Sleep-disordered breathing and the patient undergoing endoscopy: Considerations for optimization of periprocedural care

A significant proportion of patients undergoing ambulatory procedures is at risk for sleep-disordered breathing (SDB). Obstructive sleep apnea is the most common diagnosis, but other types such as opioid-related central apnea are important variants. Long-term cardiovascular, neurologic, and related sequelae of untreated SDB are significant such that screening at-risk patients with low-tech bedside tools such as STOP-BANG is warranted. Patients with presumptive SDB should be educated about the disease and referred for specialty evaluation and formal diagnosis. Those with known or presumptive moderate-to-severe disease warrant a special clinical pathway that may include sedation by an anesthesia provider with airway rescue experience and familiarity with a broader range of sedative-hypnotic medications, the availability of respiratory therapy support for periprocedural use of continuous positive airway pressure devices, and heightened vigilance and monitoring in the recovery suite.