Postoperative Complications in Patients With Obstructive Sleep Apnea

Department of Hospital Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Chest (Impact Factor: 7.13). 08/2011; 141(2):436-41. DOI: 10.1378/chest.11-0283
Source: PubMed

ABSTRACT Unrecognized obstructive sleep apnea (OSA) is associated with unfavorable perio-perative outcomes among patients undergoing noncardiac surgery (NCS).
The study population was chosen from 39,771 patients who underwent internal medicine preoperative assessment between January 2002 and December 2006. Patients undergoing NCS within 3 years of polysomnography (PSG) were considered for the study, whereas those < 18 years of age, with a history of upper airway surgery, or who had had minor surgery under local or regional anesthesia were excluded. Patients with an apnea-hypopnea index (AHI) ≥ 5 were defined as OSA and those with an AHI < 5 as control subjects. For adjusting baseline differences in age, sex, race, BMI, type of anesthesia, American Society of Anesthesiology class, and medical comorbidities, the patients were classified into five quintiles according to a propensity score.
Out of a total of 1,759 patients who underwent both PSG and NCS, 471 met the study criteria. Of these, 282 patients had OSA, and the remaining 189 served as control subjects. The presence of OSA was associated with a higher incidence of postoperative hypoxemia (OR, 7.9; P = .009), overall complications (OR, 6.9; P = .003), and ICU transfer (OR, 4.43; P = .069), and a longer hospital length of stay (LOS), (OR, 1.65; P = .049). Neither an AHI nor use of continuous positive airway pressure at home before surgery was associated with postoperative complications (P = .3 and P = .75, respectively) or LOS (P = .97 and P = .21, respectively).
Patients with OSA are at higher risk of postoperative hypoxemia, ICU transfers, and longer hospital stay.

1 Follower
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    ABSTRACT: Obstructive sleep apnea (OSA) has been linked to a myriad of chronic diseases with physically serious and economically draining consequences. There has been a substantial increase in its prevalence over the last two decades and up to one-quarter of the elective surgical patients have been found to be at high risk for OSA. These patients are at an increased risk for perioperative adverse events such as cardiac and pulmonary complications as well as postoperative delirium. This review addresses the screening methods such as the STOP-Bang questionnaire for the undiagnosed and the preoperative management of the known and at-risk patients. Recommendations for the evaluation of the systemic complications and its management are included. Recent suggestions for the intraoperative management and risk mitigation methods are reviewed, such as the role of regional anesthesia and non-opioid analgesics. Special focuses on postoperative issues such as pain control, oxygenation, positioning, and patient disposition are also included.
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    ABSTRACT: To determine whether a diagnosis of obstructive sleep apnea (OSA) imparts an increased risk of postoperative respiratory failure, cardiac events, and intensive care unit (ICU) transfer than patients with no OSA diagnosis. Systematic review and meta-analysis. Academic Veterans Affairs Medical Center. PubMed, EMBASE, CINAHL, and ISI Web of Knowledge databases were searched through April 2013 for studies that examined the relationship between OSA and postoperative respiratory and cardiac complications among adults. Either fixed or random-effects models were used to calculate the pooled risk estimates. Sensitivity analysis was conducted to examine the robustness of pooled outcomes. Seventeen studies with a total of 7,162 patients were included. Overall, OSA was associated with significant increase in risk of respiratory failure [odds ratio (OR) 2.42; 95% confidence intervals (CI) 1.53 - 3.84; P = 0.0002] and cardiac events postoperatively (OR = 1.63; 95% CI 1.16 - 2.29; P = 0.005). Heterogeneity was low for these outcomes (I(2) = 5% and 0%, respectively). ICU transfer occurred also more frequently in patients with OSA (OR 2.46; 95% CI 1.29 - 4.68; P = 0.006). These results did not materially change in the sensitivity analyses according to various inclusion criteria. Surgical patients with OSA are at increased risk of postoperative respiratory failure, cardiac events, and ICU transfer. Published by Elsevier Inc.
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