Postoperative complications after elective coronary artery bypass grafting surgery in patients with sleep-disordered breathing

Tafelmeier, Maria; Weizenegger, Teresa; Ripfel, Sarah; Fauser, Miriam; Floerchinger, Bernhard; Camboni, Daniele; Zausig, York; Wittmann, Sigrid; Drzymalski, Marzena; Zeman, Florian; Schmid, Çhristof; Maier, Lars S.; Wagner, Stefan; Arzt, Michael

doi:10.1007/s00392-018-1289-0

Cited by 19 publications

(27 citation statements)

References 58 publications

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“…To 13 Although no differences were observed in the occurrence of major pulmonary complications among CHD patients with and without OSA, reintubation and tracheostomy in the OSA group was increased by 243% and 372%, respectively, compared with the control group.…”

Section: Discussionmentioning

confidence: 76%

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OSA-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

Wang¹,

Wang²,

Yu³

et al. 2020

Preprint

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Background The aim of this study was to explore the underlying impact of obstructive sleep apnea (OSA) on postoperative parameters of multi-organ function, including cardiac and cerebral vascular, respiratory as well as renal postoperative complications, among coronary heart disease (CHD) patients following elective coronary artery bypass grafting (CABG). Methods Electronic literature databases, including PubMed, ISI Web of Science, Directory of Open Access Journals, and the Cochrane Library electronic databases, were searched manually and automatically for relevant English articles. All of the selected articles focused on a comparison of the incidence of primary and secondary outcomes in CHD patients undergoing elective CABG with and without OSA. Results A total of 13 articles met our inclusion criteria. The current study demonstrated OSA significantly increased the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in CHD patients undergoing elective CABG compared with the controls (odds risk (OR), 1.97; 95% confidence interval (CI), 1.50 to 2.59, p <0.0001). In addition, OSA was associated with an increased risk of new revascularization in CHD patients undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, p <0.0001). Moreover, reintubation and tracheostomy in the OSA group was increased (OR, 3.43; 95% CI, 1.35 to 8.71; p =0.009) and 372% (OR, 4.72; 95% CI, 1.23 to 18.13; p=0.024), respectively, compared with the control group. Besides, we also confirmed OSA significantly increased the acute kidney injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P < 0.0001). Finally, our results demonstrated that OSA increased medical resource utilization including length of postoperative hospital stay and ICU stay. Conclusions OSA may contribute to postoperative multi-organ dysfunction among CHD patients undergoing elective CABG by increasing the incidence of MACCEs, especially new revascularization, as well as respiratory, and renal complications. Peri- and postoperative management of CHD patients with OSA may be optimized to minimize the rate of postoperative parameters of multi-organ dysfunction, further reducing the consumption of limited medical resources.

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Section: Discussionmentioning

confidence: 76%

“…i online. A total of 13 articles met our inclusion criteria. 3,[11][12][13][14][15][16][17][18][19][20][21][22] The main characteristics of the included studies are described in Table 2. Total primary and secondary pooled outcomes in patients with and without OSA were demonstrated in Table 3.…”

Section: Study Selection Characteristics and Quality Assessmentmentioning

confidence: 99%

OSA-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

Wang¹,

Wang²,

Yu³

et al. 2020

Preprint

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“…Few studies showed that OSA may affect the prognosis of patients with CABG; Uchôa et al found that moderate-severe OSA signi cantly increased the long-term incidence of MACCEs (follow-up time of 4.5 years), revascularization rate, the proportion of angina attacks, and AF incidence in patients with CABG; there was no signi cant effect on the 30-day prognosis after CABG [11]. Another study found that AHI was an independent risk factor for increased duration of hospitalization and postoperative circulatory uctuation in patients with CABG [12]. In contrast, we found no signi cant difference in postoperative indicators, including the duration of hospitalization, between the moderatesevere OSA and absent-mild OSA groups.…”

Section: Discussionmentioning

confidence: 99%

The effects of obstructive sleep apnea and high-sensitivity C-reactive protein on clinical outcome in off-pump coronary artery bypass grafting

