ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Conscious (Moderate) Sedation Can Be Used Safely On Patients With Obstructive Sleep Apnea
Clinical Question Is conscious (moderate) sedation safe in patients with obstructive sleep apnea compared to patients without sleep apnea?
Clinical Bottom Line Conscious (moderate) sedation is a safe practice in patients with obstructive sleep apnea, though doses may have to be adjusted compared to patients without OSA.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21297544Gill/2011Veteran population/ 200 patients with OSA, 200 without OSA (control group)Retrospective Chart Review
Key resultsThis was a retrospective study on moderate (IV) sedation during endoscopy. The control group evidenced no complications. In the OSA group one patient had oxygen desaturation into 80's%. Oxygen supplementation was required, but no reversal agents or hospitalization was required. Medications used: Midazolam(mg), Meperidine(mg), Fentany(mcg), Promethazine(mg)
Evidence Search ("safety"[MeSH Terms] OR "safety"[All Fields]) AND ("conscious sedation"[MeSH Terms] OR ("conscious"[All Fields] AND "sedation"[All Fields]) OR "conscious sedation"[All Fields] OR ("moderate"[All Fields] AND "sedation"[All Fields]) OR "moderate sedation"[All Fields]) AND osa[All Fields] AND ("patients"[MeSH Terms] OR "patients"[All Fields])
Comments on
The Evidence
There is a limited amount of evidence available on conscious (moderate) sedation and safety on patients that have respiratory issues. This retrospective study of patients with OSA during endoscopy is a start, and shows that it is a safe practice, but doses should be initiated in smaller amounts and titrated to effect as compared to the general healthy population.
Applicability The patients in the Gill study were >93% males for both control and OSA groups with a mean age of 61 and a mean BMI of >28 for control and 33 for OSA patients. The results can be considered applicable to older males who may or may not have OSA and are overweight/obese.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Safety, moderate sedation, obstructive sleep apnea, conscious sedation
ID# 2112
Date of submission: 09/22/2011spacer
E-mail villarreald7@livemail.uthscsa.edu
Author Demitri Villarreal
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Erin Son, Erin Kern (San Antonio, TX) on 11/28/2017
Terms related to this CAT were searched in PubMed November of 2017 which yielded a more recent and higher level of evidence by Andrade et al. 2016 (PMID: 25768974) This prospective cohort study followed 248 confirmed moderate or severe OSA patients and 252 patients without OSA and measured their cardiopulmonary variables (e.g., heart rate, blood pressure, and blood oxygen saturation) during a gastrointestinal endoscopy procedure with conscious sedation. They found clinically insignificant variations in the cardiopulmonary parameters between the two groups. Therefore, preventative measures are not necessary with conscious sedation in patients with OSA. This conclusion continues to support the clinical bottom line for this topic.
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