When many people think of sleep apnea, the first thing that comes to mind may be snoring, or perhaps the inconvenience of a CPAP machine. Beyond these concerns, though, the most common type of sleep apnea, called obstructive sleep apnea, is a serious and potentially life-threatening medical condition.
Obstructive sleep apnea is a medical condition where the muscles of the throat and soft palate intermittently relax during sleep. When this happens, those anatomical structures drop and partially or fully obstruct the airway. People with obstructive sleep apnea often make a loud snorting sound when this occurs.
From a medical malpractice perspective, we’ve found that there are two common ways that doctors and mid-level providers (nurse practitioners, physician assistants, and certified registered nurse anesthetists) make mistakes in addressing obstructive sleep apnea:
• Failing to diagnose and treat this chronic condition.
• Failing to identify the potential for undiagnosed obstructive sleep apnea and take appropriate precautions before administering general anesthesia for surgery.
Diagnosis and treatment
Most patients diagnosed with obstructive sleep apnea are men over 40 years old who are overweight or obese. Other common risk factors include a large neck circumference and a family history of snoring or having this condition. Nevertheless, people of any age, even infants, could have obstructive sleep apnea.
When a patient has an early-stage or mild case of obstructive sleep apnea, some physicians and providers recommend lifestyle changes. These include common health care themes of eating healthier, eating less, and exercising more. Some people with obstructive sleep apnea even harness the power of yoga to help exercise and tone the muscles of the throat, soft palate, and upper airway. You can read about some sleep apnea yoga ideas from Slumber Yard here.
In more serious cases, a primary care provider may recommend an evaluation by a sleep medicine physician, which would likely include a sleep study. Therapies for moderate to severe obstructive sleep apnea include medical devices like the continuous positive airway pressure (CPAP) machine.
It’s our responsibility as patients to seek regular preventative medical care. It’s the responsible of our primary care and other physicians not to zone out during these visits, but rather to do a thorough assessment and workup for potential conditions, including obstructive sleep apnea. The risk to patients in not timely identifying and treating this condition are many. At the top of the list, of course, is death from a lack of oxygen, but it also increases a person’s risk of heart attack, other cardiac conditions, and stroke.
Medical studies have shown that a whopping 80% of people with moderate to severe obstructive sleep apnea haven’t been diagnosed. It’s easy to imagine the risk to those patients who show up at the hospital or ambulatory surgical center operating room for a surgical procedure. One of those risks is general anesthesia because it slows down breathing and can make emergence (waking up after surgery and general anesthesia) more difficult.
Anesthesia providers—physician anesthesiologists and certified registered nurse anesthetists (CRNAs)—have the responsibility for performing a pre-anesthesia evaluation and assessment of patients. They have the authority to stop a surgical procedure if they think it’s unreasonably dangerous for a patient to proceed. This pre-anesthesia workup includes, at a minimum taking a patient history and reviewing the relevant medical records.
Unfortunately, in my opinion, many surgeries requiring general anesthesia proceed with little to no workup before the day of surgery. This is true even in patients with one or more risk factors, and despite the fact that an advance workup is not really that expensive. On the day of surgery, I believe anesthesia providers are more likely to greenlight a procedure because the operating room and staff are waiting for the patient.
Add to this mix the significant problem of obstructive sleep apnea. It’s such a significant problem, that anesthesia experts have come up with a screening tool to help identify patients with undiagnosed obstructive sleep apnea. It’s called STOP-Bang Score, and it’s assessed like this:
Snoring: Do you snore loud enough to be heard through closed doors?
Tiredness: Do you often feel tired, fatigued, or sleepy during the daytime?
Observed you stop breathing?
Blood Pressure: Do you have, or have you been treated for high blood pressure?
Body mass index (BMI) over 35?
Age over 50?
Neck circumference over 16 inches?
Anesthesia providers interpret the STOP BANG scores like this:
Low risk of obstructive sleep apnea: “Yes” to 0–2 questions.
Intermediate risk: “Yes” to 3–4 questions.
High risk: (1) “Yes” to 5–8 questions, or (2) “Yes” to 2+ STOP questions and male gender, or (3) “Yes” to 2+ STOP questions and BMI > 35, or (4) “Yes” to 2+ STOP questions and neck circumference of greater than 17 inches in males or greater than 16 inches in females.
For patients diagnosed with obstructive sleep apnea, or who have an elevated risk of having the condition but being undiagnosed, the standard of care requires the anesthesiologist and CRNA to take special precautions. They should consider holding pre-operative sedative medications, preparing for a potentially dangerous airway, and extra monitoring after surgery.
If you’ve been seriously injured because of poor anesthesia, surgical, or operating room care in Texas, then contact a top-rated Houston, Texas medical malpractice lawyer about your potential case.