title: Safety of Gastrointestinal Endoscopy With Conscious Sedation in Patients With and Without Obstructive Sleep Apnea.
abstract: OBJECTIVE
  Patients with obstructive sleep apnea (OSA) undergoing endoscopy with sedation are considered by practitioners to be at a higher risk for cardiopulmonary complications. The aim of the present study was to evaluate the safety of conscious sedation in patients with OSA undergoing gastrointestinal endoscopy.
  
  
  METHODS
  This is an IRB-approved prospective cohort study performed at the James A. Haley VA. A total of 248 patients with confirmed moderate or severe OSA by polysomnography and 252 patients without OSA were enrolled. Cardiopulmonary variables such as heart rate, blood pressure, and level of blood oxygen saturation were recorded at 3-minute intervals throughout the endoscopic procedure.
  
  
  RESULTS
  In total, 302 colonoscopies, 119 esophagogastroduodenoscopies, 6 flexible sigmoidoscopies, and 60 esophagogastroduodenoscopy/colonoscopies were performed. None of the patients in the study required endotracheal intubation, pharmacologic reversal, or experienced an adverse outcome as a result of changes in blood pressure, heart rate, or blood oxygen saturation. There were no significant differences in the rate of tachycardia (P=0.749), bradycardia (P=0.438), hypotension (systolic/diastolic, P=0.460; mean arterial pressure, P=0.571), or hypoxia (P=0.787) between groups. The average length of time spent in each procedure and the average dose of sedation administered also did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Despite the presumed increased risk of cardiopulmonary complications, patients with OSA who undergo endoscopy with conscious sedation have clinically insignificant variations in cardiopulmonary parameters that do not differ from those without OSA. Costly preventative measures in patients with OSA are not warranted.
authors.affiliation: *Department of Gastroenterology, The James A. Haley Veterans Affairs Hospital †Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Andrade
authors.forename: Brijesh
authors.initials: B
authors.lastname: Patel
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gill
authors.forename: Donald
authors.initials: D
authors.lastname: Amodeo
authors.forename: Prasad
authors.initials: P
authors.lastname: Kulkarni
authors.forename: Susan
authors.initials: S
authors.lastname: Goldsmith
authors.forename: Barbara
authors.initials: B
authors.lastname: Bachman
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Geerken
authors.forename: Malcolm
authors.initials: M
authors.lastname: Klein
authors.forename: William
authors.initials: W
authors.lastname: Anderson
authors.forename: Branko
authors.initials: B
authors.lastname: Miladinovic
authors.forename: Ileana
authors.initials: I
authors.lastname: Fernandez
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.forename: Joel
authors.initials: J
authors.lastname: Richter
authors.forename: Gitanjali
authors.initials: G
authors.lastname: Vidyarthi
mesh_terms: D001794:Blood Pressure; D001919:Bradycardia / Q000209:etiology; D016292:Procedural Sedation / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology; D013610:Tachycardia / Q000209:etiology
chemical_list: D010100:Oxygen