Ivana Deyl, MD, Jordan Gladys-Oryhon, DO, Usman Tariq, MD, Dhruv Chaudhary, MD, Ragunath Appasamy, MD, PhD; Allegheny Health Network, Pittsburgh, PA
Introduction: Screening colonoscopies are recommended for all patients who are 50 years of age and are at average risk for colorectal cancer (CRC). Monitored anesthesia care (MAC) decreases patient discomfort and improves tolerance of the procedure. Patients with obstructive sleep apnea (OSA) are considered to be at a higher risk for cardiopulmonary complications while under anesthesia. The aim of our quality improvement project is to evaluate intraoperative cardiopulmonary (ICP) morbidity associated with MAC anesthesia in patients with OSA undergoing average risk CRC screening colonoscopy. We postulated that patients with OSA would have higher ICP morbidity compared to those without OSA. Methods: Retrospective data was collected on 304, 152 obese and 152 non-obese, randomly selected patients who underwent average risk CRC screening colonoscopy at Allegheny Health Network. Diagnostic and high-risk screening colonoscopies were excluded. Table 1 shows the overall population analysis. A total of 66 patients with documented OSA and 238 patients without OSA were included in the data analysis. Pertaining data was collected by chart review and analyzed using Pearson’s chi-squared test. Average oxygen desaturation time (ODT) was compared with ODT in patients with a diagnosis of OSA using independent T-Test. A sub-analysis of ODT in patients with OSA with and without home CPAP was performed using independent T-Test. Results: Comparatively, the OSA group did not have a statistically different rate of hypoxia (P= 0.801), the need for airway change (P= 0.719), cardiac arrhythmia (P= 0.123), or hypotension (P= 0.081) (Table 2). However, total ODT was significantly higher in OSA patients compared to patients without OSA (P= 0.009) (Table 3A). Interestingly, home CPAP use in OSA did not show a significant correlation with ODT (P =0.753) (Table 3C). Discussion: Our study shows that there are no statistically significant differences in ICP morbidity based on a history of OSA, except for ODT. These findings suggest that patients with OSA are at higher risk of prolonged oxygen desaturation during MAC assisted screening colonoscopies. Further studies are required to assess if patients with OSA are preemptively placed on a higher FiO2 or level of airway than patients without OSA, which could possibly lead to statistically skewed results.
Table 1. Patient demographics and comorbidities
Table 2: Rates of cardiopulmonary complications in patients with and without OSA while under conscious sedation during screening colonoscopy.
Table 3 A: T-test for equality of the means showing statistically significant increased average oxygen desaturation time in patients with OSA compared to patients without OSA Table 3 B: OSA vs No OSA group statistics Table 3 C: T-Test for equality of the means showing no significant difference in average oxygen desaturation time in patients with OSA on CPAP compared to patients with OSA, not on CPAP. Table 3D: CPAP vs No CPAP group statistics
Disclosures: Ivana Deyl indicated no relevant financial relationships. Jordan Gladys-Oryhon indicated no relevant financial relationships. Usman Tariq indicated no relevant financial relationships. Dhruv Chaudhary indicated no relevant financial relationships. Ragunath Appasamy indicated no relevant financial relationships.