Identification of surgical patients at high risk of OSAS using the Berlin Questionnaire to detect potential high risk of adverse respiratory events in post anesthesia care unit

Abstract

Obstructive sleep apnea syndrome (OSAS) increases the risk of post-surgery complications. This study uses Berlin Questionnaire (BQ) to identify Chinese adult surgical patients who are at a high risk of OSAS and to determine if the BQ could be used to detect potential high risk of adverse respiratory events in the post anesthesia care unit (PACU). Results indicated that only 11.4% of the patients were considered at a high risk of OSAS. Age and body mass index are the key factors for the risk of OSAS prevalence in China and also gender specific. Furthermore, the incidence of adverse respiratory events in the PACU was higher in patients with high risk of OSAS than others (6.8% vs. 0.9%, P<0.001). They also stayed longer than others in the PACU (95±28 min vs. 62±19 min, P <0.001). Age, high risk for OSAS, and smoking were independent risk factors for the occurrence of adverse respiratory events in the PACU. The BQ may be adopted as a screening tool for anesthesiologists in China to identify patients who are at high risk of OSAS and determine the potential risk of developing postoperative respiratory complications in the PACU.

Keywords

obstructive sleep apnea / Berlin Questionnaire / Chinese surgical patients / adverse respiratory event

References

[1] Ferini-Strambi L, Fantini ML, Castronovo C. Epidemiology of obstructive sleep apnea syndrome. Minerva Med 2004; 95(3): 187–202

[2] Valipour A. Gender-related differences in the obstructive sleep apnea syndrome. Pneumologie 2012; 66(10): 584–588

[3] Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, Bottros M, Selvidge JA, Jacobsohn E, Pulley D, Duntley S, Becker C, Avidan MS. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 2009; 10(7): 753–758

[4] Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea syndrome. Eur J Intern Med 2012; 23(7): 586–593

[5] Zamarron C, García Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 2008; 19(6): 390–398

[6] Chung F, Mokhlesi B. Postoperative complications associated with obstructive sleep apnea: time to wake up! Anesth Analg2014; 118(2):251–253

[7] Mador MJ, Goplani S, Gottumukkala VA, El-Solh AA, Akashdeep K, Khadka G, Abo-Khamis M. Postoperative complications in obstructive sleep apnea. Sleep Breath 2013; 17(2): 727–734

[8] Chung F.Screening for obstructive sleep apnea syndrome in the preoperative patients. Open Anesthesiol J 2011; 5 (1) :A255–A256

[9] Ahmadi N, Shapiro GK, Chung SA, Shapiro CM. Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography. Sleep Breath 2009; 13(3): 221–226

[10] Knotherus A, Buntinx F. The Evidence Base of Clinical Diagnosis: Theory and Methods of Diagnostic Research. West Sussex: Wiley-Balckwell, BMJ Books, 2009

[11] von Känel R, Malan NT, Hamer M, Lambert GW, Schlaich M, Reimann M, Malan L. Three-year changes of prothrombotic factors in a cohort of South Africans with a high clinical suspicion of obstructive sleep apnea. Thromb Haemost 2016; 115(1): 63–72

[12] Amra B, Saberpur S, Ghoharian V, Tabatabai SA, Akbari M, Beni BH. Berlin questionnaire study in surgical patient in Alzahra hospital in year 2010. Adv Biomed Res 2013; 2: 16

[13] Bouloukaki I, Komninos ID, Mermigkis C, Micheli K, Komninou M, Moniaki V, Mauroudi E, Siafakas NM, Schiza SE. Translation and validation of Berlin questionnaire in primary health care in Greece. BMC Pulm Med 2013; 13(1): 6–10

[14] Kang K, Park KS, Kim JE, Kim SW, Kim YT, Kim JS, Lee HW. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath 2013; 17(2): 803–810

[15] L� XP, Zhang C, Ma J, Su L, Jia P, Luo YP, Wei SM, Wang GF. Application of Berlin questionnaire in the screening of obstructive sleep apnea hypopnea syndrome. Chin J Tuberc Respir Dis (Zhonghua Jie He He Hu Xi Za Zhi) 2011; 34(7): 515–519 (in Chinese)

[16] Taj F, Aly Z, Arif O, Khealani B, Ahmed M. Risk for sleep apnea syndrome in Pakistan: a cross-sectional survey utilizing the Berlin questionnaire. Sleep Breath 2009; 13(1): 103–106

[17] Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131(7): 485–491

[18] Liu J, Wei C, Huang L, Wang W, Liang D, Lei Z, Wang F, Wang X, Hou X, Tang X. Prevalence of signs and symptoms suggestive of obstructive sleep apnea syndrome in Guangxi, China. Sleep Breath 2014; 18(2): 375–382

[19] Lockhart EM, Willingham MD, Abdallah AB, Helsten DL, Bedair BA, Thomas J, Duntley S, Avidan MS. Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Med 2013; 14(5): 407–415

[20] Chung F, Ward B, Ho J, Yuan H, Kayumov L, Shapiro C. Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth 2007; 19(2): 130–134

[21] Agrawal S, Gupta R, Lahan V, Mustafa G, Kaur U. Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: a preliminary study. Saudi J Anaesth 2013; 7(2): 155–159

[22] Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001; 163(3): 608–613

[23] Zhou XH, Wang HJ, Wang KF. Menopausal age of intellectual women: an investigation of 2694 cases. Anhui Med Pharm J (Anhui Yi Yao) 2012; 2: 27–29(in Chinse)

[24] Sanner B, Haske M, Buchner N, Zidek W. Hypertension and sleep-related breathing disorders. Nieren-Und Hochdrckkrankheiten 2000; 29: 321–325

[25] Malow BA, Levy K, Maturen K, Bowes R. Obstructive sleep apnea is common in medically refractory epilepsy patients. Neurology 2000; 55(7): 1002–1007

[26] Pollak L, Shpirer I, Rabey JM, Klein C, Schiffer J. Polysomnography in patients with intracranial tumors before and after operation. Acta Neurol Scand 2004; 109(1): 56–60

[27] Gaddam S, Gunukula SK, Mador MJ. Post-operative outcomes in adult obstructive sleep apnea patients undergoing non-upper airway surgery: a systematic review and meta-analysis. Sleep Breath 2014; 18(3): 615–633

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