Preoperative Assessment of Obstructive Sleep Apnea in the Ambulatory Anesthesia Patient: A Survey of Oral and Maxillofacial Surgery Providers

Abstract

Oral and maxillofacial surgeons often treat patients with both diagnosed and undiagnosed obstructive sleep apnea (OSA). Patients with OSA are at substantial risk of perioperative and postoperative complications after receiving intravenous sedation, general anesthesia, or postoperative opiate analgesia.The purpose of this study was to determine whether oral and maxillofacial surgery (OMS) providers are screening patients for perioperative and postoperative risks related to OSA before office-based ambulatory anesthesia. SurveyMonkey software (SurveyMonkey, San Mateo, CA) was used to distribute a survey to 1,658 community- and hospital-based OMS providers in the United States.A response rate of 17.4% (n=288) was achieved. The 27-question survey was created to obtain demographic information and to assess the preoperative anesthesia routine of the OMS providers. The questions were developed based on American Society of Anesthesiologists guidelines and the STOP-Bang questionnaire to determine the quality and rate of screening for OSA before office-based ambulatory anesthesia procedures. All incomplete survey responses were excluded from analysis. Demographic analysis showed that 73.61% of the 288 respondents were in private practice only, with no hospital affiliation. Of the respondents, 81.88% reported performing fewer than 50 hospital operating room procedures per year, 81.60% reported performing more than 200 office-based ambulatory anesthesia cases per year, and 96.19% reported performing their own office-based ambulatory anesthesia. In this cohort, only 34.7% of OMS providers stated that they asked patients OSA-specific screening questions, whereas 74.3% reported asking other preoperative anesthesia questions (χ2=91.0, df=1, P<.0001). Most of the surveyed OMS providers are not screening pre-anesthesia patients for OSA with a quantifiable method such as the STOP-Bang questionnaire. These findings identify a need to investigate the rate of undiagnosed OSA syndrome in the OMS office-based ambulatory anesthesia patient population. The STOP-Bang questionnaire may be a useful tool to better assess for anesthesia risk and modify management accordingly.