Postoperative outcomes in surgical patients with obstructive sleep apnoea diagnosed by sleep studies: a meta‐analysis and trial sequential analysis

Abstract

Identifying surgical patients with obstructive sleep apnoea may assist with anaesthetic management to minimise postoperative complications. Using trial sequential analysis, we evaluated the impact of obstructive sleep apnoea diagnosed by polysomnography or home sleep apnoea testing on postoperative outcomes in surgical patients. Multiple databases were systematically searched. Outcomes included: total postoperative complications, systemic complications (cardiovascular, respiratory, neurological, renal, infectious) and specific complications (atrial fibrillation, myocardial infarction, combined hospital and intensive care unit re-admission, mortality). The pooled odds ratios of postoperative complications were evaluated by the Mantel-Haenszel method random-effects model. Meta-analysis and meta-regression were conducted, and the GRADE approach was used to evaluate the certainty of evidence. Twenty prospective cohort studies with 3756 patients (2127 obstructive sleep apnoea and 1629 non-obstructive sleep apnoea) were included (9 in non-cardiac surgery and 11 in cardiac surgery). Postoperative complications were almost two-fold higher with obstructive sleep apnoea, OR (95%CI) 1.92 (1.52-2.42), p < 0.001; certainty of evidence, moderate. Obstructive sleep apnoea was associated with a 1.5 times increased risk of postoperative cardiovascular complications, OR (95%CI) 1.56 (1.20-2.02), p = 0.001; certainty of evidence, moderate; an almost two-fold increase in respiratory complications, OR (95%CI) 1.91 (1.39-2.62), p < 0.001; certainty of evidence, moderate; and hospital and ICU re-admission, OR (95%CI) 2. 25 (1.21-4.19), p = 0.01; certainty of evidence, low. Trial sequential analysis showed adequate information size for postoperative complications. Baseline confounding factors were adjusted by meta-regression, and the sub-group analysis did not materially change our results. This increased risk occurred especially in patients in whom obstructive sleep apnoea had been newly diagnosed, emphasising the importance of pre-operative screening.

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

“…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. 46 Indeed, a recent study showed that a virtual sleep-disordered breathing (SBD) management pathway and testing, resulted in a high detection of previously unknown SDB in AF patients.…”

Pulmonary assessment and optimization for older surgical patients

“…[28][29][30] Patients with a STOP-BANG score of 5 or higher have a substantial risk of moderate or severe sleep apnea and postoperative complications of multiple types, including PPCs. 28,[30][31][32][33][34][35] Furthermore, in a recent systematic review and meta-analysis, Pivetta et al 36 found that patients with OSA had an almost 2-fold increase in postoperative complications, including being 1.5 times more likely to have postoperative cardiovascular complications, and an almost 2-fold increase in respiratory complications as well as both hospital and ICU re-admissions.…”

How to perform and write a meta‐analysis

“…Anaesthesia rejects several meta-analyses each month that have been well conducted from a methodological perspective, but failed to investigate a clinically relevant and/or important topic. The meta-analysis by Pivetta et al illustrates these points well [2]. Given the large increase in patients who are obese and require surgery, their investigation into the impact of obstructive sleep apnoea on outcomes is topical and of clinical importance.…”

“…The meta‐analysis by Pivetta et al. illustrates these points well [2]. Given the large increase in patients who are obese and require surgery, their investigation into the impact of obstructive sleep apnoea on outcomes is topical and of clinical importance.…”