Airway collapsibility as an indicator of perioperative adverse event risk and obstructive sleep apnoea

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This project is an observational study assessing upper airway collapsibility and peri- and post-operative adverse events in patients undergoing surgery not related to the head, neck, airways or chest. Demographic and anthropometric (height, weight, neck circumference, Mallampati) information will be recorded and a STOP-Bang assessment performed prior to surgery in all consenting patients. Following surgery, prior to transfer to the recovery room, assessment of airway collapsibility will be performed using the Pclose technique. In addition, all adverse events including respiratory adverse events (respiratory depression (rate & depth), desaturation events, requirement for re-intubation or other medical intervention including unplanned initiation of positive airway pressure therapy) will be documented as well as length of stay in hospital and planned and unplanned intensive care unit or high dependency unit admissions. Within 3 weeks of surgery, sleep apnoea severity will be ascertained in a subgroup of consenting participants with a reliable home monitoring device (ApneaLink). The expected outcome of this research is to demonstrate that Pclose is a suitable method for quickly identifying the presence of abnormal airway collapsibility in surgical patients and that airway collapsibility, as measured by Pclose, is greater in those people who experience post-operative adverse events. This will then potentially enable high-risk patients to be stratified to the appropriate level of care and improve post-operative patient safety. It is hypothesised that more adverse respiratory events will occur in those patients with the greatest airway collapsibility. In addition, a measure of airway collapsibility in the early post-operative period may provide a useful tool for identifying patients at high risk of OSA beyond the perioperative period. In those patients, it is hypothesised that airway collapsibility will be greatest in those with the most severe OSA and lowest in those patients without OSA.

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