Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

• Type of Material: Article
• Authors: Vaishali Patel, Emory University; Paul St. Romain, Duke University School of Medicine; Juan Sanchez, Duke University School of Medicine; Deborah A. Fisher, Duke University School of Medicine; Ryan D. Schulteis, VA Medical Center
• Language: English
• Date: 2017-10-01
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals - CC-BY-NC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, Springer Science+Business Media, LLC.
• Final Published Version (URL): http://dx.doi.org/10.1007/s10620-017-4731-7
• Title of Journal or Parent Work: Digestive Diseases and Sciences
• ISSN: 0163-2116
• Volume: 62
• Issue: 10
• Start Page: 2834
• End Page: 2839
• Grant/Funding Information: Dr. Vaishali Patel was supported in part by 5T32DK007568-24 while at Duke University Medical Center.
• Keywords: Retrospective Studies; Obesity; United States; Heart Diseases; Ambulatory Care; Colonoscopy; Chi-Square Distribution; Logistic Models; Lung Diseases; Body Mass Index; Male; Female; Patient safety; Body mass index; Humans; Adverse events; Sleep Apnea, Obstructive; Risk Factors; Middle Aged; Risk Assessment; Aged; Odds Ratio; United States Department of Veterans Affairs
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background: The relationship between body mass index (BMI) and cardiopulmonary adverse events (CAEs) for ambulatory colonoscopy is unclear. Aim: To assess the association of BMI and CAEs associated with ambulatory colonoscopy. Methods: This is a retrospective cohort analysis of 418 patients who underwent outpatient colonoscopy at the Durham Veterans Affairs Medical Center categorized as normal/overweight (BMI < 30), obese (BMI 30–34), or morbidly obese (BMI ≥ 35). Adjusted logistic regression analyses were performed. Results: At least one CAE occurred in 46.4% of patients (220 events, 72.7% were hypoxia). The rate of CAEs (BMI < 30: 43.8%, BMI 30–34: 48.0%, BMI ≥ 35: 50.6%, p = 0.53) and rate of hypoxia (BMI < 30: 34.8%, BMI 30–34: 40.9%, BMI ≥ 35: 43.2%, p = 0.32) were numerically higher for obese and morbidly obese patients, but not statistically significant. Obese (OR 1.10, 95% CI 0.70–1.73) and morbidly obese (OR 1.07, 95% CI 0.61–1.85) patients did not have an increased risk of CAEs after adjusting for age, ASA class, obstructive sleep apnea (OSA), and type of sedation. OSA was independently associated with an increased risk of CAEs (OR 1.71, 95% CI 1.09–2.74, p = 0.02) after adjusting for BMI, age, ASA class, and type of sedation. Conclusion: OSA confers a higher risk of CAEs independent of BMI and sedation type. Consideration of undiagnosed OSA is recommended for appropriate pre-procedure risk stratification. While not statistically significant in this study, there may be clinically significant increased risks of CAEs and hypoxia for patient with BMI > 30 that require further evaluation with larger studies.