Does Obstructive Sleep Apnea Influence Perioperative Outcome? A Qualitative Systematic Review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing

Abstract

Obstructive sleep apnea (OSA) is a commonly encountered problem in the perioperative setting even though many patients remain undiagnosed at the time of surgery. The objective of this systematic review was to evaluate whether the diagnosis of OSA has an impact on postoperative outcomes. We performed a systematic review of studies published in PubMed-MEDLINE, MEDLINE In-Process, and other nonindexed citations, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment up to November 2014. Studies of adult patients with a diagnosis of OSA or high risk thereof, published in the English language, undergoing surgery or procedures under anesthesia care, and reporting ≥1 postoperative outcome were included. Overall, the included studies reported on 413,304 OSA and 8,556,279 control patients. The majority reported worse outcomes for a number of events, including pulmonary and combined complications, among patients with OSA versus the reference group. The association between OSA and in-hospital mortality varied among studies; 9 studies showed no impact of OSA on mortality, 3 studies suggested a decrease in mortality, and 1 study reported increased mortality. In summary, the majority of studies suggest that the presence of OSA is associated with an increased risk of postoperative complications.

Impact of obstructive sleep apnea in transsphenoidal pituitary surgery: An analysis of inpatient data

“…The influence of OSA on postoperative mortality across various surgical fields has been inconsistent and debated in the literature. Most studies report no difference in mortality, whereas others report increased or decreased mortality in OSA patients . In our analysis, it is reasonable to anticipate higher postoperative mortality for OSA patients, given their older age and greater number of comorbidities and complications.…”

“…However, this intervention is relatively contraindicated following TSS due to the risk of developing pneumocephalus and meningitis . Although some have demonstrated increased total perioperative complications and pulmonary‐specific complications among OSA patients undergoing any surgery requiring general anesthesia, there is a paucity of literature addressing the impact of OSA on TSS outcomes . We aim to elucidate this topic by utilizing the largest database of inpatient discharge data in the United States, the National Inpatient Sample (NIS).…”

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

“…107 Preoperative preparation is key in patients with OSA. 108 The guidelines by the Society of Anesthesia and Sleep Medicine recommended additional preoperative evaluation for suspected OSA patients with certain conditions such as hypoventilation syndromes, severe pulmonary hypertension, and resting hypoxemia not attributable to other cardiopulmonary disease.…”

An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine

“…The presence of OSA is associated with an increase in adverse postoperative outcomes in patients undergoing various types of elective surgeries [6,7,8 ▪▪ ]. It is important to note that OSA poses an economic burden, as it increases the length of hospital stay and healthcare costs [9,10].…”