Introduction A recent meta-analysis shows obstructive sleep apnoea (OSA) increases the incidence of postoperative desaturation, respiratory failure, cardiac events, and ICU transfers (Kaw, R., et al, 2012). A study in gastrointestinal endoscopy showed no increased risk of cardiopulmonary complications in OSA screening positive patients (Mador, M. J., et al, 2012). There are no published studies in patients with OSA undergoing bronchoscopy, as far as we are aware. It has been suggested that patients should be screened for OSAS prior to endoscopy and bronchoscopy.
Methods Nursing staff in the bronchoscopy suite used a validated OSA screening tool STOP-BANG score prior to the procedure. The physician performing the rpocedure was unaware of the score. The amount of sedation used during the procedure is recorded. Sedation score, Respiratory Rate (RR), Oxygen Sturation (SpO2) were documented 0,30,60,120 min post procedure.
Results Procedures were performed in 57 patients; diagnostic bronchoscopy 28, EBUS 29. Twenty-three patients (40.3%) were identified high risk for OSA (STOP-BANG score 3 or above). The mean age was 64 +/- 15. Male 29 (50.8%). There was no statistically significant difference in: amount of sedation used (midazolam, fentanyl or both), lignocaine use, initial sedation score, RR, SpO2, between high and low risk group. (Table 1). There was no correlation between initial sedation score with STOP-BANG score. There was no evidence of deeper sedation, drop in RR or SpO2 noticed in the post procedure observation period in the high risk group. Median length of observation was same in both groups. There were no complications or emergency admissions.
Conclusion In this small study there is no evidence of increased cardio respiratory complications in patients at high risk for OSA undergoing bronchoscopy under conscious sedation.
Kaw, R, et al. Meta-analysis of association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth 2012;109(6):897-906
Mador, MJ, et al. D patients at risk of sleep apnea have an increased risk of cardio-respiratory complications during endoscopy procedures? Sleep Breath 2012;16(3):609-615