Skip to main content
Top
Published in: Sleep and Breathing 1/2020

01-03-2020 | Sleep Breathing Physiology and Disorders • Original Article

Obstructive sleep apnoea predicted by the STOP-BANG questionnaire is not associated with higher rates of post-operative complications among a high-risk surgical cohort

Authors: Ai-Ming Wong, Michael Wang, Daniel J. Garner, Sara Bowditch, Eldho Paul, Mark J. Adams, Garun S. Hamilton, Darren R. Mansfield

Published in: Sleep and Breathing | Issue 1/2020

Login to get access

Abstract

Purpose

The purpose of this study is to establish if obstructive sleep apnoea (OSA) predicted by the STOP-BANG questionnaire would be associated with higher rates of post-operative cardiac, respiratory or neurological complications among a selected high-risk population with established major comorbidities undergoing major surgery. We hypothesise that a cohort selected for major comorbidities will show a higher post-operative complication rate that may power any potential association with co-existent OSA and identify an important target group for OSA screening and treatment pathways in preparation for major surgery.

Methods

Patients attending a high-risk preadmission clinic prior to major surgery from May 2015 to November 2015 were prospectively screened for OSA using the STOP-BANG questionnaire. Patients with treated OSA were excluded. Patient data and complications were attained from the pre-admission clinic and subsequent inpatient medical record at discharge.

Results

Three-hundred-and-ten patients were included in the study (age 68.6 ± 13.1 years, body mass index [BMI] 30.6 ± 7.4 kg/m2; 52.9% female). Sixty-four patients (20.6%) experienced 82 post-operative complications. Seventy-five percent of the cohort had a STOP-BANG ≥ 3. There was no association between the STOP-BANG score (unadjusted and adjusted for comorbidity) with the development of post-operative complications.

