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01-12-2018 | Original Paper

Postoperative complications after elective coronary artery bypass grafting surgery in patients with sleep-disordered breathing

Authors: Maria Tafelmeier, Teresa Weizenegger, Sarah Ripfel, Miriam Fauser, Bernhard Floerchinger, Daniele Camboni, York Zausig, Sigrid Wittmann, Marzena A. Drzymalski, Florian Zeman, Christof Schmid, Lars S. Maier, Stefan Wagner, Michael Arzt

Published in: Clinical Research in Cardiology | Issue 12/2018

Abstract

Background

Sleep-disordered breathing (SDB) may increase the risk of postoperative complications in patients after cardiac surgery. This study evaluated the length of hospital stay as well as postoperative cardiac, respiratory, and renal complications after elective coronary artery bypass grafting (CABG) in patients without SDB, with central sleep apnea (CSA), or with obstructive sleep apnea (OSA).

Methods

The presence and type of SDB had been assessed with polygraphic recordings in 100 patients the night before elective CABG surgery. SDB was defined as an apnea–hypopnea index (AHI) of ≥ 15/h. Prolonged length of hospital stay (LOS) and postoperative hemodynamic instability due to any cause were retrospectively evaluated as primary endpoints and cardiac, respiratory, and renal complications as secondary endpoints.

Results

37% of patients had SDB, 14% CSA, and 23% OSA. LOS differed significantly between patients without SDB and those with CSA and OSA [median (25;75. percentile): 8.0 days (7.5;11.0) vs. 9.5 days (7.0;12.5) vs. 12.0 days (9.0;17.0), Kruskal–Wallis test between three groups: p = 0.023; OSA vs. no SDB: p = 0.005]. AHI was significantly associated with prolonged LOS [> 9 days; odds ratio (OR) (95% confidence interval): 1.047 (1.001;1.095), p = 0.044]. Prolonged need of vasopressors (≥ 48 h) was observed in 36% of patients without SDB, in 64% with CSA, and in 62% with OSA (p = 0.037). AHI was significantly associated with prolonged (≥ 48 h) need of vasopressors [OR (95% CI): 1.052 (1.002;1.104), p = 0.040], independent of any confounders.

Conclusions

SDB, particularly OSA, is associated with prolonged LOS after CABG, independent of known confounders. Prolonged LOS in patients with SDB may be due to increased postoperative hemodynamic instability due to any cause.

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Title: Postoperative complications after elective coronary artery bypass grafting surgery in patients with sleep-disordered breathing
Authors: Maria Tafelmeier
Teresa Weizenegger
Sarah Ripfel
Miriam Fauser
Bernhard Floerchinger
Daniele Camboni
York Zausig
Sigrid Wittmann
Marzena A. Drzymalski
Florian Zeman
Christof Schmid
Lars S. Maier
Stefan Wagner
Michael Arzt
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 12/2018
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1289-0

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