Sedation during endoscopy for patients at risk of obstructive sleep apnea

Abstract

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.