Obstructive sleep apnea during bronchoscopy: Risk factors and the role of NIMV
K. Bakiri*a (Dr), N. Anagnostopoulosa (Dr), K. Cholidoua (Dr), E. Koukakia (Dr), E. Theodorakisb (Dr), A. Vontetsianosa (Dr), A. Koutsoukoua (Prof), G. Stratakosa (Prof)
a Interventional Pulmonology Unit and ICU of the 1st Respiratory Medicine Department National and Kapodistrian University of Athens, "Sotiria" Hospital, Athens, GREECE ; b Thoracic Surgery Department, "Sotiria" Hospital, Athens, GREECE
Background: The use of drug induced sleep endoscopy (DISE) has been applied to predict obstructive sleep apnea (OSA). Given that moderate sedation for bronchoscopy may induce moderate obstruction in sleep apnea patients and is associated with desaturation, NIMV could be used to prevent respiratory complications and severe hypoxemia. Moreover NIMV has not been extensively tested during bronchoscopy in patients with known OSA.
Methods: 60 patients (57% males) with mean age of 66 years and mean body mass of index (BMI) of 27kg/m2who required bronchoscopy were enrolled in the study. After randomization, 14 patients with high suspicion for OSA were received NIMV during bronchoscopy and 16 patients received conventional oxygen supplementation with nasal cannula. 30 patients with low suspicion for OSA were under conventional oxygen supply. The primary end points were snoring and episodes of decline in Sp02<90%. Secondary endpoints were the changes in the respiratory and hemodynamic parameters during bronchoscopy and the need of early termination and/or endotracheal intubation.
Results: During bronchoscopy, snoring and desaturations were significantly higher in patients with high suspicion for OSA. Under NIMV O2 saturation significantly improved, no patient required endotracheal intubation and the whole procedure was well-tolerated.
Conclusion: In patients with high suspicion for OSA, NIMV was superior to the conventional oxygen supply in preventing SPO2 decrease and cardiovascular/ hemodynamic compromise.
Disclosure of funding source(s): none