Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Mike Lush

Committee Member

Dr. Sheila Melander

Committee Member

Dr. Michelle Pendleton

Abstract

Background: Obstructive sleep apnea (OSA) characteristics are present in up to one-quarter of the U.S. adult population (Fernandez-Bustamante, Bartels, Clavijo, Scott, Kacmar, Bullard, Moss, Henderson, Juarez-Colunga, & Jameson, 2017). It is estimated that 80-90% of patients with moderate to severe OSA have never been diagnosed (Chung, Abdullah, & Liao, 2016a). The high prevalence of OSA combined with low diagnosis rates give rise to an environment with considerable surgical risk, including respiratory failure and cardiac arrhythmias (Kaw, Chung, Pasupuleti, Mehta, Gay, & Hernandez, 2012). Guidelines have been established by the Society of Anesthesia and Sleep (SASM) for preoperative OSA screening in an effort to decrease perioperative complications (Chung, Memtsoudis, Ramachandran, Nagappa, Opperer, Cozowicz, & Auckley, 2016b).

Objective: The goal of this project is to determine whether patients who were identified as high-risk for OSA using the STOP-Bang Questionnaire and noted as such in the electronic medical record (EMR) developed fewer postoperative respiratory complications or were more likely to be referred for outpatient OSA evaluation.

Methods: The study design is nonequivalent control group pre-test and post-test design, using a retrospective chart review. The nonequivalent control group are patients who would have scored greater than or equal to five on the STOP-Bang Questionnaire based on the current preoperative assessments (daytime excessive sleepiness, hypertension, BMI >35 kg/m2, age > 50, neck circumference ≥43 cm in males, neck circumference ≥41 cm in females, and male gender) during the three months prior to the initiation of the STOP-Bang Questionnaire screening (December 2018-February 2019). This group was compared to preoperative patients screened high-risk for OSA using the STOP-Bang Questionnaire (score 5-8) during the study period (March 2019 to August 2019). Consecutive sampling was used for participant selection.

Results: There were no statistically significant differences in age, gender, prevalence of comorbid conditions, elective procedure, or STOP-Bang score between Group 1 and Group 2 (n=59). The hospital length of stay for Group 1 ranged from one to three days with a median of one day. For Group 2, the hospital length of stay ranged from one to sixteen days with a median of one day. One patient was not extubated after surgery as planned and four patients received supplemental oxygen after being admitted. No patients used non-invasive ventilation, were re-intubated, or experienced cardiac arrest postoperatively. There were no statistically significant differences between Group 1 and Group 2 in any of the preceding measures. Outpatient polysomnography referral was ordered for one patient in each group.

Conclusion: It was found that there were no statistically significant differences between the group not screened using the STOP-Bang Questionnaire and the group who was screened during the pre-admission testing appointment.

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