Preoperative Screening for Obstructive Sleep Apnea Prior to Endoscopic Skull Base Surgery: A Survey of the North American Skull Base Society

Ryan A Rimmer; Chandala Chitguppi; Glen D'Souza; Marc R Rosen; Gurston G Nyquist; Elina Toskala; James J Evans; Christopher Farrell; Maurits Boon; Colin Huntley; Mindy R Rabinowitz

doi:10.1177/2152656720968801

Preoperative Screening for Obstructive Sleep Apnea Prior to Endoscopic Skull Base Surgery: A Survey of the North American Skull Base Society

Allergy Rhinol (Providence). 2020 Nov 12:11:2152656720968801. doi: 10.1177/2152656720968801. eCollection 2020 Jan-Dec.

Authors

Ryan A Rimmer¹, Chandala Chitguppi¹, Glen D'Souza¹, Marc R Rosen^{1

2}, Gurston G Nyquist^{1

2}, Elina Toskala¹, James J Evans^{1

2}, Christopher Farrell^{1

2}, Maurits Boon¹, Colin Huntley¹, Mindy R Rabinowitz^{1

2}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
² Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

Abstract

Background: Obstructive sleep apnea (OSA) is a commonly seen comorbidity in patients undergoing endoscopic skull base surgery and its presence may influence perioperative decision-making. Current practice patterns for preoperative screening of OSA are poorly understood.

Objective: The objective of this study was to assess how endoscopic skull base surgeons screen for OSA, and how knowledge of OSA affects perioperative decision-making.

Methods: Seven question survey distributed to members of the North American Skull Base Society.

Results: Eighty-eight responses (10% response rate) were received. 60% of respondents were from academic centers who personally performed >50 cases per year. Most respondents noted that preoperative knowledge of OSA and its severity affected postoperative care and increased their concern for complications. Half of respondents noted that preoperative knowledge of OSA and its severity affects intraoperative skull base reconstruction decision-making. 70% of respondents did not have a preoperative OSA screening protocol. Body mass index and patient history were most frequently used by those who screened. Validated screening questionnaires were rarely used. 76% of respondents agreed or somewhat agreed that a preoperative polysomnogram should ideally be performed for patients with suspected OSA; however, 50% of respondents reported that <20% of their patients with suspected OSA are advised to obtain a preoperative polysomnogram.

Conclusion: This study reveals that most endoscopic skull base surgeons agree that OSA affects postoperative patient care, but only a minority have a preoperative screening protocol in place. Additional study is needed to assess the most appropriate screening methods and protocols for OSA patients undergoing endoscopic skull base surgery.

Keywords: anterior skull base; chronic disease; endoscopic skull base surgery; from index medicus; obstructive sleep apnea; post-operative; skull base repair.