Cardiopulmonary adverse events during procedural sedation in patients with obstructive sleep apnea: a systematic review protocol

Abstract

Review question/objective This review aims to identify the type and incidence of cardiopulmonary adverse events during procedural sedation and analgesia (PSA) in patients with obstructive sleep apnea (OSA). To achieve this objective, this review will address the following question: What is the incidence of perioperative cardiopulmonary adverse events associated with PSA in patients with OSA? To address this question, this review will consider studies that compare outcomes in OSA patients with non-OSA patients, as well as studies that report the adverse events of drugs used to induce PSA in OSA patients. Inclusion criteria Types of participants This review will consider studies of participants who are: 1. 18 years and older; 2. formally diagnosed with, or at risk for OSA (as determined by formal sleep study, or assessment against the STOP-BANG criteria); and 3. undergoing a diagnostic or therapeutic procedure with intravenous PSA. Procedures that may be performed under PSA include, but are not limited to, bone marrow biopsy, colonoscopy, cardiac studies, endoscopy, bronchoscopy, minor plastic surgery, vascular stenting, and urological procedures. Studies on OSA patients receiving sedation for drug induced sleep studies to examine upper airways or receiving general anesthesia will be excluded from this review. Types of intervention(s) The incidence of perioperative cardiopulmonary adverse events associated with PSA including: 1. in control (non-OSA) and OSA populations 2. studies involving (1) midazolam or fentanyl alone, or in combination with or without local anesthesia as compared to (2) PSA using propofol, with or without supplementary drugs including midazolam and fentanyl, with or without local anesthesia. Studies in which propofol is the primary agent used for sedation, as assessed by the authors, will be allocated to the propofol group. Types of outcomes This review will consider studies that include the outcome measures (adverse events) as listed below. Criteria used to define these events may vary between published studies. Criteria used in each study will be reviewed and considered in an assessment of heterogeneity between studies. Cardiovascular events: • hyper/hypotension (20% or greater increase (hypertension) or decrease (hypotension) in the pre-procedural blood pressure value or any single systolic TRUNCATED AT 350 WORDS