P061: PREOPERATIVE SCREENING FOR OBSTRUCTIVE SLEEP APNEA AND ITS IMPLICATIONS FOR PERIOPERATIVE ANESTHESIA MANAGEMENT
Sui- Ling Perez1; Lauren Csete1; Sarah Simon1; Da Young Lee1; Marc Levine, Dr2; Vicente Behrens Bello, Dr2
1Florida International University Herbert Wertheim College of Medicine; 2Mount Sinai Medical Center
Background: A common but underdiagnosed condition that presents significant challenges for anesthesia care is obstructive sleep apnea (OSA). Sedatives and opioids can worsen airway obstruction and decrease ventilatory drive during surgery and recovery, raising the risk of cardiovascular and respiratory problems. Preoperative screening has become a critical step in identifying high-risk individuals and organizing safer anesthetic management as many surgical patients have undiagnosed OSA.
Objective: This literature review examines the current evidence on preoperative OSA screening and how it impacts perioperative outcomes and anesthesia management.
Methods: A targeted review of peer-reviewed literature was conducted using PubMed. Seven relevant studies published after 2010 were selected, including prospective cohort, multicenter observational, and diagnostic accuracy studies focused on evaluating preoperative screening tools for OSA and their associated perioperative outcomes. Studies included adult patients undergoing elective surgeries, screened with tools such as the STOP-Bang questionnaire, novel morphologic scores such as DES-OSA, photoplethysmography (PPG) devices, or periocular markers like floppy eyelid syndrome (FES). OSA severity was confirmed via portable sleep study, polysomnography, or validated clinical scoring systems. Outcomes included difficult intubation, mask ventilation, and laryngoscopy in addition to predictive performance of each screening tool.
Results: Across studies, higher STOP-Bang scores (≥3) were consistently associated with increased rates of difficult intubation, mask ventilation, and laryngoscopy. The STOP-Bang questionnaire was the most practical and sensitive tool, offering simplicity, quick administration, and high sensitivity, though specificity was moderate and it relied on accurate patient reporting. Novel tools showed variable performance: the DES-OSA score had high specificity and predictive accuracy for moderate-to-severe OSA but required physical measurements; eyelid laxity assessments (FES) were useful when questionnaires were not feasible with high negative predictive value but moderate sensitivity and specificity; and wrist-worn photoplethysmography devices reliably detected moderate-to-severe OSA, though small sample sizes and false positives for mild OSA limited generalizability. Overall, STOP-Bang remains the most practical screening tool, with morphology- and device-based assessments serving as useful complements, though questions remain about cost-effectiveness and standardized screening procedures.
Conclusion: OSA is very common in the surgical population and often goes undetected prior to anesthesia. The STOP-Bang questionnaire is a practical, sensitive, and widely validated preoperative screening tool for identifying patients at risk for OSA and difficult airway management. Morphology-based scores, eyelid laxity assessments, and wrist-worn photoplethysmography devices can complement STOP-Bang in selected populations or when questionnaires are not feasible. Further research is needed to determine the cost-effectiveness and optimal implementation of universal preoperative OSA screening.