2007 OPEN FORUM Abstracts
PREOPERATIVE SCREENING FOR OBSTRUCTIVE SLEEP APNEA USING THE MODIFIED BERLIN QUESTIONNAIRE AND POST OPERATIVE INTERVENTION WITH AND WITHOUT CPAP. RANDOMIZED CONTROL STUDY OF SAME DAY SURGICAL PATIENTS.
K. A. Ludwig1, D. S. Ross1, G. L. Snow1
Background: Obstructive Sleep Apnea Syndrome (OSAS) affects a large percentage of patients receiving surgical services. Use of the Modified Berlin Questionnaire can assisted in identifying these patients, and placing high-risk patients for OSAS on Continuous Positive Airway Pressure (CPAP) postoperatively can decrease length of stay and other respiratory complications.
Methods: Consenting same day surgical patients age 40 and over, who completed a Modification to the Berlin Questionnaire to screen for OSAS were accepted into the study. The study first divided the group into those at high risk for probable OSAS and those who were at low risk. High risk for OSAS was determined by a score of greater than 25 on the Modified Berlin Questionnaire. The low risk group was observed as the control group for the study. Those who scored greater than 25 were then randomized into the two test groups. The CPAP treatment group, postoperatively in the Post Anesthesia Care Unit (PACU), were placed on a self titrating CPAP machine until they were awake and alert. The non-treatment group postoperatively in the PACU were given O2 via mask or nasal cannula to keep O2 saturations greater than 90%.
Results: 482 patients participated in the study. 200 of those patients scored greater than 25, were considered high risk for OSAS, and randomized into the 2 groups, and 282 had scores of less than 25 and were low risk and placed in the control group. Average length of total post op stay was: control group = 203 min, CPAP group = 164 min, non-treatment group = 345 min. Total number of patients who were unexpectedly admitted to the hospital, for overnight stay, 1 from the control group admitted for pain control, 0 from the CPAP group and, 7 from the non-treatment group were admitted for respiratory difficulty. There was no statistical significance between the control and CPAP group, but high significance between CPAP group and non-treatment group.
Conclusion: Preoperative screening with the Modified Berlin Questionnaire is effective in identifying patients at high risk for OSAS. Treatment of those patients postoperatively with CPAP significantly decreases length of stay and other respiratory complications postoperatively and eliminated unexpected admissions for high potential for OSAS same day surgical patients.