Obstructive Sleep Apnea Predicts Adverse Perioperative Outcome

Bateman, Brian T.; Eikermann, Matthias

doi:10.1097/aln.0b013e31824b96e1

Cited by 17 publications

(5 citation statements)

References 13 publications

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“…37 The mechanism whereby sleep apnea increases the risk of delirium is not clear but we do know that oxygen desaturations occur during apneic phases and that hypoxia is one of the possible causes of delirium. Moreover, the cyclic oxygen desaturations and restorations during apneic episodes can cause an increase of inflammatory cytokines; and, sleep apnea, per se, can be viewed as an inflammatory process, with increased levels of interleukins and tumor necrosis factor.…”

Section: Sleep – Delirium Interactionsmentioning

confidence: 99%

Delirium: Is sleep important?

Watson

Ceriana

Fanfulla

2012

Best Practice & Research Clinical Anaesthesiology

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Delirium and poor sleep quality are common and often co-exist in hospitalized patients. A link between these disorders has been hypothesized but whether this link is a cause and effect relationship or simply an association resulting from shared mechanisms is yet to be determined. Potential shared mechanisms include: abnormalities of neurotransmitters, tissue ischemia, inflammation, and sedative exposure. Sedatives, while decreasing sleep latency, often cause a decrease in slow wave sleep and stage REM sleep and therefore may not provide the same restorative properties as natural sleep. Mechanical ventilation, an important cause of sleep disruption in ICU patients, may lead to sleep disruption not only from the discomfort of the endotracheal tube but also as a result of ineffective respiratory efforts and by inducing central apnea events if not properly adjusted for the patient’s physiologic needs. When possible, efforts should be made to optimize the patient-ventilator interaction to minimize sleep disruptions.

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Section: Sleep – Delirium Interactionsmentioning

confidence: 99%

Delirium: Is sleep important?

Watson

Ceriana

Fanfulla

2012

Best Practice & Research Clinical Anaesthesiology

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“…OSA is a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway, resulting in cessation of airflow for at least 10 S . OSA is a serious medical condition that is associated with hypertension, stroke, myocardial infarction, diabetes, long term cognitive impairment and lower quality of life [ 13 , 14 ]. OSA is more prevalent in elderly individuals [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: protocol for a multi-centre prospective randomized, controlled trial

et al. 2018

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BackgroundDelirium is a common problem that occurs in 5–50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway – are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium. However, few studies have investigated the effect of perioperative treatment of OSA to prevent postoperative delirium.MethodsThis multi-centre randomized controlled trial will enrol 634 elderly patients undergoing elective hip/knee replacement surgery. The study has been approved by the Research Ethics Boards of the three participating institutions. Patients will be screened with the STOP-Bang questionnaire. Those with a score of 3 or greater will have a portable home sleep study using the ApneaLink™ Air device. Patients identified to have OSA will be randomized to 1) Auto-titrating continuous positive airway pressure (APAP) applied during sleep for 72 h after surgery or until discharge if they are discharged before 72 h or 2) Control group – routine care, no APAP. All patients will be evaluated for delirium for 72 h after surgery or until discharge if they are discharged before 72 h. The primary outcome is the occurrence of delirium – assessed twice daily using the Confusion Assessment Method for 72 h or until discharge if the hospital stay is <72 h.DiscussionDelirium is associated with increased morbidity and mortality, and higher healthcare costs. With the aging population, the incidence of postoperative delirium will likely increase as the number of elderly individuals undergoing surgery rises. The results of our study will be published in a peer-reviewed journal and presented at local and international medical conferences. Our study findings may lead to improved surgical outcomes, enhanced patient safety and reduced healthcare costs.Trial registrationThis study was retrospectively registered at clinicaltrials.gov NCT02954224 on November 3, 2016.

