Cardiac Surgery Outcomes: A Case for Increased Screening and Treatment of Obstructive Sleep Apnea

Wolf, Seth; Wolf, Candice; Cattermole, Tessa; Rando, Hannah J.; DeNino, Walter F.; Iribarne, Alexander; Ross, Cathy S.; Ramkumar, Niveditta; Bourcier, Bethany; Westbrook, Benjamin M.; Leavitt, Bruce J.

doi:10.1016/j.athoracsur.2021.04.046

Cited by 6 publications

(12 citation statements)

References 19 publications

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“…43 One recent study also confirmed that there was a significant risk increase for POAF in patients with OSA, especially in those with severe OSA. 44 Similarly, OSA was associated with a 1.76 times increased risk of postoperative AF in a recent meta-analysis (OR 1.76, 95% CI 1.00-3.07). 45 With this evidence in mind, there is an urgent need for increased awareness and standardized pathways to allow OSA testing, and the American Society of Anesthesiologists recommended that every surgical patient should be screened preoperatively for OSA.…”

Section: Discussionmentioning

confidence: 88%

Molecular mechanisms of postoperative atrial fibrillation in patients with obstructive sleep apnea

et al. 2023

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Obstructive sleep apnea (OSA) promotes atrial remodeling and fibrosis, providing a substrate for atrial fibrillation (AF). Herein, we investigate the pathophysiological mechanisms of AF in association with OSA in a cohort of cardiac surgery patients. A prospective study including patients undergoing cardiac surgery. Biomarkers reflective of AF pathophysiology (interleukin [IL-6], C-reactive protein [CRP], von Willebrand factor [vWF], N-terminal pro-brain natriuretic peptide [NT-proBNP], high-sensitivity Troponin T [hs-TnT], and Galectin-3 [Gal-3]) was assessed by functional or immunological assays. miRNAs involved in AF were analyzed by reverse transcription-polymerase chain reaction (RT-PCR). Using atrial tissue samples, fibrosis was assessed by Masson's trichrome. Connexin 40 and 43 (Cx40; Cx43) were evaluated by immunolabeling. Fifty-six patients (15 with OSA and 41 non-OSA) were included in this hypothesis-generating pilot study.OSA group had a higher incidence of postoperative AF (POAF) (46.7% vs. 19.5%; p = .042), presented an increased risk of POAF (OR 3.61, 95% CI 1.01-12.92), and had significantly higher baseline levels of NT-proBNP (p = .044), vWF (p = .049), Gal-3 (p = .009), IL-6 (p = .002), and CRP (p = .003). This group presented lower

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Section: Discussionmentioning

confidence: 88%

Molecular mechanisms of postoperative atrial fibrillation in patients with obstructive sleep apnea

et al. 2023

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“…The definition of atrial fibrillation was mostly based on findings from continuous electrocardiographic monitoring and electrocardiographic examination, while eight studies did not supply such information [ 20–21 , 23 , 26 , 29 , 31 , 36 , 39 ]. The most common surgery type was CABG, and eleven studies included other surgery types such as valve replacement [ 21 , 27 , 30–31 , 33–35 , 37–39 , 41 ]. The information on POAF and cardiac surgery is listed in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…[ 42 ]. Another 11 studies included cardiac surgeries other than CABG [ 21 , 27 , 30–31 , 33–35 , 37–39 , 41 ], including aortic, mitral, and tricuspid/pulmonic valve procedures, and the pooled results showed the significant association between SDB and other mixed cardiac surgeries (OR = 1.30; 95% CI, 1.13–1.48; p < .001). Different cardiac surgical procedures may place different influence on the development of POAF, for example, the incidence of POAF increased when CABG was combined with valve replacement surgery [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Chen

