nach oben

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

01.11.2009 | Reports of Original Investigations

Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study

verfasst von: Pu Liao, MD, Balaji Yegneswaran, MBBS, Santhira Vairavanathan, MBBS, Paul Zilberman, MD, Frances Chung, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 11/2009

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Obstructive sleep apnea (OSA) is presumed to be a risk factor for postoperative morbidity and mortality, but the current evidence is incomplete. This retrospective matched cohort study tested the hypothesis that OSA is a risk factor for the development of postoperative complications.

Methods

Hospital ethics approval was obtained for the conduct of this study. The patients who were selected for the study were >18 yr of age, diagnosed preoperatively with OSA, and scheduled to undergo elective surgery. A cohort of surgical patients without OSA was used as a comparator group based on a one-to-one match. Matching criteria included gender, age difference <5 yr, type of surgery, and a <5 yr difference between two surgery dates. Summary data are presented and conditional logistic regression was used to identify risk factors for postoperative complications.

Results

The 240 pairs of study subjects aged 57 ± 13 yr included 184 (77%) males and 56 (23%) females. The OSA patients had a higher mean body mass index relative to their non-OSA counterparts (35 ± 9 vs 28 ± 6 kg · m⁻², respectively) and a higher frequency of co-morbidities, including hypertension (48% vs 36%, respectively) and obesity (61% vs 23%, respectively). Also, the incidence of postoperative complications in the OSA patients was significantly greater (44% OSA group vs 28% non-OSA group; P < 0.05). The most commonly observed between-group difference was oxygen desaturation < 90% (17% OSA group vs 8% non-OSA group). The OSA patients who did not use home continuous positive airway pressure (CPAP) devices prior to surgery but required the use of a CPAP device after surgery had the highest rate of complications. Conditional logistic regression was used to diagnose OSA and pre-existing stroke as significant risk factors for developing postoperative complications. The hazard ratio for OSA was 2.0 (1.25–3.19).

Conclusion

Patients with diagnosed OSA have an increased incidence of postoperative complications, the most frequent being oxygen desaturation.

Nur mit Berechtigung zugänglich

Kryger MH. Diagnosis and management of sleep apnea syndrome. Clin Cornerstone 2000; 2: 39–47.CrossRefPubMed

Young T, Hutton R, Finn L, Badr S, Palta M. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 1996; 156: 2445–51.CrossRefPubMed

Bresnitz EA, Goldberg R, Kosinski RM. Epidemiology of obstructive sleep apnea. Epidemiol Rev 1994; 16: 210–27.PubMed

Simonds AK. Sleep studies of respiratory function and home respiratory support. BMJ 1994; 309: 35–40.PubMed

Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnoea with myocardial infarction in men. Lancet 1990; 336: 261–4.CrossRefPubMed

Doherty LS, Kiely JL, Swan V, McNicholas WT. Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 2005; 127: 2076–84.CrossRefPubMed

Leung RS, Bradley TD. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 2001; 164: 2147–65.PubMed

Moruzzi P, Sarzi-Braga S, Rossi M, Contini M. Sleep apnoea in ischaemic heart disease: differences between acute and chronic coronary syndromes. Heart 1999; 82: 343–7.PubMed

Schafer H, Koehler U, Ploch T, Peter JH. Sleep-related myocardial ischemia and sleep structure in patients with obstructive sleep apnea and coronary heart disease. Chest 1997; 111: 387–93.CrossRefPubMed

10.

Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008; 31: 1071–8.PubMed

11.

Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003; 107: 2589–94.PubMed

12.

Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003; 13: 676–83.CrossRefPubMed

13.

Chung F, Ward B, Ho J, Yuan H, Kayumov L, Shapiro C. Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth 2007; 19: 130–4.CrossRefPubMed

14.

Isono S, Kochi T, Ide T, Sugimori K, Mizuguchi T, Nishino T. Differential effects of vecuronium on diaphragm and geniohyoid muscle in anaesthetized dogs. Br J Anaesth 1992; 68: 239–43.CrossRefPubMed

15.

Keamy MF III, Cadieux RJ, Kofke WA, Kales A. The occurrence of obstructive sleep apnea in a recovery room patient. Anesthesiology 1987; 66: 232–4.CrossRefPubMed

16.

Lamarche Y, Martin R, Reiher J, Blaise G. The sleep apnoea syndrome and epidural morphine. Can Anaesth Soc J 1986; 33: 231–3.CrossRefPubMed

17.

