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Anesthesiology: Clinical Case Reviews
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The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
Today, there exists a high prevalence of obstructive sleep apnea (OSA) in the general population, a great proportion of which remains undiagnosed. The STOP-Bang questionnaire has been specifically developed to meet the need for a reliable, concise and easy-to-use screening tool. It consists of eight dichotomous (yes/no) items related to the clinical features of sleep apnea (Snoring, Tiredness, Observed apnea, high blood Pressure, BMI, age, neck circumference and male gender). The total score ranges from 0 to 8. Patients can be classified for their OSA risk based on their respective scores.
The sensitivity of STOP-Bang score ≥3 to detect moderate-to-severe OSA (AHI > 15) and severe OSA (AHI > 30) is 93% and 100% respectively. The corresponding negative predictive values are 90% and 100%. As the STOP-Bang score increases from 0-2 to 7-8, the probability of moderate-to-severe OSA increases from 18% to 60%, and the probability of severe OSA rises from 4% to 38%. Patients with a STOP-Bang score of 0 to 2 can be classified as "low risk" for moderate-to-severe OSA, while those with a score of 5 to 8 can be classified as "high risk" for moderate-to-severe OSA. In patients whose STOP-Bang scores land in the mid-range (3 or 4), further criteria are required for classification. For example, a STOP score of ≥ 2 + BMI > 35 kg/m2 would classify that patient as having a high risk for moderate-to-severe OSA. In this way, patients can be stratified for their OSA risk according to their STOP-Bang scores.
*Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. ACC/AHA Representative. † ‡Society for Vascular Medicine Representative. §ACC/AHA Task Force on Practice Guidelines Liaison. American Society of Nuclear Cardiology Representative. ¶American Society of Echocardiography ║Representative. #Heart Rhythm Society Representative. **American College of Surgeons Representative. †Patient Representative/Lay Volunteer. †‡‡American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. §§ACC/AHA Task Force on Performance Measures Liasion. ║Society for Cardiovascular Angiography and Interventions Representative. ¶¶ Former Task Force member; current member ║during the writing effort.This document was approved by the American College of Cardiology Board of Trustees and the American Heart Association Science Advisory and Coordinating Committee in July 2014.
