Take a Sleep Apnea Test Prior to Surgery to Cut Risks

Obstructive sleep apnea (OSA) can put surgical patients at high risk for respiratory complications both during and after surgery. By self-administering a quick and easy test, a patient can know for sure if they have OSA, which can greatly assist anesthesiologists in taking precautionary measures to ensure the safety of an OSA patient undergoing surgery.

Anesthesiology researchers from the University of Toronto have developed this fast, affordable, and very accurate scoring system to identify surgical patients who have OSA. Lead study author, Anesthesiologist Francis Chung, M.D., and her team created the screening tool, called the STOP questionnaire, which consists of four simple yes or no questions:

S: Do you snore loudly?
T: Do you often feel tired, fatigued or sleepy during daytime?
O: Has anyone observed you stop breathing during sleep?
P: Do you have or are you being treated for high blood pressure?

A patient who answers "yes" to two or more of these questions is ranked as being at high risk for OSA. According to Dr. Chung, this patient may need to be monitored for oxygen saturation after surgery and may need more nursing care. Chung stated, "Identifying patients with OSA is the first step in preventing postoperative complications. Untreated OSA patients are known to have a higher incidence of difficult intubation, postoperative complications, increased intensive care admissions and greater duration of hospital stay." In addition, OSA patients having minor surgery may need newer and shorter-acting anesthetics and these patients are also much more sensitive to pain medications. The study was published in the May issue of Anesthesiology.

OSA is the most common breathing disturbance in sleep with repeated episodes of cessation of breathing due to a narrowing of the airway. OSA is also known to be a risk factor for high blood pressure, heart attack, and irregular heart rhythm, diabetes and is also associated with a high risk for traffic accidents. Two to 26 percent of the general population is estimated to suffer from the affects of OSA. However, about 80 percent of men and 93 percent of women with moderate to severe sleep apnea are unaware of having the disorder. The estimated average life span of an untreated OSA patient is 20 years shorter than the average life span of people who do not have the disorder.

In a prepared statement, Jeffrey B. Gross, M.D., Chairman of the ASA Task Force for Perioperative Management of Patients with Obstructive Sleep Apnea, stated that, "Identifying patients who are at risk of having OSA in advance of surgery is important to improve patient safety. In addition, when anesthesiologists are forewarned of the severity of a patient's sleep apnea, they can select appropriate anesthetic techniques and equipment, and ensure that surgery takes place in a facility which is equipped to deal with the potential complications."

The validation of these studies gives anesthesiologists and other health care professionals much needed simple and reliable tools for OSA detection in surgical patients for increased safety of overall patient care. Now, the challenge is to develop procedures that will best care for these high risk patients. According to Dr. Chung, more research is now being conducted on the topic and he added, "We hope that the evidence from our research will lead to the development of an overall care protocol for patients with OSA and the patients at high risk of having OSA."