Study Shows Large Percentage of Surgical Patients With Undiagnosed Obstructive Sleep Apnea

Preoperatively, surgeons were not aware of the ongoing study and did not identify 90% of the patients who had severe OSA. Anesthesiologists did not diagnose 53% of these patients.

Singh M, Liao P, Kobah S, Wijeysundera DN, Shapiro C, Chung F

Br J Anaesth. 2013;110:629-636

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Study Summary
The goal of this study was to better understand how many patients arriving to the operating room have undiagnosed obstructive sleep apnea (OSA). A better way to identify these patients ahead of time would be useful for tailoring the anesthetic as well as postoperative care and monitoring.

Singh and colleagues asked almost 6000 patients who were seen in a preoperative clinic in Toronto to enroll in this study, and 1085 agreed. After dropouts, 819 patients completed the study. Of the 819 patients, 111 patients had pre-existing OSA. The remaining 708 patients were screened for OSA.

First, patients answered the screening STOP-BANG questionnaire:

• Do you snore loudly (loud enough to be heard through closed doors)?

• Do you often feel tired, fatigued, or sleepy during the daytime?

• Has anyone observed you stop breathing during your sleep?

• Do you have or are you being treated for high blood pressure?

• Is your body mass index > 35 kg/m2?

• Is your age over 50 years old?

• Is your neck circumference > 40 cm?

• Are you male?

A person is deemed to be at high risk for OSA if he or she answers yes to 5 or more of the 8 questions.

The patients also underwent a sleep study (polysomnography) to measure the number of abnormal respiratory events (apnea or hypopnea) per hour of sleep. More than 30 of these events per hour is diagnostic for severe sleep apnea, as is an apnea/hypopnea index (AHI) score > 30.

Among the 708 study patients with no pre-existing diagnosis of OSA, 31% had no OSA, 31% had mild OSA (AHI: 5-15), 21% had moderate OSA (AHI: 15-30), and 17% had severe OSA (AHI > 30).

Preoperatively, surgeons were not aware of the ongoing study and did not identify 90% of the patients who had severe OSA. Anesthesiologists did not diagnose 53% of these patients. Overall, one third of patients with sleep study-identified OSA had only 1 or no cardinal symptoms of OSA. This indicates that these asymptomatic, “silent” patients are not going to be identified purely by history obtained by the physician.

More than 60% of the sleep study-identified patients with moderate and severe sleep apnea reported at least 2 symptoms suggestive of the diagnosis. These symptoms were daytime sleepiness (most common), witnessed apnea, and snoring. Singh and colleagues suggest that, had patients been screened before their surgeries with the STOP-BANG questionnaire, most cases of undiagnosed moderate and severe OSA would have been identified.

In patients with sleep apnea, perioperative pulmonary complications after orthopaedic and general surgery are significantly more frequent vs matched samples without sleep apnea, according to new research.

Stavros Memtsoudis, MD, with the Weill Medical College of Cornell University, in New York, NY, and colleagues reported their findings in Anesthesia & Analgesia.

Sleep apnea increased the risk for perioperative tracheal intubation and mechanical ventilation by 5-fold after orthopaedic surgery and doubled the risk after general surgical procedures, the researchers report.

1.  Gross JB, Bachenberg KL, Benumof JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006;104:1081-1093.

2.  Giarda M, Brucoli M, Arcuri F, Braghiroli A, Valletti PA, Benech A. Proposal of a presurgical algorithm for patients affected by obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 2012;70:2433-2439.

3.  Seet E, Chung F. Management of sleep apnea in adults – functional algorithms for the perioperative period: Continuing Professional Development. Can J Anaesth. 2010;57:849-864.

Anesthesiologists worry that such patients will be at higher recovery risk, especially when discharged home on opioids for pain. These patients may also have a higher incidence of difficult intubation, postoperative complications including delirium, increased admissions to the intensive care unit, and longer hospital stays.

Almost one fifth of surgical patients have previously undiagnosed severe OSA. These patients were only diagnosed because they agreed to be enrolled in this study. As the investigators commented, the disparity between a high prevalence of undiagnosed OSA in the population and the low level of recognition and diagnosis at the time of preoperative consultation by surgeons and anesthesiologists is important.

It should be possible to reduce the proportion of undiagnosed severe OSA by implementing a formal screening tool as part of the routine preoperative anesthesia assessment. The results of screening can be used to determine whether a formal sleep study is indicated. In addition to the American Society of Anesthesiologists[1] practice guidelines, functional algorithms have been published that recommend preoperative screening.[2,3] This information has value beyond the benefits to anesthesia care. After being diagnosed with OSA, the patient can be referred to an internist or sleep physician to receive proper long-term treatment after the operation.

