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Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States

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Abstract

Obstructive sleep apnea (OSA) is a risk factor for significant perioperative complications. This national survey study sought to determine the attitudes of physicians involved in the perioperative care of OSA patients.

Methods

We modified the perioperative survey used by Turner et al. among Canadian anesthesiologists. We mailed the survey to 3,000 US physicians practicing in the following specialties (750 of each specialty): anesthesiology (A), primary care (family practice or internal medicine) (PC), sleep (SM), and general surgery (S). The survey asked questions about attitudes and practice patterns regarding OSA in the perioperative setting.

Results

Of 2,730 eligible subjects, 783 questionnaires (28.7 %) were returned. Overall, 94 % felt OSA was a risk factor for perioperative complications (no difference by specialty) and 90 % felt it was a moderate to major risk factor (A = 91 %, PC = 81 %, SM = 94 %, S = 72 %; p < 0.001). Fifty-two percent reported experience with a patient having an adverse outcome related to OSA in the perioperative setting. Despite this, only 71 % reported regularly screening for OSA preoperatively, mostly by history and physical examination (A = 89 %, PC = 52 %, SM = 88 %, S = 49 %; p < 0.001). If they suspected a patient of having OSA, 32 % would delay surgery pending a sleep study (A = 4 %, PC = 41 %, SM = 54 %, S = 27 %; p < 0.001), while 20 % would proceed with surgery without any special precautions (A = 22 %, PC = 21 %, SM = 5 %, S = 31 %; p < 0.001). Only 27 % of respondents reported that their hospital had a written policy for perioperative care of OSA patients.

Conclusions

The majority of physicians in this survey felt OSA was a significant risk factor for perioperative complications and most reported experience with OSA patients having an adverse outcome. Perioperative management guidelines for OSA are not available at most institutions. Further work is needed to help physicians identify and intervene on patients with OSA in the perioperative setting before adverse events develop.

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References

  1. Chung S, Yuan H, Chung F (2008) A systemic review of obstructive sleep apnea and its implication for Anesthesiologists. Anesth Analg 107:1543–1563

    Article  PubMed  Google Scholar 

  2. Finkel KJ, Searleman AC, Tymkew H et al (2009) Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 10(7):753–758

    Article  PubMed  Google Scholar 

  3. Siyam MA, Benhamou D (2002) Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg 95:1098–1102

    PubMed  Google Scholar 

  4. Biddle C (1996) Comparative aspects of the airway during general anesthesia in obese sufferers of sleep apnea and matched normals. Adv Prac Nurs Q 2(3):14–19

    CAS  Google Scholar 

  5. Nandi PR, Charlesworth CH, Taylor SJ, Nunn JF, Dore CJ (1991) Effect of general anaesthesia on the pharynx. Br J Anaesth 66(2):157–162

    Article  CAS  PubMed  Google Scholar 

  6. Mathru M, Esch O, Lang J et al (1996) Magnetic resonance imaging of the upper airway: effects of propofol anesthesia and nasal continuous positive airway pressure in humans. Anesthesiology 84(2):253–255

    Article  Google Scholar 

  7. Drummond GB (1989) Influence of thiopentone on upper airway muscles. Br J Anaesth 63:12–21

    Article  CAS  PubMed  Google Scholar 

  8. Bailey PL, Pace NL, Ashburn MA et al (1990) Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 73(5):826–830

    Article  CAS  PubMed  Google Scholar 

  9. Craig DB (1981) Postoperative recovery of pulmonary function. Anesth Analg 60:46–52

    CAS  PubMed  Google Scholar 

  10. Marshall BE, Wyche MQ Jr (1972) Hypoxemia during and after anesthesia. Anesthesiology 37:178–209

    Article  CAS  PubMed  Google Scholar 

  11. Esclamado RM, Glenn MG, McCulloch TM, Cummings CW (1989) Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome. Laryngoscope 99(11):1125–1129

    Article  CAS  PubMed  Google Scholar 

  12. Catley DM, Thornton C, Jordan C et al (1985) Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology 63(1):20–28

    Article  CAS  PubMed  Google Scholar 

  13. Sollevi A, Lindahl SG (1995) Hypoxic and hypercapnic ventilatory responses during isoflurane sedation and anaesthesia in women. Acta Anaesthesiol Scand 39:931–938

    Article  CAS  PubMed  Google Scholar 

  14. Richard W, Kox D, den Herder C et al (2006) The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 263(10):946–950

    Article  PubMed  Google Scholar 

  15. Charbonneau M, Marin J, Olha A et al (1994) Changes in obstructive sleep apnea characteristics through the night. Chest 106(6):1695–1701

    Article  CAS  PubMed  Google Scholar 

  16. Ostermeier AM, Roizen MF, Hautkappe M, Klock PA, Klafta JM (1997) Three sudden postoperative respiratory arrests associated with epidural opioids in patients with sleep apnea. Anesth Analg 85:452–460

    CAS  PubMed  Google Scholar 

  17. Gupta R, Parvizi J, Hanssen A, Gay P (2001) Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 76:897–905

    Article  CAS  PubMed  Google Scholar 

  18. Mooe T, Gullsby S, Rabben T, Eriksson P (1996) Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis 7(6):475–478

    Article  CAS  PubMed  Google Scholar 

  19. Kaw R, Golish J, Ghamande S et al (2006) Incremental risk of obstructive sleep apnea on cardiac surgical outcomes. J Cardiovasc Surg 47:683–689

