„Tagesschläfrigkeit“ als Prädiktor für schlafbezogene Atmungsstörungen (SBAS) – ist eine präoperative Evaluation sinnvoll?

Zusammenfassung

Einführung | Schlafbezogene Atmungsstörungen (SBAS) gehen mit einem erhöhten Risiko für perioperative Komplikationen einher. Als häufig auftretendes Symptom wird von Patienten mit SBAS, insbesondere solchen mit obstruktiver Schlafapnoe (OSA), Tagesschläfrigkeit beklagt. Ziel der vorliegenden Studie war zu untersuchen, ob Tagesschläfrigkeit in der präoperativen Anamneseerhebung als Prädiktor für SBAS herangezogen werden kann.

Methodik | Die Datenerhebung erfolgte prospektiv, nicht randomisiert. Patienten vor elektiven Operationen wurden gebeten, einen Fragebogen zur Erfassung von Tagesschläfrigkeit (Epworth Sleepiness Scale, ESS) zu beantworten. Präoperativ erfolgte die Durchführung einer Polygraphie mit Bestimmung des Oxygen-Desaturation-Index 4 % (ODI 4%).

Ergebnis | Daten von 363 Patienten (190 Männer und 173 Frauen) konnten in die Endauswertung einbezogen werden. Hinsichtlich der Risikostratifizierung hatten 42 Patienten einen ASA-Score (American Society of Anesthesiologists) °I (gesunder Patient), 192 Patienten °II (leichte Allgemeinerkrankung), 123 Patienten °III (schwere Allgemeinerkrankung) und 6 Patienten °IV (ständige Lebensbedrohung). Der mittlere BMI der Patienten lag bei 27,9 ± 5,1 kg / m², das mittlere Alter betrug 59,2 ± 13,3 Jahre. Der ESS-Score lag im Gesamtkollektiv bei 5,7 ± 3,4, eine klinisch bedeutsame Tagesschläfrigkeit (ESS ≥ 11) wurde von 32 Patienten (9 %) beklagt. 11 der 32 Patienten (34 %) hatten einen ODI 4 % ≥ 5 / h, 21 (66 %) einen ODI 4 %  < 5 / h. Das Odds ratio zwischen einem ODI 4 % ≥ 5 / h und einem ESS ≥ 11 war 0,919 (CI 0,85–0,99, p = 0,038). Ein ODI 4 % ≥ 5 war bei 188 Patienten (52 %) zu objektivieren, bei Patienten mit ESS ≥ 11 (32) war dies bei 11 (34 %) der Fall, bei ESS < 11 (331) bei 177 (54 %).

Folgerung | Patienten mit SBAS ohne relevante Adipositas leiden nicht oder nur gering unter einer vermehrten Tagesschläfrigkeit. Das Symptom Tagesschläfrigkeit besitzt somit keinen prädiktiven Wert für das Vorliegen einer schlafbezogenen Atmungsstörung.

Abstract

Background | Sleep-disordered breathing (SDB) is associated with increased rate of perioperative complications. Daytime sleepiness is a frequent symptom of SDB. Thus, aim of the present study was to evaluate whether preoperative assessment of daytime sleepiness would be eligible for sufficient prediction of SDB.

Methods | Patients before scheduled surgery were prospectively recruited and asked to answer a standardized sleep questionnaire (Epworth Sleepiness Scale; ESS). The night before surgery, sleep polygraphy was performed and the oxygen desaturation index 4 % (ODI 4%) was calculated.

Results | Data of 363 patients (190 men and 173 women) were finally analyzed. Regarding risk assessment, 42 patients had ASA grade 1, 192 patients had ASA grade 2, 123 patients had ASA grade 3 and 6 patients had ASA grade 4. Mean Body Mass Index was 27.9 ± 5.1 kg / m2, mean age was 59.2 ± 13.3 years and mean ESS score was 5.7 ± 3.4. Clinical relevant daytime sleepiness (ESS ≥ 11) was found in 32 patients (9 %). In 11 patients (34 %) with ESS ≥ 11, ODI 4% ≥ 5 / h was calculated whereas in 21 patients with ESS ≥ 11 (66 %), ODI 4% < 5 / h was found. Odds ratio between ODI 4% ≥ 5 / h and ESS ≥ 11 was 0.919 (CI 0.85–0.99, p = 0.038).

Conclusion | In non-obese patients, daytime sleepiness is a rare event and is not associated with SDB. Thus, daytime sleepiness is not eligible for the preoperative SDB screening.

Schlüsselwörter

Tagesschläfrigkeit - Epworth Sleepiness Scale - schlafbezogene Atmungsstörungen - perioperatives Risiko

Key Words

daytime sleepiness - Epworth Sleepiness Scale - sleep-disordered breathing - perioperative risk

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