Abbreviated right-sided heart echocardiogram and the STOP-Bang questionnaire—a useful relationship for preoperative patient evaluation?

• Published in: Journal of clinical anesthesia 2016-05, Vol.30, p.90-98
• Main Authors: Evans, Rebecca E., MD, Zimmerman, Joshua, MD, Shishido, Sonia, DO, Heath, Elise, MD, Bledsoe, Amber, MD, Johnson, Ken, MD
• Format: Article
• Language: English
• Subjects: Anesthesia & Perioperative Care; Echocardiography, Doppler - methods; Elective Surgical Procedures - methods; Electrocardiography; Female; Flow velocity; Heart; Humans; Incidence; Male; Medical records; Middle Aged; Neurosurgery; Obstructive sleep apnea; Pain Medicine; Patients; Preoperative Care - methods; Preoperative evaluation; Questionnaires; Right-sided heart dysfunction; Sensitivity and Specificity; Sleep apnea; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - diagnosis; STOP-Bang questionnaire; Surgery; Surveys and Questionnaires; Transthoracic echocardiography; Ultrasonic imaging; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - epidemiology
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2015.10.002

Abstract Study objective The aims of this study were to (1) explore the incidence of right-sided heart dysfunction (RHD) and STOP-Bang questionnaire responses consistent with obstructive sleep apnea (OSA) and (2) assess the relationship between patients with STOP-Bang questionnaire responses consistent with OSA and echocardiographic findings suggestive of RHD. Design Observational study. Setting Tertiary academic center preoperative clinic. Patients Two hundred patients presenting for elective surgery to the University of Utah preoperative clinic. Intervention Abbreviated transthoracic right-sided echocardiogram and STOP-Bang questionnaire. Measurements Tricuspid annular plane systolic excursion, tissue Doppler–derived tricuspid lateral annular systolic velocity (S′), and the tricuspid inflow E wave to tricuspid annular tissue Doppler e′ wave ratio (E/e′) for the presence of RHD, as well as responses to STOP-Bang questionnaire. Main results A total of 140 echocardiograms were analyzed after exclusion of participants with incomplete STOP-Bang questionnaires and inadequate images. Thirty-five patients (25%) reported 5 or more positive responses to the STOP-Bang questionnaire. Forty-six patients (35%) had abnormal right-sided heart measurements. Of the 35 patients with STOP-Bang scores 5 or greater, 11 (31%) had evidence of RHD. No correlation was observed between STOP-Bang scores and the echocardiography metrics of RHD. Conclusions This preliminary study suggests that there are numerous sources of RHD, among one of which is sleep apnea, and/or the STOP-Bang questionnaire is not a sensitive tool for predicting RHD. We conclude that although the STOP-Bang questionnaire is easy to implement in a preoperative clinical setting, it is not useful in identifying patients at risk for RHD.