Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 90: OSA
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Aug 11, 2018 This discussion dives into the crucial topic of preoperative management for adults with Obstructive Sleep Apnea (OSA). Key highlights include the prevalence of OSA and its impact on surgical outcomes. The STOP-Bang screening tool is unpacked, revealing its effectiveness in identifying at-risk patients. Strategies for intraoperative airway management and postoperative care, including the benefits of CPAP, are also explored. The conversation emphasizes the importance of tailored approaches based on OSA severity and associated comorbidities.
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OSA Prevalence And Severity
- Obstructive sleep apnea (OSA) is common, with moderate-to-severe prevalence around 10–18% and much higher in bariatric patients.
- OSA severity is graded by AHI: <5 normal, 5–14 mild, 15–29 moderate, ≥30 severe.
Screen Preop With STOP-Bang
- Use the STOP-Bang questionnaire to screen adults for OSA preoperatively, scoring one point per positive item.
- Prefer a cutoff of ≥4 to balance sensitivity and specificity for perioperative risk stratification.
Have Patients Use Home CPAP
- Encourage patients diagnosed with OSA to bring and use their home CPAP perioperatively for better compliance and outcomes.
- Prepare to provide postoperative CPAP if they don't bring a machine, since CPAP reduces cardiac events and ICU admissions.