Date of Award

2012-08-01

Degree Name

PhD Nursing

Dissertation Committee

Joseph F. Burkard, DPNC, CRNA, Chairperson; Cynthia D. Connelly, PhD, RN, FAAN; Darren Couture, PhD, MSN, CRNA

Keywords

Anesthesia, cofactors, Nurse Anesthetists, nursing, Obstructive Sleep Apnea, Post-Anesthesia Care Unit, STOP-BANG, surgery

Abstract

Significance/Background: Obstructive Sleep Apnea (OSA) is the most common disturbance during sleep affecting 30% of the population. The occurrence of moderate/severe OSA is 11.4% in men and 4.7% in women. OSA is caused by repetitive partial or complete obstruction of the upper airway with apnea episodes. OSA is prevalent in western society, yet is frequently undiagnosed due to lack of knowledge of the disorder. This population presents a challenge during the peri-operative period due to increased risk for several complications. Of particular interest to Nurse Anesthetists, are respiratory complications that result in delayed emergence from anesthesia, delayed post-operative recovery, increased apneic episodes, hypoxemia, and death. Examining duration of recovery periods between the two OSA groups will help determine if patients with additional cofactors benefit from longer post-operative monitoring or modification of anesthetic technique. Methods: An observational correlation design to include a non-randomized convenience sample of two groups. Comparisons were made between groups regarding cofactors, complications and duration of postoperative recovery times. Patients having elective abdominal surgery under general anesthesia were identified. OSA status was determined based upon Sleep Studies, or STOP-BANG tool criteria. Medical, surgical, and anesthesia data was reviewed. Total recovery times and pre-existing disease documented. Multiple Logistic and Regression testing compared effects of cofactors on postoperative recovery times. Chi square analysis evaluated relationship of individual cofactors with OSA and Non-OSA patients. T-test analysis compared demographic information. P score of < .05 was considered significant. Results: This study indicated significant correlation with higher number of cofactors amongst patients diagnosed with OSA (p< 0.012). Increased incidence of higher ASA classification in OSA diagnosed patients; (p< .017) extended PACU stay time in OSA diagnosed patients; (p= 0.05) and unplanned admissions in OSA patients; (p=. 007). Patients with OSA use higher number of prescribed medications compared to non-OSA patients have a 3.36 greater chance of hypertension as an additional cofactor (p< .05) and were 8.75 times more likely to experience airway difficulties or complications with general anesthesia when compared to non-OSA patients (p< .05). Multiple logistic regression testing demonstrated increased incidence for both airway difficulties (p= .003) and Hypertension (p=. 054). Multiple linear regression results indicate one cofactor HTN as a significant predictor for PACU stay time. (R2= .179, R2adj= .136, F (1)) Implications: Findings will lead to optimum monitoring, management; recovery measures and anesthesia techniques that will prevent extended postoperative periods and reduce or eliminate postoperative complications of OSA.

Document Type

Dissertation: Open Access

Department

Nursing

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