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J Am Med Dir Assoc. 2019 Jun 11. pii: S1525-8610(19)30392-5. doi: 10.1016/j.jamda.2019.04.024. [Epub ahead of print]

Preoperative Sleep Questionnaires Identify Medical Emergency Team Activation in Older Adults.

Author information

1
Department of Internal Medicine, Section of Pulmonary, Critical Care and Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC. Electronic address: anamen@wakehealth.edu.
2
Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC.
3
Pulmonary, Critical Care and Sleep Medicine, Rowan Diagnostic Clinic, Salisbury, NC.
4
Department of Internal Medicine, Section of Pulmonary, Critical Care and Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC.
5
Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC.
6
Loyola University Chicago Stritch School of Medicine, Maywood, IL.

Abstract

Patients with obstructive sleep apnea (OSA) have increased postoperative complications that are important for patient safety and healthcare utilization. Questionnaires help identify patients at risk for OSA; however, among older adults who preoperatively self-administered OSA questionnaires, the frequency of postoperative Medical Emergency Team Activation (META), rapid response, code blue, code stroke, is unknown.

OBJECTIVES:

Identify whether having OSA questionnaires completed by patients is feasible in the preoperative clinic. Determine the frequency of META among older patients at risk for OSA.

DESIGN AND INTERVENTION:

Cohort of prospective patients independently completed 2 OSA questionnaires in a preoperative clinic, STOP-Bang (SB) and ISNORED (IS). Observers blinded to questionnaire responses recorded incidence of META.

SETTING AND PARTICIPANTS:

Of the 898 consecutive patients approached in the preoperative assessment clinic and surgical navigation center, 575 (64%) consented and completed the questionnaires in <5 minutes and were included in the analysis.

MEASURES:

Sleep questionnaire responses and frequency of inpatient postoperative META.

RESULTS:

With an affirmative response to ≥3 questions on either questionnaire, 65% of patients enrolled were at risk for OSA. Of these, 3.1% sustained an META. In patients at risk for OSA, META occurred in 7.6% (SB+) and 7.2% (IS+) vs 2.5% (SB+) and 1.7% (IS+) for low risk. METAs were disproportionately higher among patients aged ≥65 years (6.3% vs 1.7%; P < .018), American Society of Anesthesiologists (ASA) physical status class ≥3, and IS+. All patients with META positively answered ≥3 of 15 components of the 2 questionnaires.

CONCLUSIONS/IMPLICATIONS:

Preoperative, self-administration of SB and IS questionnaires is feasible. Overall, 65% of those with affirmative responses to ≥3 questions were at risk for OSA and associated with a disproportionate number of postoperative META in older patients. Additionally, risk of OSA identified by preoperative sleep questionnaires was associated with postoperative META among older adults. Use of clinical tools and OSA questionnaires may improve preoperative identification of META in this population.

KEYWORDS:

Sleep apnea; complications; perioperative; questionnaires

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