Patient Safety Topics
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Obstructive Sleep Apnea
Overview

Obstructive sleep apnea (OSA) is a common sleep disorder that may first be diagnosed when a surgical patient presents for preadmission testing. OSA is characterized by partial or complete obstruction of the upper airway during sleep and can present significant problems in the perioperative period, including difficult airways, increased sensitivity to anesthetic agents, and postoperative adverse events. Analysis of reports submitted to the Pennsylvania Patient Safety Authority over five years identified 99 OSA-related events. Thirty-three reports were classified as Serious Events associated with patient harm. An article published on OSA and the risk it places on positive postoperative outcomes was presented in the September 2007 issue of the Pennsylvania Patient Safety Advisory. The article offered an OSA screening tool to use during preoperative evaluation. Since 2007, additional assessment tools have become available to help facilities identify and manage patients at high risk for this condition.

Key Data and Statistics

An article published on OSA and the risk it places on positive postoperative outcomes was published in the September 2007 issue of the Pennsylvania Patient Safety Advisory. Analysis was performed on about 250 reports in which OSA was identified over approximately three years. About 20% of these reports were classified as Serious Events, including three deaths. The article indicated that sleep apnea was present in the medical history in the majority of the reports.

In 2014, an Advisory article discussed analysis of events from January 2009 through 2013.

Analysis of event reports showed a downward trend, with 27 OSA-related events occurring in 2009, 23 in 2010, 20 in 2011, 14 in 2012, and 15 in 2013. Review of the event narratives suggests OSA conditions that are not detected during the preoperative screening and assessment process may place patients at increased risk for postoperative complications.

Seven issues of concern when OSA was diagnosed during the perioperative or postoperative periods were identified:

  1. Cancellation on the day of surgery
  2. Extended length of stay in the postanesthesia care unit (PACU)
  3. Postoperative reintubation
  4. Postoperative transfer from ambulatory care center to acute care for further treatment
  5. Undiagnosed sleep apnea contributing to cardiac arrest
  6. Unplanned ICU admission
  7. Use of reversal agents following narcotic administration

A critical element in reducing the risk of surgical complications for OSA patients is the initial preoperative screening evaluation. The preoperative evaluation includes review of previous medical records, an interview with the patient and/or family, and a physical examination. The following figure illustrates blocked airway associated with OSA, compared to normal breathing during sleep.

 Figure. Anatomy of Obstructive Sleep Apnea

 Figure. Anatomy of Obstructive Sleep Apnea

Excerpted from: Wallace SC. Assessment tools help diagnose obstructive sleep apnea. Pa Patient Saf Advis 2014 Dec. http://patientsafety.pa.gov/ADVISORIES/Pages/201412_168.aspx

Educational Tools

OSA Assessment Tools and Key Characteristics
Since the Authority's 2007 publication and sample tool, below, additional assessment tools have become available to help facilities identify and manage patients at high risk for this condition. These tools vary in the number of questions asked and the time required for staff to either administer or analyze the results; this table lists key characteristics ​of the available tools.

Obstructive Sleep Apnea Preoperative Screening Tool
This sample questionnaire is not a substitute for a sleep disorder evaluation by a qualified physician, but it may help identify at-risk patients during the preoperative period.

Multimedia

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