Adverse events in patients with obstructive sleep apnea undergoing procedural sedation in ambulatory settings: An updated systematic review and meta-analysis

Felicia Ceban; Naomi Abayomi; Aparna Saripella; Jennita Ariaratnam; Glen Katsnelson; Ellene Yan; Marina Englesakis; Tong J Gan; Girish P Joshi; Frances Chung

doi:10.1016/j.smrv.2024.102029

Adverse events in patients with obstructive sleep apnea undergoing procedural sedation in ambulatory settings: An updated systematic review and meta-analysis

Sleep Med Rev. 2024 Nov 28:80:102029. doi: 10.1016/j.smrv.2024.102029. Online ahead of print.

Authors

Affiliations

¹ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
² Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
⁴ University Hospital Limerick, Health Service Executive, University of Limerick, Limerick, Ireland.
⁵ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁶ Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
⁷ Library & Information Services, University Health Network, Toronto, ON, Canada.
⁸ Division of Anesthesiology and Perioperative Medicine, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁹ Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁰ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada. Electronic address: [email protected].

PMID: 39657452
DOI: 10.1016/j.smrv.2024.102029

Abstract

Objective: Patients with obstructive sleep apnea (OSA) may be at increased risk for adverse events during procedural sedation, however, there remains a gap in the literature quantifying these risks. This systematic review and meta-analysis aimed to evaluate the risk of peri-procedural adverse events in OSA patients undergoing procedural sedation in ambulatory settings, compared to those without OSA.

Methods: Four databases were systematically searched for studies published from January 1, 2011 to January 4, 2024. The inclusion criteria were: adult patients with OSA undergoing procedural sedation in ambulatory settings, peri-procedural adverse events reported, and control group included. The primary outcome was the incidence of peri-procedural adverse events amongst patients with vs without OSA.

Results: Nineteen studies (27,973 patients) were included. The odds of respiratory adverse events were significantly increased for patients with OSA (OR 1.65, 95 % CI 1.03-2.66, P = 0.04). Furthermore, the odds of requiring an airway maneuver/intervention were significantly greater for patients with OSA (OR 3.28, 95 % CI 1.43-7.51, P = 0.005). The odds of cardiovascular adverse events were not significantly increased for patients with OSA.

Conclusion: Patients with OSA undergoing procedural sedation in ambulatory settings had 1.7-fold greater odds of respiratory adverse events and 3.3-fold greater odds of requiring airway maneuvers/interventions.

Keywords: Adverse events; Ambulatory surgery; Cardiorespiratory complications; Non-operating room anesthesia; Obstructive sleep apnea; Procedural sedation.

Publication types

Review