromso study. BMC Pulm Med. 2015;15:9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Milton K, Erman D, Stewart D, Einhorn, et al. Validation of the ApneaLink™ for the screening of sleep apnea: a novel and simple single-channel recording device. J Clin Sleep Med. 2007;3(4):387–92.

    Google Scholar 

  23. Nigro CA, Serrano F, Aimaretti S, González S, Codinardo C, Rhodius E. Utility of ApneaLink for the diagnosis of sleep apnea-hypopnea syndrome. Medicina 2010;70(1):53–9.

    PubMed  Google Scholar 

  24. Ulander M, Johansson MS, Ewaldh AE, Svanborg E, Broström A. Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence. Sleep Breath. 2014;18(4):799–807.

    Article  PubMed  Google Scholar 

  25. Cabrini L, Nobile L, Plumari VP, Landoni G, Borghi G, Mucchetti M, Zangrillo A. Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review. Br J Anaesth. 2014;112(4):638–47.

    Article  CAS  PubMed  Google Scholar 

  26. Nozaki-Taguchi N, Isono S, Nishino T, Numai T, Taguchi N. Upper airway obstruction during midazolam sedation: modification by nasal CPAP. Can J Anaesth. 1995;42:685–90.

    Article  CAS  PubMed  Google Scholar 

  27. Iwama H. Application of nasal bi-level positive airway pressure to respiratory support during combined epidural–propofol anesthesia. J Clin Anesth. 2002;14:24–33.

    Article  CAS  PubMed  Google Scholar 

  28. Iwama H, Obara S, Ozawa S, et al. A survey of combined epidural–propofol anesthesia with noninvasive positive pressure ventilation as a minimally invasive anesthetic protocol. Med Sci Monit. 2003;9:316–23.

    Google Scholar 

  29. Georg F, Alexandra L, John W, et al. Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)—systematic review and meta-analysis. BMC Med. 2013;12:41.

    Google Scholar 

  30. Junbo Z, Yang G, Xiaoyu X, et al. Correlation of bispectral index and Richmond agitation sedation scale for evaluating sedation depth: a retrospective study. J Thorac Dis. 2018;10(1):190–5.

    Article  Google Scholar 

  31. Mondello E, Siliotti R, Noto G, et al. Bispectral Index in ICU: correlation with Ramsay Score on assessment of sedation level. Clin Monit Comput. 2002;17(5):271–7.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Hyunyoung Lim and Minseok Oh have contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea

    Hyunyoung Lim & Hyunseo Ki

  2. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Minseok Oh & Jeong Jin Lee

  3. Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea

    Yang Hoon Chung

Authors
  1. Hyunyoung Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Minseok Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yang Hoon Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyunseo Ki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeong Jin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong Jin Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Appendix

Appendix

1.1 STOP-bang questionnaire

  1. 1.

    Snoring

Do you snore loudly (loud enough to be heard through closed doors or wakes your bed-partner at night)?

  1. 2.

    Tired

Do you often feel tired, fatigued, or sleepy during the daytime (such as falling asleep during driving or talking to someone)?

  1. 3.

    Observed

Has anyone observed you stop breathing or choking/gasping during your sleep?

  1. 4.

    Pressure

Do you have or are you being treated for high blood pressure?

  1. 5.

    BMI

Body mass index more than 35 kg/m2?

  1. 6.

    Age

Age older than 50?

  1. 7.

    Neck circumference

Neck size large? (measured around Adam’s apple).

For males, is your shirt collar 17 inches (or 43 cm) or larger?

For females, is your shirt collar 16 inches (or 41 cm) or larger?

  1. 8.

    Gender

Is your gender male?

High risk group for sleep apnea: STOP-Bang score ≥ 3.

Low risk group for sleep apnea: STOP-Bang score < 3.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lim, H., Oh, M., Chung, Y.H. et al. Effects of continuous positive airway pressure in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia. J Clin Monit Comput 33, 657–663 (2019). https://doi.org/10.1007/s10877-018-0202-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-018-0202-8

Keywords

Search

Navigation