Gao¹,

Fan²,

Yu³

et al. 2021

Preprint

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Purpose This study aimed to investigate the relationship between obstructive sleep apnea (OSA) and high-sensitivity C-reactive protein (hs-CRP) to determine their effects on postoperative complications and clinical outcomes during hospitalization in patients undergoing off-pump cardiac artery bypass grafting (OPCABG). Methods This prospective, single-center study enrolled patients who underwent OPCABG. OSA was evaluated using a portable sleep monitor before OPCABG. Spearman correlation was performed to investigate the relationship between hs-CRP and polygraphy test indicators; regression analysis was performed to determine whether hs-CRP is an independent influencing factor for postoperative atrial fibrillation, duration of hospitalization, and hospital cost. Results Partial pressure of carbon dioxide (P = 0.033), high-sensitivity C-reactive protein (hs-CRP) (P = 0.001), apnea hypopnea index (AHI) (P = 0.000), mean apnea time (P = 0.000), maximum apnea time (P = 0.000), and ODI ≥ 3% (P = 0.000) were significantly higher in the moderate–severe OSA group than in the absent–mild OSA group. LVEF (P = 0.034), lowest arterial oxygen saturation (SaO2) (P = 0.000), and mean SaO2 (P = 0.000) were significantly lower in the moderate–severe OSA group. Hs-CRP levels correlated with AHI (rs = 0.235, P = 0.009), ODI ≥ 3% (rs = 0.228, P = 0.011), lowest SaO2 (rs = 0.186, P = 0.040), and mean SaO2 (rs = 0.331, P = 0.000). AHI independently correlated with hs-CRP levels (P = 0.01); hs-CRP was an independent risk factor for post-CABG atrial fibrillation (POAF) (OR = 1.17, P = 0.006); and hs-CRP level independently correlated with duration of hospitalization (P = 0.002) and hospital cost (P = 0.040). Conclusion Hs-CRP levels are closely related to the degree of OSA and have potential utility in predicting POAF, duration of hospitalization, and hospital costs in patients undergoing OPCABG.

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“…Although the total hospital stay did not differ, moderate to severe SDB had an adverse effect on the postoperative need for intensive care and the ventilation time in our study. Moderate to severe SDB in the context of coronary artery bypass grafting is known to worsen the postoperative outcome, with prolonged hospital stay and a greater risk of postoperative hemodynamic instability [ 8 ]. In general, newer postoperative care protocols aim for a fast-track recovery, including early extubation and mobilization to avoid postoperative pneumonia and complications contributing to reduced intensive care needs and in-hospital costs [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Longer-lasting respiratory events are generally more prevalent in patients with more impaired cardiac contractility, leading to pulmonary congestion and forward failure [ 6 ]. Furthermore, SDB may predispose patients to peri- and postoperative complications such as myocardial infarction, bleeding, prolonged hospital stay and respiratory complications in cardiac and also non-cardiac surgery [ 8 , 9 ]. Rupprecht et al have demonstrated that severe SDB may increase the risk of death, septic and respiratory complications after elective coronary bypass grafting.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Sleep Disordered Breathing in Patients with Primary Mitral Regurgitation Undergoing Mitral Valve Surgery

Gerçek

Oldenburg²,

Gerçek³

et al. 2021

JCM

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Background: Sleep disordered breathing (SDB) is a frequent comorbidity in cardiac disease patients. Nevertheless, the prevalence and relationship between SDB and severe primary mitral regurgitation (PMR) has not been well investigated to date. Methods: A cohort of 121 patients with significant PMR undergoing mitral valve surgery were prospectively enrolled and received a cardiorespiratory single night polygraphy screening using ApneaLink before surgery. Eighty-two of them underwent a follow-up examination including a follow-up single-night sleep study 3 months after surgery. Results: The mean age of patients was 65.3 ± 12.0 years. Sixty patients (49.6%) were female. The mean EuroSCORE II was 2.5 ± 2.4%. Initially, 91 (75.2%) patients presented with SDB, among whom 50.4% (46 patients, 38.0% of total cohort) were classified as moderate to severe. These patients tended to require significantly longer postoperative intensive care and mechanical ventilation. Among the 82 patients who completed follow-up exams, mitral valve surgery led to a significant reduction in relevant SDB (20.7%). The apnea-hypopnea index (from 11/h [4;18] to 4/h [3;14] (p = 0.04)), the oxygenation-desaturation index (from 8/h [3;18] to 5/h [3;12] (p = 0.008)) as well as the saturation time below 90% (from 32 min [13;86] to 18 min [5;36] (p = 0.005)), were all shown to be improved significantly. Conclusion: The prevalence of SDB is very high in patients with severe primary mitral regurgitation and may contribute to postoperative complications and prolonged intensive care. A significantly reduced but still high prevalence of SDB was observed 3 months after mitral valve surgery, highlighting the bidirectional relationship between SDB and heart failure.

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Postoperative complications after elective coronary artery bypass grafting surgery in patients with sleep-disordered breathing

Abstract: SDB, particularly OSA, is associated with prolonged LOS after CABG, independent of known confounders. Prolonged LOS in patients with SDB may be due to increased postoperative hemodynamic instability due to any cause.

Cited by 19 publications

References 58 publications

OSA-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

OSA-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

The effects of obstructive sleep apnea and high-sensitivity C-reactive protein on clinical outcome in off-pump coronary artery bypass grafting

Prevalence of Sleep Disordered Breathing in Patients with Primary Mitral Regurgitation Undergoing Mitral Valve Surgery

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