Postoperative Complications in Patients With Obstructive Sleep Apnea

Department of Hospital Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Chest (Impact Factor: 7.48). 08/2011; 141(2):436-41. DOI: 10.1378/chest.11-0283
Source: PubMed


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.

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Available from: Vinay Pasupuleti, May 04, 2014
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    • "Taking these limitations into consideration, to separate cases from true controls, our group used PSG data on all 282 patients undergoing noncardiac surgery. This study confirmed that patients with OSA had a higher incidence of postoperative hypoxemia (OR, 7.9; P = 0.009), overall complications (OR, 6.9; P = 0.003), unplanned ICU transfer (OR, 4.43; P = 0.069), and higher hospital length of stay (OR, 1.65; P = 0.049) compared to 189 controls [19]. Also to account for study limitations as well as the single center data reported in most of these studies our group reported a meta-analysis using data on 3942 patients from 13 case control or cohort studies [20]. "
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    ABSTRACT: Modern surgery is faced with the emergence of newer "risk factors" and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery.
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