Samuels SI, Rabinov W. Difficulty reversing drug-induced coma in a patient with sleep apnea. Anesth Analg 1986; 65: 1222–4.CrossRefPubMed

18.

Cullen DJ. Obstructive sleep apnea and postoperative analgesia—a potentially dangerous combination. J Clin Anesth 2001; 13: 83–5.CrossRefPubMed

19.

Catley DM, Thornton C, Jordan C, Lehane JR, Royston D, Jones JG. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology 1985; 63: 20–8.CrossRefPubMed

20.

Reeder MK, Goldman MD, Loh L, Muir AD, Casey KR, Lehane JR. Late postoperative nocturnal dips in oxygen saturation in patients undergoing major abdominal vascular surgery. Predictive value of pre-operative overnight pulse oximetry. Anaesthesia 1992; 47: 110–5.CrossRefPubMed

21.

Rosenberg J, Wildschiodtz G, Pedersen MH, von Jessen F, Kehlet H. Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. Br J Anaesth 1994; 72: 145–50.CrossRefPubMed

22.

Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clinic Proc 2001; 76: 897–905.CrossRef

23.

Fleiss JL, Levin B, Paik MC. Regression models for matched samples. Statistical methods for rates and proportions. 3rd ed. Wiley; 2004.

24.

Alexander MT, Kufera JA. Butting heads on matched cohort analysis using SAS^® software. www.nesug.org/proceedings/nesug07/sa/sa01.pdf. Accessed August 2009.

25.

Hathaway B, Johnson JT. Safety of uvulopalatopharyngoplasty as outpatient surgery. Otolaryngol Head Neck Surg 2006; 134: 542–4.CrossRefPubMed

26.

Esclamado RM, Glenn MG, McCulloch TM, Cummings CW. Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome. Laryngoscope 1989; 99: 1125–9.PubMed

27.

Kim JA, Lee JJ, Jung HH. Predictive factors of immediate postoperative complications after uvulopalatopharyngoplasty. Laryngoscope 2005; 115: 1837–40.CrossRefPubMed

28.

Pang KP. Identifying patients who need close monitoring during and after upper airway surgery for obstructive sleep apnoea. J Laryngol Otol 2006; 120: 655–60.CrossRefPubMed

29.

Terris DJ, Fincher EF, Hanasono MM, Fee WE Jr, Adachi K. Conservation of resources: indications for intensive care monitoring after upper airway surgery on patients with obstructive sleep apnea. Laryngoscope 1998; 108: 784–8.CrossRefPubMed

30.

Kezirian EJ, Weaver EM, Yueh B, et al. Incidence of serious complications after uvulopalatopharyngoplasty. Laryngoscope 2004; 114: 450–3.CrossRefPubMed

31.

Mickelson SA, Hakim I. Is postoperative intensive care monitoring necessary after uvulopalatopharyngoplasty? Otolaryngol Head Neck Surg 1998; 119: 352–6.CrossRefPubMed

32.

Kaw R, Golish J, Ghamande S, Burgess R, Foldvary N, Walker E. Incremental risk of obstructive sleep apnea on cardiac surgical outcomes. J Cardiovasc Surg (Torino) 2006; 47: 683–9.

33.

Sabers C, Plevak DJ, Schroeder DR, Warner DO. The diagnosis of obstructive sleep apnea as a risk factor for unanticipated admissions in outpatient surgery. Anesth Analg 2003; 96: 1328–35.CrossRefPubMed

34.

Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008; 108: 822–30.CrossRefPubMed

35.

Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications. Chest 2008; 133: 1128–34.CrossRefPubMed

36.

Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J. Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 2008; 107: 138–43.CrossRefPubMed

37.

Liao P, Sun F, Amirshahi B, et al. A significant exacerbation of sleep breathing disorders in OSA patients undergoing surgery with general anesthesia. Sleep 2009; 32: 0684.

38.

Gross JB, Bachenberg KL, Benumof JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2006; 104: 1081–93.CrossRefPubMed

Titel: Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study
verfasst von: Pu Liao, MD
Balaji Yegneswaran, MBBS
Santhira Vairavanathan, MBBS
Paul Zilberman, MD
Frances Chung, MD
Publikationsdatum: 01.11.2009
Verlag: Springer-Verlag
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 11/2009
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-009-9190-y

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study