Source of information: MedScape

If you weren’t there, you missed one of the best Sleep Medicine seminars ever.

Twenty-one attendees- novices and experienced dentists alike, were treated to 8 hours of practical, valuable “hands-on” education, demonstrating the selection, placement and titration of various Oral Appliances. On Saturday, 20 April 2013, at the SGS offices in Hollywood, Florida, there were dentists from Virginia, Maryland, NYC, Missouri, and throughout Florida.

Dr. Michael Gelb who is respected as one of the most knowledgeable dentists in sleep disorders and TMD was joined by David Walton, founding partner of Respire Medical, and Ben Scarborough of Sleep Group Solutions.

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Dr. Gelb said , “For men, sleep apnea is a lifestyle problem.” He explained how it effects so much of normal function. Referring to oral appliance toleration, he compares oral appliances to Invisalign trays. Dr. Gelb prefers the hard/hard appliances because they are easier to trim and adjust, easier to clean, and are thinner on the lingual surfaces, which provides more room for the tongue.

Meeting attendees had the opportunity to make their own appliances. David Walton said he is considering holding this program again in a few months. Look for it!

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In the meantime, you can choose from this comprehensive selection of cities and dates of sleep seminars presented by some of the most highly recognized experts in Sleep Medicine.

Dr. Gelb will be speaking at the AAPMD in Oakland, Calif. on Fri June 14 – Sat June 15. The American Association of Physiological Medicine & Dentistry is a multidisciplinary group formed to build a bridge between physicians, dentists, other health care practitioners and the public to provide fuller, integrated care for children and adults.
David Walton’s Herbst Pink, Respire Blue and Green are among the world’s most popular sleep apnea intra-oral appliances.
Ben Scarborough is a Speaker and Account Representative of Sleep Group Solutions, the nations’ most comprehensive organization in Sleep Apnea education and service.



Are you looking for a way to stand out in your community? Here is how you can gain respect as a Leader, generate New Patients, and provide a great public service.

Select a topic that will draw an audience.The “hottest” topic today is Sleep Apnea. Just google into the internet and you will see the widespread interest in SA. People are becoming very aware of the dangers caused by the stoppage of breathing while they are asleep. They are looking for answers and very few Dentists are prepared. Take a training course or a seminar, become knowledgeable in the signs and symptoms, the risk factors,and in the various treatment options. Sharpen your expertise.
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Here’s how you do it:
Present a free seminar in your Reception Room. Select a date at least one month out so you and your invitees will be able to get it into your schedules.
How to Announce and Promote it:
  • Have a “sign-up sheet in your office
  • Send out email announcements to patients of record; ask them to assure their place by return email.
  • Let each invitee know that they may invite two friends or relatives.
  • Place a large colorful poster in your Reception Room.
  • Distribute flyers to local businesses and professional offices.
  • Place a small display ad in your local newspaper.


Some Tips for your Seminar
  • Present it in the largest room in your office- usually the Reception Room
  • Prevent any interruptions – turn off phone ringers, etc.
  • Have a “Welcome Table” with some juices and other beverages (sugarless, of course).
  • Have your flyers, brochures, and business cards on the “Welcome Table”.
  • Prepare a power point presentation with video.
  • Subjects like Sleep Apnea are serious, but to keep the audience entertained, infuse some humor.
  • Encourage interactive participation. Invite questions from the audience.
  • Prepare some hand-outs for the participants to take home.
  • These are just a few ideas. I am sure you will think of a lot more.

Objectives and Outcomes

You will be respected as a Leader and Educator.

You will generate New Patient leads.

You will provide a needed and valuable public service.

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Sleep Apnea from A to Z with Dr. Marty Lipsey in Indianapolis on April 12th and 13th

Learn Sleep Apnea Medical Insurance Billing in Indianapolis, Indiana

 This course is designed to provide you with the knowledge to confidently return to your practice and immediately begin implementing new screening and treatment protocols.


In this 2 day seminar Dr. Marty Lipsey presents a Dental Sleep protocol from A to Z, including Medical Insurance billing- Codes, Fees and Procedures.

After the Seminar Dr. Lipsey will continue to Mentor you, giving you the confidence to be a Sleep Medicine Doctor.

 Read the 2-day course outline and register here:

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About Dr. Marty Lipsey the Instructor:

Dr. Marty Lipsey

Dr. Marty Lipsey, received his DDS degree from UCLA and a Master of Science from Northwestern University Dental School. Dr. Lipsey is the founder of Dental Sleep Med Systems, offering dental teams assistance in implementing and/or improving their dental sleep medicine practices, including electronic medical billing and successful insurance coding and processing. Dr. Lipsey is also a Sleep Group Solutions Instructor, and teaches Dental Sleep Medicine regularly.