Sedation during endoscopy for patients at risk of obstructive sleep apnea

Background

Obstructive sleep apnea (OSA) has become increasingly prevalent in the United States and often goes undiagnosed.

Objective

To assess the proportion of patients undergoing routine endoscopic procedures who are at risk of OSA and to determine whether these patients are at risk of sedation-related hypoxia.

Design and Setting

Prospective case-control study at an academic medical center.

Patients and Interventions

Patients undergoing routine EGD and colonoscopy were administered the Berlin Questionnaire, a brief validated survey that stratifies patients into high or low risk of OSA. Data on pulse oximetry and oxygen use were collected.

Main Outcome Measurements

Rates of transient hypoxia, defined as a pulse oximetry measurement less than 92% requiring an increase in supplemental oxygen were compared between the high- and low-risk OSA groups.

Results

Of the 261 prospectively recruited patients, 28 were excluded for violating study protocol. Ninety (39%) of the remaining 233 patients were scored as being at high risk of OSA. There was no significant difference in the rate of transient hypoxia between the high- and low-risk groups (odds ratio 1.48; 95% CI, 0.58-3.80).

Limitations

Single-center study. OSA was not confirmed with a sleep study.

Conclusion

Approximately one third of patients undergoing routine outpatient endoscopic procedures at a university hospital scored as being at high risk of OSA. There was no significant difference in the rates of transient hypoxia between high- and low-risk groups, suggesting that the majority of patients with no diagnosis of OSA can undergo conscious sedation for routine endoscopic procedures with standard monitoring practices.

Abbreviations: BMI, body mass index, OSA, obstructive sleep apnea