Results of a National Survey of Endoscopic Sedation Practice for Patients with Obstructive Sleep Apnea

Abstract

Purpose: Conscious sedation used during endoscopic procedures is thought to be associated with an increased risk for cardiopulmonary complications in patients with obstructive sleep apnea. We performed a national survey of gastrointestinal endoscopists to determine sedation practices in OSA patients. Methods: A two page survey was initially mailed to members of the regional endoscopy society. The survey was then revised to eliminate ambiguous questions and mailed to a random subset of ASGE members. Most questions were multiple choice and included items on physician demographics, training, and reported practice for sedation during endoscopic procedures in patients with diagnosed or suspected OSA. Results: A total of 187 (39%) of 580 mailed surveys were returned. Most endoscopists (66.8%) reported no difference in their anesthetic approach for EGD versus colonoscopies in OSA patients. Thirty-six percent felt that lighter conscious sedation was adequate for all OSA patients, whereas 18% of endoscopists used anesthesia services for all procedures. Sedation practices for patients known to use CPAP or home oxygen varied with the largest proportion of endoscopists reporting lighter sedation as the only special precaution (28% and 25% respectively). Twenty-three and 33.8% percent felt that either a hospital endoscopy unit or anesthesia assistance was required for OSA patients and patients on home oxygen, respectively. Forty-six percent of respondents referred patients for OSA evaluation if they had apneic episodes during endoscopy. Conclusion: There is a wide variation in conscious sedation practices for OSA patients among gastrointestinal endoscopists. Lighter sedation rather than anesthesiologist administered sedation appears to be the preferred management approach for gastrointestinal endoscopy in these patients.