    CAS  Google Scholar 

  20. Memtsoudis S, Liu SS, Ma Y et al (2011) Perioperative pulmonary outcomes in patient with sleep apnea after noncardiac surgery. Anesth Analg 112(1):113–121

    Article  PubMed  Google Scholar 

  21. Kaw R, Chung F, Pasupuleti V et al (2012) Meta-analysis of the association between obstructive sleep apnea and postoperative outcomes. Br J Anaesth 109(6):897–906

    Article  CAS  PubMed  Google Scholar 

  22. Meoli AL, Rosen CL, Kristo D et al (2003) Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period—avoiding complications. Sleep 26(8):1060–1065

    PubMed  Google Scholar 

  23. Gross JB, Bachengerg KL, Benumof JL et al (2006) 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 104(5):1081–1093

    Article  PubMed  Google Scholar 

  24. Bolden N, Smith CE, Auckley D (2009) Avoiding adverse outcomes in patients with obstructive sleep apnea (OSA): development and implementation of a perioperative OSA protocol. J Clin Anesth 21(4):286–293

    Article  PubMed  Google Scholar 

  25. Turner K, Vandenkerkhof E, Lam M, Mackillop W (2006) Perioperative care of patients with obstructive sleep apnea—a survey of Canadian anesthesiologists. Can J Anaesth 53(3):299–304

    Article  PubMed  Google Scholar 

  26. Patil RD, Patil YJ (2012) Perioperative management of obstructive sleep apnea: a survey of Veterans Affairs health care providers. Otolaryngol Head Neck Surg 146(1):156–161

    Article  PubMed  Google Scholar 

  27. Dillman DA (2000) Mail and Internet Surveys. The Tailored Design Method, 2nd edn. John Wiley and Sons, New York

    Google Scholar 

  28. Bamgbabe OA, Chung AS, Khalaf WM et al (2009) Survey of perioperative care of adults with obstructive sleep apnea. Eur J Anaesthesiol 26(8):706–708

    Article  Google Scholar 

  29. Vasu TS, Doghramji K, Cavallazzi R et al (2010) Obstructive sleep apnea and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 136(10):1020–1024

    Article  PubMed  Google Scholar 

  30. Chung F, Yegneswaran B, Liao P et al (2008) Validation of the Berlin Questionnaire and American Society for Anesthesiologists Checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 108:822–830

    Article  PubMed  Google Scholar 

  31. Ravesloot MJ, van Maanen JP, Hilgevoord AA et al (2012) Obstructive sleep apnea is under recognized and under diagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol 269(7):1865–1871

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Singh M, Liao P, Kobah S et al (2013) Proportion of surgical patients with undiagnosed obstructive sleep apnea. Br J Anaesth 110(4):629–636

    Article  CAS  PubMed  Google Scholar 

  33. Redline S, Strohl KP (1998) Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med 19(1):1–19

    Article  CAS  PubMed  Google Scholar 

  34. Ramachandran SK, Josephs LA (2009) A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology 110:928–939

    Article  PubMed  Google Scholar 

  35. Gross JB, Apfelbaum JL, Caplan RA et al (2014) Practice guidelines for the perioperative management of patients with obstructive sleep apnea. An updated report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea. Anesthesiology 120(2):268–286

    Article  Google Scholar 

  36. Adesanya AO, Lee W, Greilich NB, Joshi G (2010) Perioperative management of obstructive sleep apnea. Chest 138(6):1489–1498

    Article  PubMed  Google Scholar 

  37. Seet E, Chung F (2010) Management of sleep apnea in adults—functional algorithms for the perioperative period: Continuing Professional Development. Can J Anesth 57:849–864

    Article  PubMed  Google Scholar 

  38. Kellerman SE, Herold J (2001) Physician response to surveys. A review of the literature. Am J Prev Med 20:61–67

    Article  CAS  PubMed  Google Scholar 

  39. Cummings SM, Savitz LA, Konrad TR (2001) Reported response rates to mailed physician questionnaires. Health Serv Res 35:1347–1355

    PubMed Central  CAS  PubMed  Google Scholar 

  40. Tambor ES, Chase GA, Faden RR et al (1993) Improving response rates through incentive and follow-up: the effect on a survey of physicians’ knowledge of genetics. Am J Public Health 83:1599–1603

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgment

The authors would like to thank Dr. Kim Turner for allowing the use and modification of her questionnaire.

Conflict of interest

Robynn Cox, Dr. Norman Bolden, and Dr. Daryl Thornton report no disclosures.

Dennis Auckley has received research equipment from ResMed Corporation and receives grant funding from Teva Pharmaceuticals.

Source of financial support

Teva Pharmaceuticals

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH, 44109, USA

    Dennis Auckley

  2. Department of Neurology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Robynn Cox

  3. Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Norman Bolden

  4. Division of Pulmonary, Critical Care and Sleep Medicine, Center for Reducing Health Disparities, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    J. Daryl Thornton

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  1. Dennis Auckley
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  2. Robynn Cox
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  3. Norman Bolden
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  4. J. Daryl Thornton
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Correspondence to Dennis Auckley.

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Auckley, D., Cox, R., Bolden, N. et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath 19, 315–325 (2015). https://doi.org/10.1007/s11325-014-1023-8

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  • DOI: https://doi.org/10.1007/s11325-014-1023-8

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