Conclusions

OSA predicted by the STOP-BANG score was not associated with higher rates of post-operative complications in patients with major comorbidities undergoing high-risk surgery. As the findings from this cohort contrast with other observational studies, more definitive studies are required to establish a causative link between OSA and post-operative complications and determine whether treating OSA reduces this complication rate.
Glossary
ASAPS
American Society of Anesthesiologists Physical Status classification score
BMI
Body mass index
BPAP
Bilevel positive airway pressure
CPAP
Continuous positive airway pressure
ESS
Epworth Sleepiness Scale
HDU
High-dependency unit
ICU
Intensive care unit
NIV
Non-invasive ventilation
OSA
Obstructive sleep apnoea
RCT
Randomised controlled trials
Literature
1.
go back to reference Narkiewicz K, Somers VK (1997) The sympathetic nervous system and obstructive sleep apnea: implications for hypertension. J Hypertens 15(12 Pt 2):1613–1619CrossRef Narkiewicz K, Somers VK (1997) The sympathetic nervous system and obstructive sleep apnea: implications for hypertension. J Hypertens 15(12 Pt 2):1613–1619CrossRef
2.
go back to reference Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81CrossRef Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81CrossRef
3.
go back to reference Knauert M, Naik S, Gillespie MB, Kryger M (2015) Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngol Head Neck Surg 1(1):17–27CrossRef Knauert M, Naik S, Gillespie MB, Kryger M (2015) Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngol Head Neck Surg 1(1):17–27CrossRef
4.
go back to reference Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053CrossRef Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053CrossRef
5.
go back to reference Yu J, Zhou Z, McEvoy R et al (2017) Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. Jama. 318(2):156–166CrossRef Yu J, Zhou Z, McEvoy R et al (2017) Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. Jama. 318(2):156–166CrossRef
6.
go back to reference Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, Bottros M, Selvidge JA, Jacobsohn E, Pulley D, Duntley S, Becker C, Avidan MS (2009) Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 10(7):753–758CrossRef Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, Bottros M, Selvidge JA, Jacobsohn E, Pulley D, Duntley S, Becker C, Avidan MS (2009) Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 10(7):753–758CrossRef
7.
go back to reference Chung F, Liao P, Elsaid H, Shapiro CM, Kang W (2014) Factors associated with postoperative exacerbation of sleep-disordered breathing. Anesthesiology. 120(2):299–311CrossRef Chung F, Liao P, Elsaid H, Shapiro CM, Kang W (2014) Factors associated with postoperative exacerbation of sleep-disordered breathing. Anesthesiology. 120(2):299–311CrossRef
8.
go back to reference Gupta RM, Parvizi J, Hanssen AD, Gay PC (2001) Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 76(9):897–905CrossRef Gupta RM, Parvizi J, Hanssen AD, Gay PC (2001) Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 76(9):897–905CrossRef
9.
go back to reference Abdelsattar ZM, Hendren S, Wong SL, Campbell DA Jr, Ramachandran SK (2015) The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep. 38(8):1205–1210CrossRef Abdelsattar ZM, Hendren S, Wong SL, Campbell DA Jr, Ramachandran SK (2015) The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep. 38(8):1205–1210CrossRef
10.
go back to reference Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J (2008) Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 107(1):138–143CrossRef Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J (2008) Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 107(1):138–143CrossRef
11.
go back to reference Ursavaş A, Güven T, Coskun F, Ege E, Yılmazlar A (2013) Association between self reported snoring, STOP questionnaire and postoperative pulmonary complications in patients submitted to ortophaedic surgery. Multidiscip Respir Med 8(1):3CrossRef Ursavaş A, Güven T, Coskun F, Ege E, Yılmazlar A (2013) Association between self reported snoring, STOP questionnaire and postoperative pulmonary complications in patients submitted to ortophaedic surgery. Multidiscip Respir Med 8(1):3CrossRef
12.
go back to reference Hai F, Porhomayon J, Vermont L, Frydrych L, Jaoude P, El-Solh AA (2014) Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth 26(8):591–600CrossRef Hai F, Porhomayon J, Vermont L, Frydrych L, Jaoude P, El-Solh AA (2014) Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth 26(8):591–600CrossRef
13.
go back to reference Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV (2012) Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth 109(6):897–906CrossRef Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV (2012) Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth 109(6):897–906CrossRef
14.
go back to reference Liao P, Luo Q, Elsaid H, Kang W, Shapiro CM, Chung F (2013) Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial. Anesthesiology. 119(4):837–847CrossRef Liao P, Luo Q, Elsaid H, Kang W, Shapiro CM, Chung F (2013) Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial. Anesthesiology. 119(4):837–847CrossRef
15.
go back to reference O'Gorman SM, Gay PC, Morgenthaler TI (2013) Does autotitrating positive airway pressure therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome? A randomized controlled clinical trial. Chest. 144(1):72–78CrossRef O'Gorman SM, Gay PC, Morgenthaler TI (2013) Does autotitrating positive airway pressure therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome? A randomized controlled clinical trial. Chest. 144(1):72–78CrossRef
