Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2013 Mar;42(3):110-9.
Obstructive sleep apnoea (OSA) is associated with increased perioperative morbidity and mortality. Patients at risk of OSA as determined by pre-anaesthesia screening based on the American Society of Anesthesiologists checklist were divided into 2 groups for comparison: (i) those who proceeded to elective surgery under a risk management protocol without undergoing formal polysomnography preoperatively and; (ii) those who underwent polysomnography and any subsequent OSA treatment as required before elective surgery. We hypothesised that it is clinically safe and acceptable for patients identified on screening as OSA at-risk to proceed for elective surgery without delay for polysomnography, with no increase in postoperative complications if managed on a perioperative risk reduction protocol.
A retrospective review of patients presenting to the preanaesthesia clinic over an 18-month period and identified to be OSA at-risk on screening checklist was conducted (n = 463). The incidence of postoperative complications for each category of OSA severity (mild-moderate and severe) in the 2 study groups was compared.
There was no statistically significant difference in the incidence of cardiac (3.3% vs 2.3%), respiratory (14.3% vs 12.5%), and neurologic complications (0.6% vs 0%) between the screening-only and polysomnography-confirmed OSA groups respectively (P >0.05). There was good agreement of the OSA risk that is identified by screening checklist with OSA severity as determined on formal polysomnography (kappa coefficient = 0.953).
Previously undiagnosed OSA is common in the presurgical population. In our study, there was no significant increase in postoperative complications in patients managed on the OSA risk management protocol. With this protocol, it is clinically safe to proceed with elective surgery without delay for formal polysomnography confirmation.
阻塞性睡眠呼吸暂停（OSA）与围手术期发病率和死亡率增加有关。根据美国麻醉师学会检查表进行术前筛查，确定有 OSA 风险的患者分为两组进行比较：（i）根据风险管理方案进行择期手术，而无需术前进行正式多导睡眠图检查；（ii）那些进行多导睡眠图检查，如果需要，根据任何后续的 OSA 治疗，然后进行择期手术。我们假设，对于在筛查中被确定为 OSA 高风险的患者，在没有延迟进行多导睡眠图检查的情况下，根据围手术期风险降低方案进行择期手术是安全且可以接受的，如果管理得当，不会增加术后并发症。
回顾性分析了在 18 个月的时间内在麻醉前诊所就诊并在筛查检查表上被确定为 OSA 高风险的患者（n = 463）。比较了两个研究组中每个 OSA 严重程度（轻度-中度和重度）类别术后并发症的发生率。
在筛查组和多导睡眠图确诊 OSA 组中，心脏（3.3%对 2.3%）、呼吸（14.3%对 12.5%）和神经系统并发症（0.6%对 0%）的发生率没有统计学差异（P > 0.05）。通过筛查检查表确定的 OSA 风险与通过正式多导睡眠图确定的 OSA 严重程度之间具有良好的一致性（kappa 系数= 0.953）。
在术前人群中，以前未诊断的 OSA 很常见。在我们的研究中，根据 OSA 风险管理方案进行管理的患者术后并发症没有显著增加。使用该方案，在没有延迟进行正式多导睡眠图检查的情况下，进行择期手术在临床上是安全的。
