Original ArticlePostoperative Complications in Patients With Obstructive Sleep Apnea Syndrome Undergoing Hip or Knee Replacement: A Case-Control Study
Section snippets
Inclusion Criteria
Mayo Clinic Total Joint Registry and Sleep Center databases were used to identify the patients with a clinically suspected or objectively documented diagnosis of OSAS between January 1995 and December 1998 and undergoing hip or knee replacement at our institution. Patients with OSAS who had their orthopedic surgery within 3 years before or anytime after the diagnosis were included. We assumed that, if the operation was done within 3 years before the diagnosis, the patient had unrecognized OSAS
RESULTS
A total of 122 patients met the time period criterion set forth for inclusion. Of these, 21 patients were excluded, 18 because they lacked objective data (oximetry or PSG) to confirm clinical suspicion of OSAS and 3 because their PSG was performed elsewhere and no details were available. For the sake of simplicity in data presentation, the remaining 101 study patients were grouped by diagnostic status.
Group 1A consisted of 36 patients with OSAS undiagnosed before their joint replacement. These
DISCUSSION
Unexpected and unexplained postoperative deaths, within 7 days of an operation, most often occur at night.18 Cardio-pulmonary events related to sleep have been proposed as the most likely cause of postoperative mortality at night.19 Gill et al20 showed that prolonged episodes of myocardial ischemia, as recorded by electrocardiogram, occurred during hypoxemia.
Many factors influence the development of respiratory instability and episodic desaturation in the postoperative period, including sleep,
CONCLUSIONS
In this study, we have shown that the presence of OSAS in patients undergoing elective hip replacement or knee replacement is associated with a considerable number of complications in the postoperative period. Almost one third of the patients with OSAS in our study suffered a substantial respiratory or cardiac complication. Patients who were not using CPAP prior to hospitalization had a significantly higher incidence of serious complications. Patients diagnosed with OSAS have been shown to be
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