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Diagnosis and Screening

Why do Ambulatory Surgery Centers, Urgent Care Centers, Vascular Access Centers, and Hospitals need a perioperative screening program?

It is important that today’s healthcare providers implement Diagnosis and Screening protocols for Obstructive Sleep Apnea. Patients with obstructive sleep apnea are at an increased risk of peri-procedure complications such as respiratory depression and decreased pharyngeal muscle tone, which may exacerbate airway obstruction. Further reduction of the airway can lead to hypoxia, hypercarbia, arrhythmias, and ultimately, cardiopulmonary arrest. Ambulatory Surgery Centers should exercise caution in obstructive sleep apnea patients who develop prolonged and frequent severe respiratory events in the postoperative period.

  • 86% of patients were not identified by surgeons.
  • 47% of OSA patients were not identified by Anesthesiologists.

OSA patients are at an increased risk due to:

  • Difficult Intubation
  • Difficult Extubation
  • Hypercapnia
  • Oxygen desaturations
  • Cardiac insults

What type of patients have sleep apnea?

With the prevalence of obesity increasing across the country, the incidence rate of obstructive sleep apnea (OSA) is also on the rise.  According to Dr. Mia Zaharna, in a presentation for the Stanford Center for Sleep Sciences and Medicine, 70% of individuals with OSA are obese, while 40% of the obese population has OSA.

ASC practitioners should be wary of other key indicators of sleep apnea besides obesity or BMI, including loud snoring, daytime sleepiness, memory loss, depression, low energy, a neck circumference of more than 17 inches, and hypertension.

What does a perioperative screen program entail?

Predictive screening questionnaires are a simple initial way to help evaluate the increased chances of the patient suffering from OSA.  Predictive tests, such as the STOP-BANG, should be included during H&P which measure snoring incidence rates, tiredness during daytime, observed apnea, high blood pressure, body mass index, age, neck circumference, and gender.

Some examples of screening questionnaires and their descriptions:

Berlin Questionnaire

The Berlin Questionnaire is a simple sleep apnea screening questionnaire used to quickly identify the risk of sleep disordered breathing. The questionnaire consists of 3 categories and risk is based on the responses to individual items and overall scores in the symptom categories.

STOP-BANG Questionnaire

The STOP-BANG questionnaire is a concise and easy-to-use more practical screening tool for OSA. It has been developed and validated in surgical patients at preoperative clinics. STOP-BANG is an acronym, which stands for snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference and gender.

 

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