Clinical predictors of underlying severe obstructive sleep apnea in patients undergoing gastrointestinal endoscopy...

Of patients suspected as having obstructive sleep apnea (OSA) while undergoing routine gastrointestinal endoscopy under conscious sedation (GE-CS), 43% have severe disease but have never consulted specialist clinics because of the absence of significant symptoms/signs. If patients with possible severe OSA can be predicted during GE-CS, they could be advised to consult sleep specialist clinics.

We retrospectively analyzed data of 112 patients who were suspected as having OSA during GE-CS and underwent sleep apnea testing at our hospital, to evaluate whether patient characteristics, endoscopic detection of upper airway obstruction (UAO), and vital signs during routine GE-CS can predict the possibility of severe underlying OSA.

The mean age of the patients was 55 years, 74% were men, and 64% had obesity. Severe OSA was diagnosed in 13% of patients with mild UAO (< 50% luminal stenosis), 18% of patients with moderate UAO (50%-75% stenosis), and 45% of patients with severe UAO (> 75% stenosis). The UAO severity was positively correlated with the apnea hypopnea index score (r = 0.305, p = 0.001) and negatively correlated with the minimum SpO₂ during GE-CS (r = 0.285, p = 0.023). Logistic regression analysis identified male gender (HR 4.19, p = 0.0267), severe UAO (HR 3.69, p = 0.009), and minimum SpO₂ < 90% during GE-CS (HR 3.82, p = 0.008) as an independent predictors of severe OSA.

Not only the presence of UAO, but also minimum SpO₂ < 90% during GE-CS was identified as an independent predictor of severe OSA.