title: Post-gastrointestinal endoscopy complications in patients with obstructive sleep apnea or at high risk for sleep apnea: a systematic review and meta-analysis.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is becoming increasingly more prevalent with the rise in obesity. Complications from gastrointestinal (GI) endoscopy in this patient population have been reported in several studies, but the modest complication rates from these procedures make it difficult to come to definitive conclusions based on single studies. The objective of our study was to systematically review these studies reporting the incidence of post-procedure complications in patients with OSA undergoing endoscopy to determine whether the presence of OSA increases post-procedure complications.
  
  
  METHODS
  We conducted a systematic review using the Cochrane Collaboration Methodology. We searched Medline via Ovid, PubMed, Embase, and Evidence Based Medicine Reviews databases from 1950 to August 2013. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Meta-analysis was done using Review Manager Version 5.0.20.
  
  
  RESULTS
  Our search resulted in seven eligible studies. There was no significant association between diagnosis of OSA and post-GI endoscopy complications including hypoxemia, respiratory distress, variations in blood pressure or heart rate, bradypnea, or need for significant interventions. Subgroup analysis based on the type of GI endoscopy or the type of anesthesia used did not show any significant associations either.
  
  
  CONCLUSIONS
  Obstructive sleep apnea patients and/or patients at high risk for obstructive sleep apnea do not appear to be at increased risk of adverse outcomes from GI endoscopy.
authors.affiliation: Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
authors.forename: Swarna
authors.initials: S
authors.lastname: Gaddam
authors.affiliation: Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Gunukula
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, University at Buffalo and Western New York Veteran Affairs Healthcare System, 3495 Bailey Ave, Buffalo, NY, 14215, USA. mador@buffalo.edu.
authors.forename: M Jeffery
authors.initials: MJ
authors.lastname: Mador
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D009765:Obesity / Q000150:complications; D017063:Outcome Assessment, Health Care; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000150:complications*
keywords: Complications; Endoscopy; Sleep apnea