title: Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) has been associated with increased perioperative morbidity and mortality. We initiated a protocol designed to screen patients preoperatively and monitor them postoperatively. The goal was to identify patients who were at risk for oxygen desaturation after discharge from the postanesthesia recovery room (PACU).
  
  
  METHODS
  Patients without previously diagnosed OSA presenting to the preoperative evaluation clinic were assessed over a 10.5-month period using a validated prediction rule to identify patients thought to be at high risk of OSA (sleep apnea clinical score, SACS > or = 15). Following surgery, patients were monitored in the PACU for significant respiratory events: apnea, increased FiO2 requirement, pain-sedation mismatch, or episodes of desaturation. Patients were placed in 3 groups based on their SACS and the presence or absence of recurrent PACU respiratory events (group 1: SACS < 15, no recurrent events; group 2: SACS > or =15, no recurrent events; and group 3: SACS > or = 15, recurrent events.) The number of oxygen desaturations > or = 4% per hour, the oxygen desaturation index (ODI), was calculated for each patient for 24 to 48 hours after PACU discharge. An ODI > 10 was the threshold chosen to indicate a high frequency of oxygen desaturation.
  
  
  RESULTS
  The percentage of patients with ODI > 10 differed significantly across the 3 study groups (12%, 37%, and 57%, for groups 1-3, p = 0.005). Mean ODI in group 1 was significantly different from groups 2 and 3 (5.8 compared to 10.0 group 2 and 11.4 group 3 with p = 0.001).
  
  
  CONCLUSIONS
  We have shown that combining preoperative screening is useful for identifying patients at risk for oxygen desaturation after PACU discharge.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. gali.bhargavi@mayo.edu
authors.forename: Bhargavi
authors.initials: B
authors.lastname: Gali
authors.forename: Francis X
authors.initials: FX
authors.lastname: Whalen
authors.forename: Peter C
authors.initials: PC
authors.lastname: Gay
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Olson
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: David J
authors.initials: DJ
authors.lastname: Plevak
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010100:Oxygen / Q000097:blood*; D019990:Perioperative Care / Q000379:methods*; D017286:Polysomnography; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000601:surgery*
chemical_list: D010100:Oxygen