Abstract
Objective: The aim of this study was to evaluate the suitability of 2 different screening methods for the detection of obstructive sleep apnea syndrome (OSAS) in the preadmission clinic at a university hospital. Methods: Patients were screened for OSAS using 2 different methods. Method 1: If they were deemed conspicuous by answering three specific medical history questions (daytime sleepiness, snoring and BMI (body mass index)), the patients hat to fill in the Epworth Sleepiness Scale (ESS). Method 2: All patients had to fill in the ESS. An ESS-score of 10 or higher was deemed conspicuous and regarded as a high risk for OSAS. The length of hospital stay of these patients was compared to a matched non OSAS group. Results: Of the 4355 (100%) patients evaluated with method 1, 109 (2.5%) had a known OSAS and 631 (14.5%) had to fill in the ESS-Score in consequence of the 3 specific medical history questions. 82 (13% of the 631 patients) of them reached a score ≥ 10, which equals 1.9% of all patients screened with method 1. At least 191 (4.4%) of all patients who were screened with method 1, were declared as conspicuous. Of the 3415 (100%) patients detected with method 2, 115 patients (3.35%) had a known OSAS. 115 patients (3.35%) achieved an ESS score ≥ 10. Thus 230 patients (6.7%) screened with method 2 were classified as conspicuous. The deviation of mean hospital stay was significantly higher in the group of conspicuous patients compared to the inconspicuous patients. Conclusion: At the pre-admission clinic more patients with OSAS or high risk for OSAS were detected using a standardized screening tool (ESS-Questionnaire) compared to specific questions alone. Due to the increased risk for perioperative complications, the preoperative detection is essential for perioperative management and to initiate further diagnostics and therapy.
Highlights
The prevalence of OSA (Obstructive Sleep Apnea) is about 20% in the middle aged [1]
Of the 4355 (100%) patients evaluated with method 1, 109 (2.5%) had a known obstructive sleep apnea syndrome (OSAS) and 631 (14.5%) had to fill in the Epworth Sleepiness Scale (ESS)-Score in consequence of the 3 specific medical history questions. 82 (13% of the 631 patients) of them reached a score ≥ 10, which equals 1.9% of all patients screened with method 1
Does the patient suffer from a known OSAS? If the answer was, no“ three more questions were asked: Does the patient feel daytime sleepiness? Does the patient snore? Does the patient have a Body Mass Index (BMI)> 28kg/m2? The BMI was calculated using a table where size and weight were requested by the patient
Summary
The prevalence of OSA (Obstructive Sleep Apnea) is about 20% in the middle aged [1]. In 1997 Young et al showed that the OSA is undiagnosed in about 80% of women and 93% of men [2]. Large parts of the patient’s population remain undiagnosed [3]. OSA is defined as apnea or hypopnea as a result of airway obstruction during sleep (apnea/hypopnea per hour of sleep: Apnea-/ Hypopnea-index AHI; AHI ≥ 5 is considered as pathologic). If the patient suffers from a relevant daytime sleepiness, it is called an obstructive sleep apnea syndrome (OSAS). The prevalence of OSAS is approximately 4% [4]
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