Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2017; 9(11): 552-557
Published online Nov 16, 2017. doi: 10.4253/wjge.v9.i11.552
Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea
Christian M Andrade, Brijesh Patel, Meghana Vellanki, Ambuj Kumar, Gitanjali Vidyarthi
Christian M Andrade, Brijesh Patel, Gitanjali Vidyarthi, the James A. Haley Veterans Affairs, Department of Gastroenterology, Tampa, FL 33612, United States
Christian M Andrade, Brijesh Patel, Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL 33612, United States
Meghana Vellanki, Morsani College of Medicine, University of South Florida Tampa, FL 33612, United States
Ambuj Kumar, Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
Author contributions: Andrade CM and Patel B contributed to conception and design, acquisition of data; Andrade CM, Patel B and Vellanki M interpreted the data, drafted the article; Kumar A and Vidyarthi G analyzed and interpreted the data; Vidyarthi G revised the article; all authors approved the final version to be submitted.
Conflict-of-interest statement: The authors deny any conflict of interest. This manuscript is not under consideration elsewhere.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Brijesh Patel, MD, Division of Digestive Diseases and Nutrition, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 72, Tampa, FL 33612, United States. bpatel10@health.usf.edu
Telephone: +1-305-9348973 Fax: +1-813-9745333
Received: January 27, 2017
Peer-review started: February 6, 2017
First decision: March 16, 2017
Revised: April 25, 2017
Accepted: July 22, 2017
Article in press: July 24, 2017
Published online: November 16, 2017
Processing time: 291 Days and 9.1 Hours
Abstract
AIM

To perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea (OSA).

METHODS

A comprehensive electronic search of MEDLINE and EMBASE was performed from inception until March 1, 2015. In an effort to include unpublished data, abstracts from prior gastroenterological society meetings as well as other reference sources were interrogated. After study selection, two authors utilizing a standardized data extraction form collected the data independently. Any disagreements between authors were resolved by consensus among four authors. The methodological quality was assessed using the Newcastle Ottawa tool for observational studies. The primary variables of interest included incidence of hypoxia, hypotension, tachycardia, and bradycardia. Continuous data were summarized as odds ratio (OR) and 95%CI and pooled using generic inverse variance under the random-effects model. Heterogeneity between pooled studies was assessed using the I2 statistic.

RESULTS

Initial search of MEDLINE and EMBASE identified 357 citations. A search of meeting abstracts did not yield any relevant citations. After systematic review and exclusion consensus meetings, seven studies met the a priori determined inclusion criteria. The overall methodological quality of included studies ranged from moderate to low. No significant differences between OSA patients and controls were identified among any of the study variables: Incidence of hypoxia (7 studies, 3005 patients; OR = 1.11; 95%CI: 0.73-1.11; P = 0.47; I2 = 0%), incidence of hypotension (4 studies, 2125 patients; OR = 1.10; 95%CI: 0.75-1.60; P = 0.63; I2 = 0%), incidence of tachycardia (3 studies, 2030 patients; OR = 0.94; 95%CI: 0.53-1.65; P = 0.28; I2 = 21%), and incidence of bradycardia (3 studies, 2030 patients; OR = 0.88; 95%CI: 0.63-1.22; P = 0.59; I2 = 0%).

CONCLUSION

OSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures with conscious sedation.

Keywords: Conscious sedation; Obstructive sleep apnea; Endoscopy; Complications; Safety; Meta-analysis

Core tip: Patients with obstructive sleep apnea (OSA) often receive monitored anesthesia care in lieu of conscious sedation due to a perceived elevated risk of complications. However, prior studies have failed to note any clinically significant variations in cardiopulmonary parameters in OSA patients when compared to controls during endoscopy but studies have been underpowered due to small sample sizes. The objective was to perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with OSA. This meta-analysis showed OSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures with conscious sedation.