Issue 5 Stories
Clinical Excellence

Screening for Sleep Apnea

Presurgery Protocol Makes Patient Procedures Safer

Sleep apnea, a common sleep disorder characterized by numerous, brief pauses in breathing during sleep, can do more than just cause a poor night’s sleep—the condition also can put surgical patients at greater risk for complications.

Obstructive sleep apnea, the most common type, occurs when a person’s airway becomes partly or completely closed during sleep. The person’s breathing either ceases or becomes labored, causing the brain to awaken him or her briefly—just long enough to restore breathing. Usually, the person doesn’t recall waking up during these sleep disturbances, which usually lead to fatigue and sleepiness the following day.

Known to affect about 18 million Americans, sleep apnea is actually significantly underdiagnosed, according to the National Sleep Foundation. In reality, millions more Americans may have the condition.

Sleep Apnea and Surgical Risks

Given that such a large number of people experience sleep apnea—many unknowingly—Sentara RMH Medical Center and Sentara Martha Jefferson Hospital now offer sleep apnea screenings for patients before undergoing surgery. This simple test provides an extra measure of safety for patients who are preparing for procedures such as joint replacements and bariatric (weight-loss) surgery.

Patients with sleep apnea have a higher risk in general for respiratory and cardiovascular problems, such as irregular heartbeat and reduced oxygen levels, and an increased risk for stroke or heart attack. For such patients who undergo surgery, these risk factors can be compounded by the use of anesthesia and pain medications. As a result, during the postoperative recovery period, patients with untreated sleep apnea may have difficulty waking from surgery.

“If a patient has his or her sleep apnea treated prior to surgery, the operative risks are greatly reduced,” says Dr. Chris Winter, a neurologist and sleep specialist at Charlottesville Neurology and Sleep Medicine. “Patients are more likely to have better outcomes when the condition is dealt with properly before undergoing a surgical procedure.”

Presurgical Screenings

When getting patients ready for surgery, both Sentara RMH and Sentara Martha Jefferson administer what is known as the STOP BANG questionnaire, a proven tool for screening for obstructive sleep apnea. These presurgical screenings enable doctors to identify patients who may suffer from sleep apnea and take appropriate precautions before, during and after surgery. The STOP BANG acronym represents a set of eight questions similar to the following:

•    Snoring.Do you snore? Is it loud enough to be heard through closed doors, or does it disturb your partner?

•    Tired.Do you often feel tired, fatigued or sleepy during the day, even after a good night’s rest?

•    Observed.Has anyone observed you stop breathing, or choke or gasp for air, while you’re sleeping?

•    Pressure.Are you being treated for high blood pressure?

•    Body Mass Index.Is your BMI greater than 35?

•    Age.Are you older than 50?

•    Neck.Is your neck larger than 17 inches for men or 16 inches for females?

•    Gender.Are you male?

Patients who answer “yes” to three or more of these questions are referred for a sleep study. Both Sentara RMH and Sentara Martha Jefferson perform sleep studies, which can either be done in a sleep medicine center, where patients are monitored by a sleep technologist in real time, or, in some cases, at home. If a home study is ordered, the patient goes home with a device that he or she wears to monitor one night of sleep.

“Even if you were to take surgery out of the equation, and we were just screening people generally, there would be so many health benefits to identifying and treating sleep apnea,” Dr. Winter says. “So it’s not just about the reduction in operative risks, but also about improving overall health.”

Any patient diagnosed with sleep apnea starts treatment immediately, before his or her surgery. The most common treatment is the use of a continuous positive airway pressure (CPAP) device, which pushes oxygen into the airway through a mask that the patient wears during sleep. The CPAP also can be used for the recovery period following surgery, helping to reduce the patient’s risk of complications.

“This is something proactive and positive that we do for our patients,” adds Dr. Winter. “At the same time, we make sure not to delay surgical scheduling, which could create difficulties. We strive to complete the process within two weeks of a scheduled surgery. It’s built into our process of optimizing safety for our patients and doing everything possible to ensure that there are no surprises during or after a procedure.”

Sentara’s Commitment to Safe, High-Quality Care

By offering presurgery sleep apnea screenings, both Sentara Blue Ridge hospitals are demonstrating a commitment to quality care and patient safety.

“Our patients’ safety is always our No. 1 concern,” says Anne Lowery, RN, a preanesthesia surgical screening specialist at Sentara RMH. “We want to set patients up for the best outcomes possible, and that starts with appropriate health screenings and treatments before surgery ever takes place. This not only keeps them safe while they’re in the hospital—it helps reinforce overall health benefits for the patient as well.”

Could You Have Sleep Apnea?

Even if you’re not scheduled for a surgery, sleep apnea can lead to a wide range of health problems, including stroke and heart attack. If three or more of the STOP BANG screening questions in the accompanying article apply to you, ask your doctor whether you might be a candidate for a sleep study.

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