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

Liao, Pu; Yegneswaran, Balaji; Vairavanathan, Santhira; Zilberman, Paul; Chung, Frances

doi:10.1007/s12630-009-9190-y

Cited by 278 publications

(160 citation statements)

References 39 publications

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“…Identification of patients at risk of OSA could potentially reduce the rate of OSA-related postoperative complications. 45 Due to the inconsistent literature, it is difficult to draw a definite conclusion regarding the most accurate OSA questionnaire available. However, we suggest the STOP questionnaire and its extended version, STOP-Bang, for OSA screening in surgical patients.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of screening questionnaires for obstructive sleep apnea

Abrishami

Khajehdehi

Chung

2010

Can J Anesth/J Can Anesth

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490

341

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Purpose Obstructive sleep apnea (OSA) may lead to lifethreatening problems if it is left undiagnosed. Polysomnography is the ''gold standard'' for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA. Source We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group's guideline. Principal findings Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on ''sleep-disorder patients'', and six studies were conducted on ''patients without history of sleep disorders''. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I 2 = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I 2 = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I 2 = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I 2 = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality. ConclusionThe existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easyto-use features. RésuméObjectif L'apne´e obstructive du sommeil (AOS) peut provoquer des proble`mes de sante´fatals si elle n'est pas diagnostique´e. La polysomnographie est «l'e´talon or» du diagnostic de l'AOS; cependant, cette me´thode est one´reuse et n'est pas disponible partout. L

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Section: Discussionmentioning

confidence: 99%

A systematic review of screening questionnaires for obstructive sleep apnea

Abrishami

Khajehdehi

Chung

2010

Can J Anesth/J Can Anesth

Self Cite

490

341

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“…In a study by Liao and colleagues on known OSA patients who underwent elective surgery other than airway surgery, they found that patients diagnosed with OSA have an increased incidence of oxygen desaturation. 15 Gupta et al studied patients with OSA undergoing orthopedic surgeries, and found that OSA patients had higher incidence of respiratory and cardiac complications in the postoperative period. The length of hospital stay and unplanned ICU admissions were also higher.…”

Section: Discussionmentioning

confidence: 99%

The use of practice guidelines by the American Society of Anesthesiologists for the identification of surgical patients at high risk of sleep apnea

et al. 2012

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American Society of Anesthesiologists (ASA) has introduced a simple tool to assess the perioperative risk of surgery/anesthesia in patients with obstructive sleep apnea (OSA). We compared the surgical outcomes in patients at high risk of OSA with the matched controls. This was a case-control study conducted on 3593 surgical patients receiving a general anesthesia at a single institution. On the basis of a preoperative OSA scoring system using the ASA checklist, patients were classified as high-risk OSA (HR-OSA) or low-risk OSA (LR-OSA) groups. Apnea/hypopnea index of >5 h À1 during a formal preoperative sleep study was used to confirm or rule out the diagnosis of OSA. Receiver operating characteristic curves were plotted to determine the predictive values as well as sensitivity and specificity of the ASA tool in predicting HR-OSA. The HR-OSA group was matched with the patients in LR-OSA using the propensity scoring and logistic regression. Patients were analyzed for premorbid conditions, intraoperative course and postoperative events using cross tabulation, logistic regression model and paired t test. The development of a composite respiratory complication in the postoperative period was considered as the primary end point. The ASA risk tool was found to have 95.1% sensitivity and 52.2% specificity. At a prevalence of 10%, the negative predictive value was 98.5%. Of the 3593 patients, 306 were identified as HR-OSA. The HR-OSA group was found to have a higher incidence of hypertension and diabetes preoperatively when compared with LR-OSA. Postoperatively, the HR-OSA group had higher incidence of hypoxia, reintubation, postoperative use of continuous positive airway pressure and a longer stay in the recovery room. The ASA checklist offers a highly sensitive tool to identify the patients at a higher risk of OSA during the perioperative period. Patients at HR-OSA have a higher incidence of adverse events in the postoperative period when compared with those with LR-OSA.

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“…In a study by Ramachandran et al, 83% of patients who used CPAP at home brought their machines to the hospital for use. However, another study by Liao et al, showed only 49% of OSA patients to actually receive CPAP postoperatively [14]. In order to encourage perioperative use of CPAP amongst home using patients, some hospitals have implemented a service that checks CPAP machines preoperatively, and patients are called to bring in their own machines and masks.…”

Section: Home Cpap Usersmentioning

confidence: 99%

“…Thus, a mild pre-operative case of OSA can easily become a severe postoperative one. OSA patients require more monitoring, oxygen therapy, and unplanned ICU admissions [14]. When compared with controls, OSA patients have longer hospital stays and more adverse events than non-OSA patients [15].…”

Section: Introductionmentioning

confidence: 99%

“…When compared with controls, OSA patients have longer hospital stays and more adverse events than non-OSA patients [15]. Additionally, an OSA diagnosis is associated with increased post-operative complications, including, but not limited to: airway obstruction, cardiac arrhythmias, hypoxemia, encephalopathy and death [14,16]. Adverse outcomes related to respiratory events remains the largest class of injuries reported in the American Society of Anesthesiology Closed Claims study -in cases involving general anesthesia, sedation and monitored anesthetic care (MAC) [17].…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Implementation of Continuous Positive Airway Pressure: A Review of the Considerations

Karan

Black²,

Mouton³

2011

TOATJ

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OSA patients present unique challenges in the peri-operative period. They routinely require more monitoring, oxygen therapy, unplanned ICU admissions, longer hospital stays, and have more adverse events than healthy counterparts. Some data suggest that perioperative CPAP use is associated with reduced morbidity and mortality of patients with OSA, and yet its application remains inconsistent. This review aims to summarize existing literature on the peri-operative use of CPAP, identify barriers to its implementation, and begin defining an algorithm for the practical application of peri-operative CPAP.

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

Cited by 278 publications

References 39 publications

A systematic review of screening questionnaires for obstructive sleep apnea

A systematic review of screening questionnaires for obstructive sleep apnea

The use of practice guidelines by the American Society of Anesthesiologists for the identification of surgical patients at high risk of sleep apnea

Perioperative Implementation of Continuous Positive Airway Pressure: A Review of the Considerations

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