Feasibility of Expedited Home Sleep Testing Before Surgery for Detection of High-Risk Sleep-Related Breathing...

Background: Sleep-related breathing disorders (SRBDs) are associated with perioperative morbidity. Guidelines recommend preoperative screening for SRBDs, but testing is rarely completed before surgery. We aimed to address this gap by expediting preoperative home sleep apnea testing (HSAT) among persons with suspected SRBDs. Methods: We developed an expedited referral pathway for preoperative HSAT in a subset of persons with high-risk SRBDs (HR-SRBDs) (ie, obesity hypoventilation syndrome and overlap of COPD and obstructive sleep apnea). The primary outcome was change in rate of preoperative HSAT interpretation. Secondary outcomes were surgery delay or cancellation rates and correct use of the referral pathway by providers. Results: After implementation of the expedited HSAT referral pathway, the preoperative HSAT interpretation rate increased nearly 6-fold compared with preimplementation (7% vs 43%, P = .001). Time elapsed from sleep study referral to surgery, a surrogate for surgery delay, did not substantially change from pre- to postimplementation (7 d vs 10 d, P = .26). There were no surgery cancellations. Providers used the expedited HSAT referral pathway correctly 36% of the time in the first 3 months; this increased to 67% in the last 3 months of the postimplementation period. Conclusions: Preoperative HSAT interpretation in persons with HR-SRBDs was feasible without causing surgery delay or cancellations and may improve management of persons with SRBDs perioperatively. Future studies should clarify if preoperative identification of HR-SRBDs improves outcomes in this surgical population.