Association of Unrecognized Obstructive Sleep Apnea With Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery

Abstract

; for the Postoperative Vascular Complications in Unrecognized Obstructive Sleep Apnea (POSA) Study Investigators IMPORTANCE Unrecognized obstructive sleep apnea increases cardiovascular risks in the general population, but whether obstructive sleep apnea poses a similar risk in the perioperative period remains uncertain. OBJECTIVES To determine the association between obstructive sleep apnea and 30-day risk of cardiovascular complications after major noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study involving adult at-risk patients without prior diagnosis of sleep apnea and undergoing major noncardiac surgery from 8 hospitals in 5 countries between January 2012 and July 2017, with follow-up until August 2017. Postoperative monitoring included nocturnal pulse oximetry and measurement of cardiac troponin concentrations. EXPOSURES Obstructive sleep apnea was classified as mild (respiratory event index [REI] 5-14.9 events/h), moderate (REI 15-30), and severe (REI >30), based on preoperative portable sleep monitoring. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of myocardial injury, cardiac death, heart failure, thromboembolism, atrial fibrillation, and stroke within 30 days of surgery. Proportional-hazards analysis was used to determine the association between obstructive sleep apnea and postoperative cardiovascular complications. RESULTS Among a total of 1364 patients recruited for the study, 1218 patients (mean age, 67 [SD, 9] years; 40.2% women) were included in the analyses. At 30 days after surgery, rates of the primary outcome were 30.1% (41/136) for patients with severe OSA, 22.1% (52/235) for patients with moderate OSA, 19.0% (86/452) for patients with mild OSA, and 14.2% (56/395) for patients with no OSA. OSA was associated with higher risk for the primary outcome

Concomitant Sleep Apnea and Diabetes Mellitus Are Independently Associated with Cardiovascular Events and Hospitalization for Heart Failure after Coronary Artery Bypass Grafting

“…No previous study on the association between DM and CABG outcomes has reported the additional prognostic effect of sleep apnea [3][4][5][6][7][8]. Recently, two relatively large-scale studies demonstrated an independent association of sleep apnea with adverse cardiovascular events in patients undergoing CABG and major non-cardiac surgery [16,25]. The predictive effects of sleep apnea and DM for adverse cardiovascular events were reported to be additive in patients undergoing percutaneous coronary intervention [26].…”

Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial

“…Nearly half of the episodes detected by capnography were Levels I and II apnea notifications (Table 3). At trial outset, the apnea notification delay was decreased from device default of 30 to 10 s, to align with detection of OSA, which is a challenge in the postoperative setting and is associated with increased cardiovascular complications when severe OSA goes unrecognized [25,26]. If this notification delay was changed to the default setting (30 s), it would likely report fewer episodes and could reduce alarm fatigue.…”

Pulse-ox paradox: potential versus pitfalls of pulse oximetry monitoring in surgical patients with obstructive sleep apnea

“…11 In a recent prospective cohort study of 1,218 patients undergoing elective non-cardiac surgery, severe undiagnosed OSA was associated with a two-fold increased risk of cardiovascular complications (adjusted hazard ratio, 2.23) and longer duration of hypoxemia. 5 As well, the mean cumulative duration of SpO 2 \ 80% during the first three postoperative nights for patients with cardiovascular complications was increased compared with patients with no cardiovascular complications (23.1 [95% confidence interval (CI), 15.5 to 27.7] min vs 10.2 [95% CI, 7.8 to 10.9] min). In another study, we showed an association between preoperative mean SpO 2 \93% and increased risk of postoperative complications.…”

“…4 Furthermore, a large proportion of patients undergoing surgery have undiagnosed and untreated OSA and are at the highest risk of postoperative complications. 5 The real-world scenario is less than ideal; short of PAP therapy, the default alternative on the general care ward is supplemental oxygen.…”

“…4 De plus, une importante proportion de patients subissant une chirurgie n'ont pas reçu de diagnostic et donc de traitement pour l'AOS et courent un risque plus élevé de complications postopératoires. 5 La situation réelle est loin d'être idéale; en l'absence de traitement en VPP, l'alternative par défaut est la supplémentation d'oxygène.…”