Perioperative management of patients with obstructive sleep apnea: a survey of Canadian anesthesiologists.
BACKGROUND
Obstructive sleep apnea (OSA) may increase the incidence of postoperative complications when undiagnosed. The purpose of this study was to evaluate the perspectives of Canadian anesthesiologists regarding the perioperative management of patients with diagnosed or suspected OSA.


METHODS
This study was conducted as a survey of Canadian anesthesiologists using a self-administered scenario-based questionnaire. We initially mailed the survey questionnaire and then mailed it again to non-respondents six weeks later. Subsequently, we e-mailed the online version of our survey to active members of the Canadian Anesthesiologists' Society.


RESULTS
The response rates were 35% and 26% for the postal and online modes of administration, respectively. About 50% of the respondents relied on clinical suspicion rather than on a systematic screening to identify patients who may have undiagnosed OSA preoperatively. Forty-seven percent of all respondents either did not know of any institutional policy to guide their perioperative management of patients with OSA or reported an absence of an institutional policy. Fifteen percent of the respondents would discharge diagnosed OSA inpatients with compliant use of continuous positive airway pressure (CPAP) to the ward without monitoring. Nevertheless, a more conservative approach was observed for CPAP non-compliant inpatients. We indeed observed that more than 40% of respondents would send an ambulatory OSA patient home, while another 60% would favour hospital admission.


CONCLUSIONS
The majority of anesthesiologists continue to rely on clinical suspicion alone to identify OSA. Moreover, the lack of institutional policy is concerning. A concerted effort to develop an evidence-based guideline may be the next step to assist institutions.
Department of Anesthesiology, Toronto Western Hospital, University Health Network, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada.
Ligia
L
Cordovani
Department of Anesthesiology, Toronto Western Hospital, University Health Network, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada. frances.chung@uhn.on.ca.
Frances
F
Chung
Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec, QC, Canada.
Geneviève
G
Germain
Departments of Anesthesiology, Community Health and Epidemiology, Kingston General Hospital, Kingston, ON, Canada.
Kim
K
Turner
CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, CHU de Québec - Université Laval, Quebec, QC, Canada.
Alexis F
AF
Turgeon
Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
Richard
R
Hall
Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Peter C
PC
Gay
Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Gregory L
GL
Bryson
Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
Peter T
PT
Choi
D000758:Anesthesia; D002170:Canada; D045422:Continuous Positive Airway Pressure; D006801:Humans; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires