Mary Frances Mullins DNP CRNA graduated in June 2016 from Grand Canyon University with her Doctor of Nursing Practice (DNP) degree. In 2001, she graduated from the Uniformed Services University in Bethesda with an MSN in nurse anesthesia. She also holds CPAN and CAPA certification and currently works at Memorial Medical Center in Modesto, CA
Preoperative Screening for Obstructive Sleep Apnea: Enhancing Perioperative Safety
Abstract
Nearly 25 million people in the United States suffer from obstructive sleep apnea (OSA). This serious under-recognized, under-diagnosed medical disorder is associated with significant comorbidities as well as increased perioperative risks. Therefore, preoperative screening for OSA using a validated OSA screening tool such as the STOP-Bang OSA screening questionnaire is imperative. Using a quantitative methodology with a comparative design, this author observed for statistically significant differences in the proportion of postoperative hypoxemia between two sample groups. Group A (
n=100) was comprised of adult (ages 18-75) general anesthesia elective surgery patients who were screened preoperatively for OSA on the STOP-Bang OSA screening instrument. Group B (
n=100) was comprised of adult (ages 18-75) general anesthesia elective surgery patients who were not screened preoperatively for OSA on the STOP-Bang OSA screening instrument. A Chi-square analysis was conducted comparing the proportion of positive postoperative hypoxemia occurrences in the Post Anesthesia Care Unit (PACU). The proportion of patients who experienced hypoxemia in the PACU pre implementation of the STOP-Bang screening program was not equal to the proportion of patients who experienced hypoxemia in the PACU post implementation of the program,
χ2 (1,
N = 94) = 2.085,
p = .149. This was statistically nonsignificant, but clinically relevant. Clinician awareness of the potential existence of OSA can guide the perioperative care plan to safely meet the special needs of surgical patients with OSA.
Table of Contents
List of Tables. ix
List of Figures. x
Chapter 1: Introduction to the Project 1
Background of the Project 2
Problem Statement 4
Purpose of the Project 5
Clinical Question. 6
Advancing Scientific Knowledge. 6
Significance of the Project 7
Rationale for Methodology. 9
Nature of the Project Design. 9
Definition of Terms. 10
Assumptions, Limitations, and Delimitations. 13
Summary and Organization of the Remainder of the Project 15
Chapter 2: Literature Review.. 18
Background. 20
Conceptual Framework for Implementing Preoperative STOP-Bang OSA Screening: The Iowa Model 22
Literature Review.. 25
Obstructive Sleep Apnea: Pathogenesis and Comorbidities. 25
Obstructive Sleep Apnea: Cardinal Features. 27
Treatment of Obstructive Sleep Apnea. 27
Obstructive Sleep Apnea: Preoperative Diagnosis. 30
Obstructive Sleep Apnea Associated Perioperative Complications. 36
Perioperative Management of Patients with Obstructive Sleep Apnea. 45
Healthcare Professional Attitudes on Perioperative Care of Patients with OSA.. 46
Summary. 47
Chapter 3: Methodology. 51
Project Methodology. 52
Project Design. 53
Population and Sample Selection. 55
Instrumentation. 55
Validity. 57
Reliability. 58
Data Collection Procedures. 59
Data Analysis Procedures. 60
Ethical Considerations. 61
Limitations. 62
Summary. 63
Chapter 4: Data Analysis and Results. 66
Descriptive Data. 67
Data Analysis Procedures. 70
Results. 70
Summary. 77
Chapter 5: Summary, Conclusions, and Recommendations. 79
Summary of the Project 81
Summary of Findings and Conclusions. 82
Practical, Future, and Theoretical Implications. 85
Recommendations for Future Projects. 86
Recommendations for Future Practice. 87
Conclusion. 88
References. 90
Appendix A.. 107
Appendix B.. 108
Appendix C.. 109
Appendix D.. 111
Appendix E. 112
List of Tables
Table 1. Descriptive Statistics of Demographic Variables
.................................................. 70
Table 2. Pearson Chi-Square Goodness of Fit Between Implementation of the STOP-Bang Screening Program and Proportion of Patients who Experience Hypoxemia in the PACU
................ 73
List of Figures
Figure 1. STOP-Bang Questionnaire Total Score Occurrence Frequency ........................ 75
Figure 2. STOP-Bang Obstructive Sleep Apnea Level of Risk Percent ............................ 76
Figure 3. Hypoxemia Frequency Occurrence .................................................. .................. 77
Chapter 1: Introduction to the Project
Obstructive sleep apnea (OSA) is a prevalent sleep-associated breathing disorder characterized
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