Introduction and objectives There is currently no UK guidance (from BTS, BSS or RCA) regarding screening for obstructive sleep apnoea in the pre-operative setting. Evidence suggests that undiagnosed OSA is associated with increased post-operative complications but no trials have examined whether screening the UK’s general surgical population is justifiable. We sought to examine current UK practice and opinion in this regard.
Methods A postal survey was sent to all 180 UK sleep service providers asking whether they had a hospital policy for pre-operative screening for OSA and what this consisted of. If there was no policy they were asked how pre-operative patients with suspected OSA were identified. Further details regarding diagnostic confirmation and opinion regarding practice were sought.
Results We received 84 replies. There is a spectrum of current practice amongst respondents. There were 31 centres (37%) with a policy for screening for OSA. Of these, 42% screened all patients with a questionnaire e.g. STOP BANG, 23% screened only patients undergoing certain operations, 13% screened patients with high BMI only. Of those with a policy who estimated the number of referred patients, 60% saw more than >5 per month. Of centres with no policy only 26% estimated that they received >5 referrals per month. Without a policy 72% of referrals came from clinical suspicion alone.
Overall 96% of respondents felt that all patients at high risk of OSA should be screened for OSA. 36 respondents thought it would be ethical to randomise identified cases of OSA to a potential trial of peri-operative CPAP or no CPAP, compared with 40 who did not.
Conclusions There is no established UK standard practice for screening for OSA pre-operatively, despite a majority opinion amongst questionnaire responders that high risk patients should be. There would be cost implications if National pre-operative OSA screening was implemented and there therefore needs to be clear evidence based benefit before proceeding.
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