Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri, USA.
Clin Gastroenterol Hepatol. 2010 Aug;8(8):660-665.e1. doi: 10.1016/j.cgh.2010.05.015. Epub 2010 May 23.
BACKGROUND & AIMS: Among patients undergoing advanced endoscopy, unrecognized obstructive sleep apnea (OSA) could predict sedation-related complications (SRCs) and the need for airway maneuvers (AMs). By using an OSA screening tool, we sought to define the prevalence of patients at high risk for OSA and to correlate OSA with the frequency of AMs and SRCs.
We enrolled 231 consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) (n = 176) and endoscopic ultrasound (n = 55). Propofol-based sedation and patient monitoring were performed by a nurse anesthetist and an anesthesiologist. A previously validated screening tool for OSA (STOP-BANG) was used to identify patients at high risk for OSA (score, > or =3 of 8; SB+) or low risk (SB-). AMs were defined as a chin lift, modified mask ventilation, nasal airway, bag-mask ventilation, and endotracheal intubation. SRCs were defined as any duration of pulse oximetry less than 90%, systolic blood pressure less than 90 mm Hg, apnea, or early procedure termination.
The prevalence of SB+ was 43.3%. The frequency of hypoxemia was significantly higher among patients with SB+ than SB- (12.0% vs 5.2%; relative risk [RR], 1.83; 95% confidence interval [CI], 1.32-2.54). The rate of AMs was also significantly higher among SB+ (20.0%) compared with SB- (6.1%) patients (RR, 1.8; 95% CI, 1.3-2.4). These rates remained significant after adjusting for American Society of Anesthesiologists class 3 or higher (RR, 1.70; 95% CI, 1.28-2.2 for AMs; RR, 1.63; 95% CI, 1.19-2.25 for hypoxemia). Each element of the STOP-BANG was reported more commonly in SB+ patients (P < .0001 for each comparison).
A significant number of patients undergoing advanced endoscopic procedures are at risk for OSA. AMs and hypoxemia occur at an increased frequency in these patients.
在接受高级内镜检查的患者中，未被识别的阻塞性睡眠呼吸暂停（OSA）可能预测镇静相关并发症（SRCs）和气道操作（AMs）的需要。通过使用 OSA 筛查工具，我们旨在确定患有 OSA 高风险的患者的患病率，并将 OSA 与 AMs 和 SRCs 的频率相关联。
我们招募了 231 例连续接受内镜逆行胰胆管造影术（ERCP）（n = 176）和内镜超声检查（n = 55）的患者。护士麻醉师和麻醉师进行了基于异丙酚的镇静和患者监测。使用先前验证的 OSA 筛查工具（STOP-BANG）来识别患有 OSA 高风险（评分> = 8 分中的 3 分；SB +）或低风险（SB-）的患者。AMs 被定义为颏部提升、改良面罩通气、鼻气道、气囊面罩通气和气管插管。SRCs 被定义为任何持续时间的脉搏血氧饱和度低于 90%、收缩压低于 90mmHg、呼吸暂停或早期手术终止。
SB+的患病率为 43.3%。与 SB-相比，SB+患者的低氧血症发生率显著更高（12.0%比 5.2%；相对风险 [RR]，1.83；95%置信区间 [CI]，1.32-2.54）。SB+（20.0%）患者的 AMs 发生率也显著高于 SB-（6.1%）患者（RR，1.8；95% CI，1.3-2.4）。在调整美国麻醉师协会 3 级或更高（RR，1.70；95% CI，1.28-2.2 用于 AMs；RR，1.63；95% CI，1.19-2.25 用于低氧血症）后，这些比率仍然显著。SB+患者报告的 STOP-BANG 每个元素更常见（P <.0001，每项比较）。
接受高级内镜检查的患者中有相当数量的患者患有 OSA。这些患者中 AMs 和低氧血症的发生率更高。