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“…10,11 Furthermore, OSA has been linked to neurocognitive impairment and structural changes in the brain. 35 Based on our findings, these factors, which greatly contribute to the pathophysiology of delirium, 31 might become especially relevant in patients undergoing complex surgeries. 36 For example, the magnitude of the inflammatory response after surgical interventions strongly correlates with procedural duration and complexity.…”

Section: Discussionmentioning

confidence: 80%

“…3 Previous authors have speculated on multiple factors that magnify the risk of delirium in patients with OSA. 31 In addition to well-documented fragmentation and interruption of sleep, 28,32 OSA facilitates the onset and progression of cardiovascular disease (including arrhythmias, myocardial infarction, and pulmonary hypertension) 4 and associated vascular risks, for example, through increased systemic inflammation, endothelial dysfunction, hypoxemia, metabolic dysregulation, sympathetic activation, hypercoagulability, and left atrial enlargement. 33,34 These factors have been associated with increased risk of delirium and further increase vulnerability to intraprocedural cerebral hypoperfusion, which has been associated with delirium.…”

Section: Discussionmentioning

confidence: 99%

Association of Obstructive Sleep Apnea With Postoperative Delirium in Procedures of Moderate-to-High Complexity: A Hospital-Registry Study

Wagner

Ahrens

Wachtendorf

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Patients suffering from obstructive sleep apnea (OSA) experience chronic sleep disturbances and desaturation, factors that have been associated with postoperative delirium and that can be aggravated after anesthesia for complex procedures. We investigated whether OSA is associated with delirium after anesthesia, and whether this association is modified by procedural complexity. METHODS: Hospitalized patients ≥60 years who underwent general anesthesia or procedural sedation for procedures of moderate-to-high complexity between 2009 and 2020 at a tertiary health care network in Massachusetts were included. The primary exposure was OSA, defined based on International Classification of Diseases (Ninth/Tenth Revision, Clinical Modification) (ICD-9/10-CM) diagnostic codes, structured nursing interviews, anesthesia alert notes, and a validated risk score (BOSTN [body mass index, observed apnea, snoring, tiredness, and neck circumference]). The primary end point was delirium within 7 days after the procedure. Multivariable logistic regression and effect modification analyses adjusted for patient demographics, comorbidities, and procedural factors were applied. RESULTS: A total of 46,352 patients were included, of which 1694 patients (3.7%) developed delirium, 537 (3.2%) with OSA, and 1,157 (4.0%) without OSA. In adjusted analyses, OSA was not associated with postprocedural delirium in the overall cohort (adjusted odds ratio [OR adj ], 1.06; 95% confidence interval [CI], 0.94-1.20; P = .35). However, a high procedural complexity modified the primary association (P value for interaction = .002). OSA patients had a higher risk of delirium after high-complexity procedures (≥40 work relative value units) such as cardiac (OR adj , 1.33; 95% CI, 1.08-1.64; P = .007, P value for interaction = .005) or thoracic surgery (OR adj , 1.89; 95% CI, 1.19-3.00; P = .007, P value for interaction = .009), but no increased risk after moderate complexity procedures, including general surgery (OR adj , 0.86; 95% CI, 0.55-1.35; P = .52). CONCLUSIONS: Compared to non-OSA patients, a history of OSA is associated with a higher risk after high-complexity procedures such as cardiac or thoracic surgery but not after procedures of moderate complexity. (Anesth Analg 2024;138:626-34) KEY POINTS• Question: Is obstructive sleep apnea (OSA) associated with a higher risk of delirium within 7 days after surgery? • Findings: In this hospital registry study of 46,352 inpatients ≥60 years, we found that compared to non-OSA patients, patients with OSA are at higher risk after high-complexity procedures such as cardiac or thoracic surgery.

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Obstructive Sleep Apnea Predicts Adverse Perioperative Outcome

Cited by 17 publications

References 13 publications

Delirium: Is sleep important?

Delirium: Is sleep important?

The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: protocol for a multi-centre prospective randomized, controlled trial

Association of Obstructive Sleep Apnea With Postoperative Delirium in Procedures of Moderate-to-High Complexity: A Hospital-Registry Study

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