Rebecca E Evans1, Joshua Zimmerman2, Sonia Shishido3, Elise Heath4, Amber Bledsoe5, Ken Johnson6. 1. Department of Anesthesiology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756, USA. Electronic address: Rebecca.E.Evans@hitchcock.org. 2. Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Joshua.Zimmerman@hsc.utah.edu. 3. Bend Anesthesiology Group, 2500 NE Neff Rd, Bend, OR 97701, USA. Electronic address: sonia.shishido@gmail.com. 4. Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Elise.Heath@hsc.utah.edu. 5. Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Amber.Bledsoe@hsc.utah.edu. 6. Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Ken.B.Johnson@hsc.utah.edu.
Abstract
STUDY OBJECTIVE: The aims of this study were to (1) explore the incidence of right-sided heart dysfunction (RHD) and STOP-Bang questionnaire responses consistent with obstructive sleep apnea (OSA) and (2) assess the relationship between patients with STOP-Bang questionnaire responses consistent with OSA and echocardiographic findings suggestive of RHD. DESIGN: Observational study. SETTING: Tertiary academic center preoperative clinic. PATIENTS: Two hundred patients presenting for elective surgery to the University of Utah preoperative clinic. INTERVENTION: Abbreviated transthoracic right-sided echocardiogram and STOP-Bang questionnaire. MEASUREMENTS: Tricuspid annular plane systolic excursion, tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), and the tricuspid inflow E wave to tricuspid annular tissue Doppler e' wave ratio (E/e') for the presence of RHD, as well as responses to STOP-Bang questionnaire. MAIN RESULTS: A total of 140 echocardiograms were analyzed after exclusion of participants with incomplete STOP-Bang questionnaires and inadequate images. Thirty-five patients (25%) reported 5 or more positive responses to the STOP-Bang questionnaire. Forty-six patients (35%) had abnormal right-sided heart measurements. Of the 35 patients with STOP-Bang scores 5 or greater, 11 (31%) had evidence of RHD. No correlation was observed between STOP-Bang scores and the echocardiography metrics of RHD. CONCLUSIONS: This preliminary study suggests that there are numerous sources of RHD, among one of which is sleep apnea, and/or the STOP-Bang questionnaire is not a sensitive tool for predicting RHD. We conclude that although the STOP-Bang questionnaire is easy to implement in a preoperative clinical setting, it is not useful in identifying patients at risk for RHD.
STUDY OBJECTIVE: The aims of this study were to (1) explore the incidence of right-sided heart dysfunction (RHD) and STOP-Bang questionnaire responses consistent with obstructive sleep apnea (OSA) and (2) assess the relationship between patients with STOP-Bang questionnaire responses consistent with OSA and echocardiographic findings suggestive of RHD. DESIGN: Observational study. SETTING: Tertiary academic center preoperative clinic. PATIENTS: Two hundred patients presenting for elective surgery to the University of Utah preoperative clinic. INTERVENTION: Abbreviated transthoracic right-sided echocardiogram and STOP-Bang questionnaire. MEASUREMENTS: Tricuspid annular plane systolic excursion, tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), and the tricuspid inflow E wave to tricuspid annular tissue Doppler e' wave ratio (E/e') for the presence of RHD, as well as responses to STOP-Bang questionnaire. MAIN RESULTS: A total of 140 echocardiograms were analyzed after exclusion of participants with incomplete STOP-Bang questionnaires and inadequate images. Thirty-five patients (25%) reported 5 or more positive responses to the STOP-Bang questionnaire. Forty-six patients (35%) had abnormal right-sided heart measurements. Of the 35 patients with STOP-Bang scores 5 or greater, 11 (31%) had evidence of RHD. No correlation was observed between STOP-Bang scores and the echocardiography metrics of RHD. CONCLUSIONS: This preliminary study suggests that there are numerous sources of RHD, among one of which is sleep apnea, and/or the STOP-Bang questionnaire is not a sensitive tool for predicting RHD. We conclude that although the STOP-Bang questionnaire is easy to implement in a preoperative clinical setting, it is not useful in identifying patients at risk for RHD.