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Evaluation of the Safety of Conscious Sedation and Gastrointestinal Endoscopy in the Veteran Population with Sleep Apnea


Andrade, Christian MD2; Gill, Jeffrey MD1; Kulkarni, Prasad MD1; Amodeo, Donald MD1; Goldsmith, Susan MD1; Boyd, William MD1; Anderson, William MD1; Klein, Malcolm MD1; Vidyarthi, Gitanjali MD1

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American Journal of Gastroenterology: October 2013 - Volume 108 - Issue - p S480
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Purpose: Obstructive sleep apnea (OSA) has been described to affect up to 26% of the general population and is an increasingly common disorder among the veteran population. Patients with OSA are considered to be high risk for endoscopy with sedation secondary to a presumed elevated risk of cardiopulmonary complications. Given the concern for increased risk, these patients are sometimes denied endoscopy or endoscopy is performed contingent upon patient admission thereby increasing the cost of healthcare. This presumption is rather unsubstantiated as the current literature lacks prospective randomized trials. The aim of the present study is to evaluate the safety of conscious sedation in patients with OSA undergoing gastrointestinal endoscopy via chart review of cardiopulmonary variables collected prospectively.

Methods: After IRB approval, a total of 125 consecutive patients with confirmed OSA by polysomnography scheduled to undergo gastrointestinal endoscopy were consented for the study. Patients with moderate and severe OSA were included while patients with mild OSA were excluded. Cardiopulmonary variables such as heart rate, blood pressure and level of blood oxygen saturation were recorded at 3-minute intervals throughout the endoscopic procedure. In addition, patients were continuously monitored by a registered nurse as well as the endoscopist. The necessity of endotracheal intubation, use of a reversal agent or the development of an adverse outcome was also documented.

Results: As expected in the veteran population, 118 (94.4%) of the patients were male and 7 (5.6%) were female. The average age was 59.5 years and the average BMI was 35.1. A total of 9 (7.2%; max. HR 141 bpm) patients experienced tachycardia (HR >100 bpm), while 10 (8.0%; min. HR 43 bpm) patients experienced bradycardia (HR <60 bpm). Hypotension (MAP <65 mmHg) occurred in 14 (11.2%; min. MAP 44 mmHg) patients. Blood oxygen desaturation (oxygen saturation <93%) was common and occurred in 46 (37.1%; min. O2 saturation 89%) patients. None of the patients in the study required endotracheal intubation, pharmacologic reversal or experienced an adverse outcome as a result of changes in blood pressure, heart rate or blood oxygen saturation. Significant intraprocedural changes were noted to be transient and did not result in premature termination of any procedure.

Conclusion: Despite the presumed increased risk of cardiopulmonary complications, patients with OSA who undergo endoscopy have clinically insignificant variations in cardiopulmonary parameters similar to those previously described in the general population. Future studies should include larger cohorts with a control arm and consider comparing these outcomes with conscious sedation versus monitored anesthesia care.

© The American College of Gastroenterology 2013. All Rights Reserved.