Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 11/2009

01-11-2009 | Reports of Original Investigations

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

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

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 11/2009

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
2.
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
3.
Bresnitz EA, Goldberg R, Kosinski RM. Epidemiology of obstructive sleep apnea. Epidemiol Rev 1994; 16: 210–27.PubMed
4.
Simonds AK. Sleep studies of respiratory function and home respiratory support. BMJ 1994; 309: 35–40.PubMed
5.
Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnoea with myocardial infarction in men. Lancet 1990; 336: 261–4.CrossRefPubMed
6.
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
7.
Leung RS, Bradley TD. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 2001; 164: 2147–65.PubMed
8.
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
9.
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.
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
Metadata
Title
Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study
Authors
Pu Liao, MD
Balaji Yegneswaran, MBBS
Santhira Vairavanathan, MBBS
Paul Zilberman, MD
Frances Chung, MD
Publication date
01-11-2009
Publisher
Springer-Verlag
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 11/2009
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-009-9190-y

Other articles of this Issue 11/2009

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 11/2009 Go to the issue

Correspondence

Intubation using lidocaine, low dose rocuronium, remifentanil and propofol—what should we know?

Correspondence

The optimal dose of rocuronium for rapid sequence induction

Reports of Original Investigations

Double-blind comparison of granisetron, promethazine, or a combination of both for the prevention of postoperative nausea and vomiting in females undergoing outpatient laparoscopies

Special Article

Eligibility for organ donation: a medico-legal perspective on defining and determining death

Case Reports/Case Series

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Book and New Media Reviews

Functional Pain Syndromes: Presentation and Pathophysiology