16.
go back to reference Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 108(5):768–775CrossRef Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 108(5):768–775CrossRef
17.
go back to reference Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C (2017) Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth Sleepiness Scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 36:57–70CrossRef Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C (2017) Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth Sleepiness Scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 36:57–70CrossRef
18.
go back to reference Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, Markov D, Reiter D, Kraft WK, Witkowski T (2010) Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 136(10):1020–1024CrossRef Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, Markov D, Reiter D, Kraft WK, Witkowski T (2010) Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 136(10):1020–1024CrossRef
19.
go back to reference Schaumburg I (2017) ASA physical status classification system; [approved 2014 Oct 15; cited 2017 Feb 6]; 1 screen. American Society of Anesthesiologists Clinical Information [Internet] Schaumburg I (2017) ASA physical status classification system; [approved 2014 Oct 15; cited 2017 Feb 6]; 1 screen. American Society of Anesthesiologists Clinical Information [Internet]
20.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349CrossRef
21.
go back to reference Nagappa M, Mokhlesi B, Wong J, Wong DT, Kaw R, Chung F (2015) The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: a systematic review and meta-analysis. Anesth Analg 120(5):1013–1023CrossRef Nagappa M, Mokhlesi B, Wong J, Wong DT, Kaw R, Chung F (2015) The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: a systematic review and meta-analysis. Anesth Analg 120(5):1013–1023CrossRef
22.
go back to reference Gali B, Whalen FX, Gay PC, Olson EJ, Schroeder DR, Plevak DJ et al (2007) Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. J Clin Sleep Med 3(6):582–588CrossRef Gali B, Whalen FX, Gay PC, Olson EJ, Schroeder DR, Plevak DJ et al (2007) Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. J Clin Sleep Med 3(6):582–588CrossRef
23.
go back to reference Lockhart EM, Willingham MD, Abdallah AB, Helsten DL, Bedair BA, Thomas J, Duntley S, Avidan MS (2013) Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Med 14(5):407–415CrossRef Lockhart EM, Willingham MD, Abdallah AB, Helsten DL, Bedair BA, Thomas J, Duntley S, Avidan MS (2013) Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Med 14(5):407–415CrossRef
24.
go back to reference Hwang D, Shakir N, Limann B, Sison C, Kalra S, Shulman L, Souza AC, Greenberg H (2008) Association of sleep-disordered breathing with postoperative complications. Chest. 133(5):1128–1134CrossRef Hwang D, Shakir N, Limann B, Sison C, Kalra S, Shulman L, Souza AC, Greenberg H (2008) Association of sleep-disordered breathing with postoperative complications. Chest. 133(5):1128–1134CrossRef
25.
go back to reference Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, Mazumdar M (2011) Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg 112(1):113–121CrossRef Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, Mazumdar M (2011) Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg 112(1):113–121CrossRef
26.
go back to reference Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample. Obes Surg 23(11):1842–1851CrossRef Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample. Obes Surg 23(11):1842–1851CrossRef
27.
go back to reference Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest. 144(3):903–914CrossRef Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest. 144(3):903–914CrossRef
28.
go back to reference Auckley D, Bolden N (2012) Preoperative screening and perioperative care of the patient with sleep-disordered breathing. Curr Opin Pulm Med 18(6):588–595CrossRef Auckley D, Bolden N (2012) Preoperative screening and perioperative care of the patient with sleep-disordered breathing. Curr Opin Pulm Med 18(6):588–595CrossRef
29.
go back to reference Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, Patrawala S, Lam D, Kumar A, Joshi GP, Fleetham J, Ayas N, Collop N, Doufas AG, Eikermann M, Englesakis M, Gali B, Gay P, Hernandez AV, Kaw R, Kezirian EJ, Malhotra A, Mokhlesi B, Parthasarathy S, Stierer T, Wappler F, Hillman DR, Auckley D (2016) Society of Anesthesia and Sleep Medicine Guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg 123(2):452–473CrossRef Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, Patrawala S, Lam D, Kumar A, Joshi GP, Fleetham J, Ayas N, Collop N, Doufas AG, Eikermann M, Englesakis M, Gali B, Gay P, Hernandez AV, Kaw R, Kezirian EJ, Malhotra A, Mokhlesi B, Parthasarathy S, Stierer T, Wappler F, Hillman DR, Auckley D (2016) Society of Anesthesia and Sleep Medicine Guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg 123(2):452–473CrossRef
Metadata
Title
Obstructive sleep apnoea predicted by the STOP-BANG questionnaire is not associated with higher rates of post-operative complications among a high-risk surgical cohort
Authors
Ai-Ming Wong
Michael Wang
Daniel J. Garner
Sara Bowditch
Eldho Paul
Mark J. Adams
Garun S. Hamilton
Darren R. Mansfield
Publication date
01-03-2020
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 1/2020
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-019-01825-3

Other articles of this Issue 1/2020

Sleep and Breathing 1/2020 Go to the issue

Sleep Breathing Physiology and Disorders • Original Article

Gender-specific change in leptin concentrations during long-term CPAP therapy