Colonoscopy and Apnea

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From Reuters Health Information

Snoring During Colonoscopy May Indicate Sleep Apnea Apnea

NEW YORK (Reuters Health) Apr 09 - Patients who snore under conscious

sedation during colonoscopy probably have obstructive sleep apnea (OSA),

researchers from Lebanon suggest.

Out of 20 sedated patients who snored during colonoscopy in their study,

all turned out to have sleep apnea.

Conscious sedation can alter the normal respiratory response to hypoxemia

and hypercapnia and facilitate pharyngeal collapse in patients with OSA,

according to Dr. Ala I. Sharara and colleagues - so endoscopy may

therefore provide " a unique opportunity " to make a diagnosis

that might otherwise be missed.

For the study reported online March 22nd in Gastrointestinal Endoscopy,

Dr. Sharara and colleagues at the American University of Beirut Medical

Center recruited 131 patients who were undergoing outpatient colonoscopy.

They found that 24 (18%) snored continuously for 10 seconds or longer

during conscious sedation with meperidine and midazolam. All were lying

in the left lateral decubitus position. Twenty of the snorers and 18

controls matched by age and body mass index underwent portable home

polysomnography.

All 20 snorers and 4 controls had OSA, for a positive predictive value of

100% and a negative predictive value of 78%. Fourteen snorers and one

control had moderate or severe OSA (p < 0.001; positive predictive

value 70%, negative predictive value 94%).

The authors had also performed physical exams and assessed sleepiness

using validated tools. But snoring during conscious sedation was superior

to any other indicators for predicting OSA. In fact, it was the only

independent predictor of OSA on multivariate analysis (odds ratio 33.3).

" Given the medical and financial burden of undiagnosed OSA, these

patients should be carefully identified and referred for sleep medication

evaluation, " Dr. Sharara and associates conclude.

The researchers acknowledge the limitations of their study, including its

small sample size and lack of capnographic monitoring.

Also, they point out, detecting OSA during endoscopy depends on the

vigilance of the endoscopy team and may be affected by the type of

sedatives used, depth of sedation, and patient positioning.

Gastrointest Endosc 2010.

—

Marilyn

New

Orleans, Louisiana, USA

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