Zhang

et al. 2022

Annals of Medicine

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Objective: An increasing number of studies suggest that sleep disordered breathing (SDB) may be associated with postoperative atrial fibrillation (POAF), but these studies present discrepant results. Thus, this meta-analysis aimed to synthesize the data associating SDB with POAF in patients who underwent cardiac surgery. Methods: A literature search was performed in the Scopus, PubMed, Web of Science, EMBASE, CENTRAL, Weipu, Wanfang Data, and China National Knowledge Infrastructure databases before August 2022. Data were extracted, and the strength of the relationship between SDB and the risk of POAF was evaluated using odds ratio (OR) and 95% confidence intervals (CIs). All statistical analysis was carried out using the Stata 12.0 software. Results: A total of 24 studies with 660,685 subjects were included in current meta-analysis. SDB was significantly associated with the risk of POAF in the patients who underwent cardiac surgery (OR = 1.49; 95% CI, 1.30–1.70; p < .001). Next subgroup analysis revealed that such association may be increased in the group with medical equipment-measured SDB (OR = 2.27; 95% CI, 1.59–3.23; p < .001), prospective studies (OR = 2.17; 95% CI, 1.55–3.03; p < .001), patients without a previous history of atrial fibrillation (OR = 2.04; 95% CI, 1.47–2.82; p < .001), and patients who received a coronary artery bypass graft (OR = 2.10; 95% CI, 1.45–3.05; p < .001). No publication bias was identified. Conclusion: The results of meta-analysis support that SDB may be associated with an increased risk of POAF in patients who had undergone cardiac surgery, and these results should be confirmed in more rigorously designed studies. KEY MESSAGES Patients with SDB who underwent cardiac surgery showed increased risk of POAF. The relationship between SDB and POAF should be explained with caution with the consideration of various covariate. The effect of pre-treatment of SDB on POAF should be examined in future.

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“… 18 In addition, OSA has adverse effects on the postoperative outcomes of patients undergoing cardiac surgery and increases the incidence of postoperative pneumonia. 19 Therefore, it is necessary to improve our understanding of preoperative screening for OSA.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have found that among high‐risk adults undergoing major noncardiac surgery, unrecognized severe OSA is significantly associated with an increased risk of cardiovascular complications 30 days postoperatively 18 . In addition, OSA has adverse effects on the postoperative outcomes of patients undergoing cardiac surgery and increases the incidence of postoperative pneumonia 19 . Therefore, it is necessary to improve our understanding of preoperative screening for OSA.…”

Section: Discussionmentioning

confidence: 99%

Screening for obstructive sleep apnea before coronary angiography

Pei

Chen

et al. 2022

Clinical Respiratory J

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Introduction:The prevalence of obstructive sleep apnea (OSA) in patients with suspected coronary heart disease (CHD) is yet to be clarified. This study aimed to investigate the prevalence of OSA before coronary angiography (CAG). Methods:We retrospectively evaluated patients with suspected CHD admitted to the Department of Geriatric Cardiology of our hospital between July 2019 and July 2021. OSA was screened using the level III home sleep apnea test before CAG. The prevalence of OSA was then compared between the CHD and non-CHD groups. CHD severity was determined using the Gensini score of CAG results, and OSA severity was graded using the apnea-hypopnea index (AHI). Results: Among the 327 patients, 211 had CHD. In total, 264 patients were diagnosed with OSA (80.7%) (184 patients, CHD group [87.2%]; 80 patients, non-CHD group [69.0%]). The CHD group had a significantly higher prevalence of OSA (P < 0.01) and higher AHI (CHD group 18.76 AE 14.94, non-CHD group 11.56 AE 10.67, P < 0.01). The Gensini score was positively correlated with OSA severity in patients with CHD, and AHI ≥ 20 was a risk factor for CHD (odds ratio: 1.961, 95% confidence interval: 1.065-3.608, P < 0.05). Conclusion:OSA screening before CAG revealed a higher prevalence in CHD patients than in non-CHD patients. The degree of coronary artery obstruction is positively correlated with AHI, and AHI ≥ 20 is a risk factor for CHD. Therefore, attention should be paid to OSA screening and management before CAG in patients with suspected CHD.

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Cardiac Surgery Outcomes: A Case for Increased Screening and Treatment of Obstructive Sleep Apnea

Cited by 6 publications

References 19 publications

Molecular mechanisms of postoperative atrial fibrillation in patients with obstructive sleep apnea

Molecular mechanisms of postoperative atrial fibrillation in patients with obstructive sleep apnea

Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Screening for obstructive sleep apnea before coronary angiography

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