Integrating a sleep apnoea assessment into an anaesthetic pre-admission clinic

Untreated obstructive sleep apnoea (OSA) is associated with increased post-operative complications.

To assess the impact of integrating a sleep physician into an anaesthetic pre-admission clinic (PAC) on the identification of patients at high risk of OSA, wait times to OSA management and to surgery.

An interrupted time series of a PAC service was conducted at a tertiary hospital, before and after integration of a sleep physician into PAC. Before integration, anaesthetists who identified patients at risk of OSA were referred to the sleep clinic on a future date. After integration, such patients were referred to the sleep physician in PAC on the same day. Number of referrals for OSA assessment, time to: sleep physician assessment, sleep study, OSA management and surgery, were compared.

Three hundred eighty-two patients were reviewed in PAC before integration (26% bariatric, 31% orthopaedic, 43% other surgery) and 355 after integration (16% bariatric, 39% orthopaedic, 45% other). The introduction of a sleep physician into PAC resulted in a 10-fold increase in patients being referred for assessment by a sleep physician (2% vs 20%) (P = <0.001) and was associated with a reduction in time to surgery (261 ± 93 vs 38 ± 32 days, P = 0.015). However, in both groups (before and after integration), 30-day mortality and unplanned non-invasive ventilation (NIV) did not differ.

Integration of a sleep physician into PAC resulted in a 10-fold increase in patients identified at high risk of OSA, a same-day sleep physician assessment, 91% reduction in time to OSA management and 85% reduction in surgical wait time.