Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center.
BACKGROUND
Obstructive sleep apnea (OSA) affects approximately 20% of US adults, of whom about 90% are undiagnosed. While OSA may increase risk of perioperative complications, its prevalence among surgical patients is unknown. We tested the feasibility of screening surgical patients for OSA and determined the prevalence of undiagnosed OSA.


METHODS
In a prospective, observational study adult surgical patients were screened for OSA in an academic hospital. Patients without an OSA diagnosis who screened high-risk were offered a home sleep study to determine if they had OSA. The results were compared with polysomnography (PSG) when available. Charts of high-risk patients were examined for postoperative complications. High-risk patients received targeted interventions as part of a hospital safety initiative.


RESULTS
There were 2877 patients screened; 661 (23.7%) screened high-risk for OSA, of whom 534 (81%) did not have diagnosed OSA. The portable sleep study detected OSA in 170/207 (82%) high-risk patients without diagnosed OSA. Twenty-six PSGs confirmed OSA in 19 of these patients. Postoperatively there were no respiratory arrests, two unanticipated ICU admissions, and five documented respiratory complications.


CONCLUSIONS
Undiagnosed OSA is prevalent in adult surgical patients. Implementing universal screening is feasible and can identify undiagnosed OSA in many surgical patients. Further investigation is needed into perioperative complications and their prevention for patients with undiagnosed OSA.
Finkel
Kevin J
KJ
Washington University School of Medicine, Department of Anesthesiology, 660 S Euclid Ave, Campus Box 8054, St. Louis, MO 63110, USA.
Searleman
Adam C
AC
Tymkew
Heidi
H
Tanaka
Christopher Y
CY
Saager
Leif
L
Safer-Zadeh
Elika
E
Bottros
Michael
M
Selvidge
Jacqueline A
JA
Jacobsohn
Eric
E
Pulley
Debra
D
Duntley
Stephen
S
Becker
Colleen
C
Avidan
Michael S
MS
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011184:Postoperative Period; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D020521:Stroke / Q000453:epidemiology; D011795:Surveys and Questionnaires