Featured Articles from January 2013

Serum Bicarbonate Level Improves Specificity of STOP-Bang Screening for OSA

A STOP-Bang score ≥3 is highly sensitive but only moderately specific. Apnea/hypopnea during sleep can lead to intermittent hypercapnia and may result in serum bicarbonate (HCO3-) retention. The addition of serum HCO3– to the STOP-Bang questionnaire may improve its specificity. With the addition of HCO3– ≥28 mmol/L to the STOP-Bang score ≥3, the specificity for all OSA, moderate/severe OSA and severe OSA improved to 85.2%, 81.7%, 79.7%, respectively. Serum HCO3– level increases the specificity of STOP-Bang screening in predicting moderate/severe OSA. The authors propose a 2-step screening process. The first step uses a STOP-Bang score to screen patients and the second step uses serum HCO3– in those with a STOP-Bang score ≥3 for increased specificity.


The ASPAN Obstructive Sleep Apnea in the Adult Patient Evidence-Based Practice Recommendation

A vision of the American Society of PeriAnesthesia Nurses (ASPAN) is to provide empirical support to guide the safe care of perianesthesia patients. Biannually, the Perianesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements are revised to include the most current evidence-based findings. The development of an OSA Practice Recommendation was identified as a priority for 2012 by the ASPAN Board of Directors. Clinical practice (CP) questions relating to the safe care of patients with obstructive sleep apnea (OSA) are received monthly by ASPAN from national and international perianesthesia nurses. Eighteen questions were refined from the CP questions relating to OSA. ASPAN’s evidence based practice process was used for the literature search, critical review of the evidence and consensus of recommendations for the development and refinement of the OSA-Practice Recommendation.