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Cited by 98Obstructive Sleep Apnea ResearchCardiac, Anesthesia and Surgical OutcomesAirway Management and Intubation Techniques

Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort

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Lockhart, Ellen M., Willingham, Mark D., Abdallah, Arbi Ben, Helsten, Daniel L., Bedair, Bahaa A., Thomas, James, Duntley, Stephen, Avidan, Michael S.·2013·Sleep Medicine
DOI 10.1016/j.sleep.2012.10.018PMC PMC4575681
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Abstract

Objective A recent investigation at Barnes-Jewish Hospital located in St. Louis, Missouri, found that an estimated 22% of adults presenting for inpatient surgery screened as high risk for obstructive sleep apnea (OSA). Surgical patients with OSA have multiple comorbidities and are at increased risk for perioperative complications. Our objective was to determine if a prior diagnosis of OSA or a positive screen for OSA was associated with increased risk for 30-day and one-year mortality.Methods B-J APNEAS (Barnes-Jewish Apnea Prevalence in Every Admission Study) was a prospective cohort study. Unselected adult surgical patients at Barnes Jewish Hospital were prospectively enrolled between February 2006 and April 2010. All patients completed preoperative OSA screening and those who were at risk for OSA according to a combination of the Berlin and Flemons screening tools received targeted postoperative interventions. STOP (loud Snoring, daytime Tiredness, Observed apneas, and high blood Pressure) and STOP-BANG (STOP, plus body mass index [BMI], age, neck circumference, and gender) scores also were obtained.Results Overall, the sample included 14,962 patients, of whom 1939 (12.9%) reported a history of OSA. All four screening tools identified a high prevalence of undiagnosed patients at risk for OSA (9.5%-41.6%), but agreement among screens was not strong with κ statistic ranging from 0.225 to 0.611. There was no significant difference in 30-day postoperative mortality between patients with possible OSA (based on their history or on a positive OSA screen with any of the four instruments) and the rest of the surgical population. Significant differences in one-year mortality were noted between the low-risk and high-risk groups as identified by the Flemons' (4.96% vs 6.91%; p<0.0001), STOP (5.28% vs 7.57%; p<0.0001) and STOP-BANG (4.13% vs 7.45%; p<0.0001) screens. After adjusting for risk factors, none of the OSA screening tools independently predicted mortality rate up to one year postoperatively.Conclusion Neither a prior diagnosis of OSA nor a positive screen for OSA risk was associated with increased 30-day or one-year postoperative mortality. Differences in 1 year postoperative mortality were noted with three of the screening tools. The results of our study highlight uncertainties and research priorities for the medical community.

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  • Data about postoperative mortality is mixed but generally shows no increased 30-day mortality, thought to be due to increased monitoring.

    “Data about postoperative mortality is mixed but generally shows no increased 30-day mortality, which is thought to be due to increased monitoring in this group of patients.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [481]

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  1. [38]Adesanya AO Lee W Greilich NB Joshi GP Perioperative management of obstructive sleep apnea Chest 138 6 1489 1498 21138886

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Authors
Lockhart, E. M., Willingham, M. D., Abdallah, A. B., Helsten, D. L., Bedair, B. A., Thomas, J., Duntley, S., & Avidan, M. S.
Affiliations
  • Washington University in St. Louis (US)
  • Barnes-Jewish Hospital (US)
Corresponding author
Lockhart, Ellen M.
ORCID
Venue
Sleep Medicine
Publisher
Elsevier BV
Published
2013-05
Volume
14
Issue
5
Pages
407-415
ISSN
1389-9457 (ISSN-L)
DOI
10.1016/j.sleep.2012.10.018
PMC
PMC4575681
OpenAlex
W2119671473
Cited by
98
References
38
Citations by year
2025: 10 · 2023: 4 · 2022: 9 · 2021: 6 · 2020: 5 · 2019: 9 · 2018: 7 · 2017: 12 · 2016: 17 · 2015: 4 · 2014: 11 · 2013: 4
FWCI
8.36
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Sleep Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000448, TL1TR000449)
  • U.S. Public Health Service (TLRR024 995)
  • National Center for Research Resources (TL1RR024995, UL1RR024992)
  • National Center for Advancing Translational Sciences (UL1TR00044)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Keywords
obstructive sleep apnea, OSA screening, postoperative mortality, surgical patients, STOP-BANG questionnaire, Berlin questionnaire, undiagnosed sleep apnea, preoperative screening, 30-day mortality, one-year mortality, screening agreement, postoperative interventions, inpatient surgery, comorbidities, perioperative complications, body mass index, neck circumference, snoring
MeSH terms
Adult, Aged, Cardiovascular Diseases, Female, Humans, Male, Mass Screening, Middle Aged, Postoperative Complications, Postoperative Period, Prospective Studies, Risk Factors, Social Security, United States, Comorbidity, Prevalence, Sleep Apnea, Obstructive, Kaplan-Meier Estimate

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