A critical appraisal of perioperative sleep apnoea management after nasal surgery: A review of up-to-date literature supplemented by findings of a retrospective observational study.
Anne Duvekot, Markus Klimek, Frank R Datema
PMID 38205591WHAT IT FOUND
In 61 obstructive sleep apnoea patients with nasal packing, only 13 had low oxygen levels and five needed oxygen.
No severe events occurred. The authors suggest general ward monitoring may replace intensive recovery unit admission, but this is an uncontrolled observation, not proof of safety.
Key findings
01Decreased oxygen saturation was observed in 13 patients, but only five required supplemental oxygen and no other interventions were needed.
02Using an oral CPAP interface instead of nasal packing could have avoided recovery unit admission in 90% of the study group, according to the authors' retrospective analysis.
03The authors acknowledge that randomised trials are lacking and that their suggestion to move patients to general wards is based on expert opinion and this single retrospective study.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is retrospective and observational, with no control group of patients monitored on a general ward, so it cannot prove that ward monitoring is safe. The sample size is small (61 patients), and the authors admit that respiratory events might be underestimated because patients slept poorly in the PACU due to noise and checks, potentially preventing the deep REM sleep where apnoeas are most severe. The authors suggest that using oral CPAP interfaces could avoid admission in 90% of cases, but this was a theoretical calculation based on literature, not a tested intervention in this patient group. Medical chart data may be incomplete, and the study only looked at the first postoperative night, whereas the authors note that the highest risk for respiratory events occurs on days three to four.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research.
The easy way to misread this
Do not interpret the low number of events as proof that general ward monitoring is safe for these patients. The study observed patients in a high-acuity setting (PACU) where they slept poorly, which may have masked respiratory events. The authors' recommendation to move patients to general wards is a suggestion for future research, not a validated protocol change.