7.4 STOP BANG + OSA

Question 1

a) List all of the elements of the STOP-BANG assessment for a patient with suspected obstructive sleep apnoea (OSA) (4 marks) and explain how it is used to quantify their risk. (3 marks)

Answer 1

Elements of STOP-BANG assessment:

S – loud snoring.

T – daytime tiredness.

O – observed cessation in breathing.

P – high blood pressure, treated or untreated.

B – BMI greater than 35 kg/m2.

A – age greater than 50 years.

N – neck circumference greater than 40 cm.

G – male gender.

Question 2

STOP-BANG explain how it is used to quantify their risk

Answer 2

Risk quantification:

> > Score less than 3 virtually excludes sleep apnoea.

> > Score of 3–4 indicates
intermediate risk of sleep apnoea.

> > Score of 5–8 indicates high risk of sleep apnoea.

Question 3

b) What are the cardiovascular consequences of OSA? (3 marks)

Answer 3

> > Overall increased risk of
cardiovascular morbidity and mortality.

> > Arrhythmias.

> > Hypertension.

> > Biventricular dysfunction.

> > Pulmonary hypertension.

> > Congestive heart failure.

> > Myocardial infarction
(risk increased - increased presence of dyslipidaemia,
enhanced platelet activation,
inflammatory pathway activation
and endothelial dysfunction seen in OSA).

Question 4

c) How can perioperative risks be minimised in a patient with known severe OSA, but no other
cardiovascular or respiratory comorbidities, who is having peripheral surgery involving at least one night
in hospital? (10 marks)

Pre

Answer 4

Preoperative:
>> Ensure patient is established on 
and compliant with CPAP for three
months prior to surgery, 
if clinical condition permits, 
and continue use in
the perioperative period.

> > Encourage preoperative weight loss
if overweight.

Dietician referral if necessary.

> > If a smoker, encourage to stop and refer for cessation therapies if necessary.

> > Assess for the possibility of associated difficult airway and plan accordingly.

> > Consider the possibility of using regional technique only, or regional technique as a method of reducing overall use of systemic drugs that will
impact on respiratory drive and alertness.

> > Avoid sedative premedication.

2. Intraop

Use or regional anaesthesia where feasbile - avoid use of sedative medication where possible
avoid respiratory depressant effects of GA

Short acting opioids if required
Multimodal analgesia to reduce opiod use

Avoid use of muscle relaxanat if possible - if essential ensure adeqaute reversal

Short acting anaes if ga essential - consider TIVA

3. montiroing
   Level 1 bed
   O2 sats monitoring

use of cpap - patients own or provide overnight

Question 5

c) How can perioperative risks be minimised in a patient with known severe OSA, but no other cardiovascular or respiratory comorbidities, who is having peripheral surgery involving at least one night in hospital? (10 marks)

Intra

Answer 5

Intraoperative:

> > If general anaesthesia is used,
target normal oxygen saturations and
end tidal carbon dioxide.

> > Use short-acting agents such as
desflurane, propofol and remifentanil.

> > Monitor neuromuscular blockade
and ensure adequate reversal before extubation.

Consider need for sugammadex.

> > Extubate awake.

> > Use multimodal analgesia to
reduce/avoid need for long-acting opioid.

Question 6

c) How can perioperative risks be minimised in a patient with known severe OSA, but no other cardiovascular or respiratory comorbidities, who is having peripheral surgery involving at least one night in hospital? (10 marks)

Answer 6

Postoperative:

> > Ensure CPAP available for use in PACU.

> > Consider prolonged PACU stay.

>> Ensure ward is suitable for the 
level of monitoring, and assistance with
CPAP, that the patient requires – 
dependent on mode of anaesthesia,
individual patient and complexity of surgery. 

Consideration of level 2 care.

> > Supplemental oxygen.

> > Continuous oxygen saturation
monitoring including overnight