A study determined the Obstructive sleep apnea (OSA) may be related to episodes of oxygen desaturation, hypercapnia, cardiovascular dysfunction, cor?pulmonale, and pulmonary hypertension. STOP?BANG is an acronym for eight specific questions used to assess the likelihood of OSA. If the individual exhibits three or more of these indicators., Therefore, the decision of proceeding with inpatient versus outpatient ENT surgery still remains controversial. 

The American Society of Anesthesiologists (ASA) defines obstructive sleep apnea (OSA) as a partial/complete obstruction of the upper airway while the patient is asleep, causing arousal to restore airway patency. This may be related to episodes of oxygen desaturation, hypercapnia, or other serious complications, such as cardiovascular dysfunction, systemic hypertension, cor pulmonale, and hypoxic pulmonary vasoconstriction with pulmonary hypertension.

Statistical Analysis

According to the literature, the estimated prevalence of OSA in the United States varies between 1–24% in middle?aged men, and 2–9% in adult women. Various reported conditions that increase the susceptibility for OSA include age, obesity, menopause status, craniofacial irregularities, male gender, family history of OSA.

Postoperative monitoring of OSA patients in the intensive care unit (ICU) was a standard procedure until a publication, with follow?up studies by Mickelson and Gessler, concluded that only patients with severe OSA, marked morbid obesity, and other comorbidities could benefit from non?ICU floor monitoring. 

There is limited literature available on whether patients at high risk for OSA should be admitted or managed in an ambulatory setting after an ENT procedure. Therefore, the following assessments should be considered: anatomical abnormalities, type of procedure, type of anesthesia, opioid consumption, and facility capabilities. Currently, OSA is primarily identified by a standard polysomnography test, a procedure not routinely performed in all ENT patients.

A total of 48 patients (51%) developed at least one perioperative complication, and according to a multivariable model, the incidence of complications increased with age and BMI but was not associated with AHI severity.  A few limitations are worth mentioning. Considering that polysomnography is the most accurate method to diagnose OSA and assess its severity, only 48.97% of our OSA study patients were evaluated based on this test.

Our retrospective analysis suggested that patients diagnosed with three OSA risk factors based on the STOP?BANG questionnaire did not experience any postoperative complications and that hospital admission was not justified.

The study also showed that patients with four risk factors should be assessed on a patient?by?patient basis to identify those individuals who require hospitalization and monitoring. Early supplementary oxygen administration at admission associated with reduced perioperative opioid consumption and multimodal pain therapy management should be considered as well. 

The author concluded that a STOP?BANG score of three for patients undergoing ENT procedures might be considered a reliable indicator of uneventful perioperative outcomes and immediate patient discharge, reducing financial burden created by unnecessary hospitalizations. However, several factors along with STOP?BANG score should be considered when deciding to admit or not ENT patients.