Obstructive Sleep Apnea Syndrome and Postoperative Complications Clinical Use of the STOP-BANG Questionnaire

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Archives of otolaryngology--head & neck surgery (Impact Factor: 2.33). 10/2010; 136(10):1020-4. DOI: 10.1001/archoto.2010.1020
Source: PubMed


To determine whether high risk scores on preoperative STOP-BANG (Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) questionnaires during preoperative evaluation correlated with a higher rate of complications of obstructive sleep apnea syndrome (OSAS).
Historical cohort study.
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Adult patients undergoing elective surgery at a tertiary care center who were administered the STOP-BANG questionnaire for 3 consecutive days in May 2008.
Number and types of complications.
A total of 135 patients were included in the study, of whom 56 (41.5%) had high risk scores for OSAS. The mean (SD) age of patients was 57.9 (14.4) years; 60 (44.4%) were men. Patients at high risk of OSAS had a higher rate of postoperative complications compared with patients at low risk (19.6% vs 1.3%; P < .001). Age, American Society of Anesthesiologists class of 3 or higher, and obesity were associated with an increased risk of postoperative complications. On multivariate analysis, high risk of OSAS and American Society of Anesthesiologists class 3 or higher were associated with higher odds of complications.
The STOP-BANG questionnaire is useful for preoperative identification of patients at higher than normal risk for surgical complications, probably because it identifies patients with occult OSAS.

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    • "Anesthetics and analgesics also alter upper airway tone, making it more prone to collapse and obstruction. Additionally, rapid eye movement (REM) sleep is greatly diminished if not completely absent the first night following surgery and then rebounds in the following 48 hours, subjecting the patient to increased hypoxemic obstructive episodes during this period (Vasu et al., 2010). Patients with moderate-to-severe OSA experience an adjusted hazard ratio for all-cause mortality that is three to six times higher than those without OSA (Singh et al., 2013). "
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    ABSTRACT: Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term “STOP-BANG” is an acronym for eight independent elements predictive of OSA—three are OSA-related symptoms, three are physiological measurements, and two are patient characteristics.Methods: This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey.Results: This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool.Conclusions: The results suggest that programs targeted at raising CRNAs’ and SRNAs’ PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.
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    • "An additional point is added for each of the following conditions: a BMI of more than 35 kg/m 2 , an age of 50 years or greater, a neck circumference of greater than 40 cm, and male gender. A total score of three or more places the individual at a high risk for OSA [15]. PSG: This procedure was performed at either the patient's home using type 2 devices (Somnotouch; Somnomedics and Embletta X100; Natus) or the sleep laboratory using type I devices (Somnoscreen EEG32; Somnomedics and Z4 Sleep System; Somnostar). "
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    ABSTRACT: Background: Despite the association between obstructive sleep apnea (OSA) and coronary artery disease (CAD), few studies have investigated this issue in Saudi Arabia. Objectives: This study aimed to identify the prevalence of OSA among CAD patients. Subjects and methods: This was a cross-sectional (descriptive) study conducted at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia from April 2012 to December 2013. All consecutive patients referred to the cardiac catheterization lab for coronary angiography who exhibited evidence of CAD were included in this study. This study was conducted in two stages. During the first stage, each participant was interviewed individually. The administered interview collected data pertaining to demographics, comorbidities, and the STOP-BANG questionnaire score. The second stage of this study consisted of a diagnostic overnight polysomnography (PSG) of 50% of the subjects at high risk for OSA according to the STOP-BANG questionnaire. Results: Among the patients with CAD (N = 156), 128 (82%) were categorized as high risk for developing OSA. PSG was conducted on 48 patients. The estimated prevalence of OSA in the study sample was 56.4%. Approximately 61% of the documented sleep apnea patients suffered from moderate to severe OSA. Conclusion: This local study concurs with reports in the literature indicating that OSA is very common among CAD patients.
    Full-text · Article · Mar 2015 · Journal of the Saudi Heart Association
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    ABSTRACT: Command Surgeon, HQ AFSOC As you know, this is my last article as president of the society. It has been a great pleasure serving as the presi-dent for the past year. It was wonderful seeing everyone in Atlanta during AsMA. We had an outstanding turnout for both the social and luncheon. Col (ret) Tom McNish presented an amazing luncheon speech on his career and time as a POW. Lt Gen Ogata (previously, the Japanese Self-Defense Force Surgeon General and currently the Vice President of the National Defense Medical University – Japan's USUHS) thanked the society for our support to Operation Tomadachi in Japan last year. Finally, congrats to those awarded our society awards. This year the society became the official sponsor of the Team Aerospace Award, and for next year we will sponsor the Olsen-Wegner Outstanding Aeromedical Technician Award. It was a great honor to present Gen Bruce Green the George E. Schafer Award for his dedication to the specialty of Aerospace Medicine throughout his career. Now for a summary of what is in this FlightLines. Col Alden Hilton has authored an article on the many significant changes confronting Aerospace Medicine and what Air Staff has done to match policy and personnel to confront the myriad of changes. Although Aerospace Medicine is an operationally challenged career field, we have not had a better time to impact world events than we currently have. There are so many operational, clinical, and developing issues in Aerospace Medicine that we have opportunities wherever we look. Col Steve Barnes' article on the Air Force Materiel Command and the two following articles on pre-RAM training by Lt Col Michael Hodges and Maj Sanjay Gogate highlight some of the methods used by the School of Aerospace Medicine and our university partners to prepare RAMs for careers in Aerospace Medicine. Additionally, Col Len Profenna and Col Gerry Brower's article on the Air Force Undersea and Hyperbarics Medicine Fellowship reflects how this training program is utilized to address some of the issues I mentioned previously (i.e., F-22 hypoxia). Lt Col Laura Brodhag and Maj Patricia Pankey authored a very nice article entitled "Obstructive Sleep Apnea in the Military Aviator." We don't often get journal-type submissions to FlightLines, but this is a great addition and we welcome more (as long they are related to aeromedical operational issues and not a basic research rat study).
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