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Association of Sleep-Disordered Breathing With Postoperative Complications

      Background

      Obstructive sleep apnea (OSA) is associated with increased perioperative risk, but the incidence of postoperative complications and the severity of OSA associated with increased risk have not been established. We investigated the relationship between intermittent hypoxemia measured by home nocturnal oximetry with the occurrence of postoperative complications in patients with clinical signs of OSA identified during preoperative assessment for elective surgery.

      Methods

      This study was performed at a tertiary care hospital. Home nocturnal oximetry was performed on elective surgical patients with clinical features of OSA. The number of episodes per hour of oxygen desaturation (or oxygen desaturation index) of ≥ 4% (ODI4%) was determined. Subjects with five or more desaturations per hour (ODI4%≥ 5) were compared to those with less than five desaturations per hour (ODI4%< 5). Hospital records were reviewed to assess the incidence and type of postoperative complications.

      Results

      A total of 172 patients were investigated as part of this study. No significant differences were observed between groups in terms of age, body mass index, number of medical comorbidities, or smoking history. Patients with an ODI4%≥ 5 had a significantly higher rate of postoperative complications than those with ODI4%< 5 (15.3% vs 2.7%, respectively [p < 0.01]; adjusted odds ratio, 7.2; 95% confidence interval, 1.5 to 33.3 [p = 0.012]). The complication rate also increased with increasing ODI severity (patients with an ODI4% of 5 to 15 events per hour, 13.8%; patients with an ODI4% of ≥ 15 events per hour, 17.5%; p = 0.01) Complications were respiratory (nine patients), cardiovascular (five patients), GI (one patient), and bleeding (two patients). The hospital length of stay was similar in both groups.

      Conclusion

      An ODI4%≥ 5, determined by home nocturnal oximetry, in patients with clinical features of OSA is associated with an increased rate of postoperative complications.

      Keywords

      ABBREVIATIONS:

      BMI (body mass index), CPAP (continuous positive airway pressure), ODI (oxygen desaturation index), ODI4% (oxygen desaturation index of ≥ 4%), ODI4%< 5 (oxygen desaturation index of ≥ 4% with less than five desaturations per hour), ODI4%≥ 5 (oxygen desaturation index of ≥ 4% with five or more desaturations per hour), OSA (obstructive sleep apnea), PACU (postanesthesia care unit), SDB (sleep-disordered breathing), T90% (time spent with an oxygen saturation of < 90%)
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