The Association Between the STOP-Bang Score and the Integrated Pulmonary Index in Patients Undergoing Endobronchial Ultrasound with Sedation: The STOP OSA-IPI Cohort Study.

Background and Perspectives: Obstructive sleep apnea (OSA) is a prevalent condition associated with increased perioperative risks. Endobronchial ultrasound (EBUS), a diagnostic and staging procedure requiring deep sedation, may pose additional risks for patients at high risk of OSA. The Integrated Pulmonary Index (IPI), derived from capnography and vital signs, offers a single numerical value reflecting respiratory status. This study aimed to assess the association between high OSA risk and adverse events using the IPI during EBUS under sedation. Materials and

Methods

This prospective cohort study included 65 patients undergoing EBUS with sedation between December 2024 and April 2025 at a tertiary referral center. STOP-Bang questionnaire scores were used to stratify patients into high- (≥3) and low-risk (<3) OSA groups. During the procedure, IPI, oxygen saturation, end-tidal carbon dioxide, respiratory rate, and hemodynamic parameters were recorded at multiple time points. Hypoxemia, hypoventilation, and apnea were defined using standard thresholds. Logistic regression and Generalized Linear Mixed Models (GLMM) were applied to examine associations between OSA risk and respiratory outcomes.

Results

Forty-three patients (66.2%) were classified as high risk for OSA. Patients with high STOP-Bang scores were older and had higher BMI, comorbidity rates, and ASA scores (all p < 0.05). IPI values were lowest between 5 and 10 min, accompanied by more frequent interventions. Logistic regression showed no significant association between STOP-Bang scores and low IPI or hypoxemia. GLMM analysis also indicated no significant association between high OSA risk and low IPI (OR = 1.02; 95% CI = 0.36-2.86; p = 0.974). Hypoxemia was nearly threefold higher in high-risk patients, though not statistically significant (p = 0.080).

Conclusions

Although no statistically significant association was identified between high OSA risk and adverse respiratory events, GLMM analyses revealed that patients with high STOP-Bang scores demonstrated approximately three times higher odds of developing hypoxemia (OR = 2.76; 95% CI = 0.99-7.66; p = 0.052), a result that approached statistical significance. The present findings do not support the routine use of IPI-based monitoring in this setting, and further adequately powered studies are warranted. The early procedural period (5-10 min) is critical for hypoxemia and respiratory compromise.