The Diagnosis of Obstructive Sleep Apnea as a Risk Factor for Unanticipated Admissions in Outpatient Surgery

Sabers, Candace J.; Plevak, David J.; Schroeder, Darrell R.; Warner, David O.

doi:10.1213/01.ane.0000061585.09157.66

Cited by 101 publications

(58 citation statements)

References 23 publications

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“…[25][26][27][28][29][30][31] Only a few studies have evaluated postoperative complications in patients who underwent other types of surgery. 22,[32][33][34][35][36] Our study complements this growing body of literature by demonstrating that OSA patients undergoing different types of surgery have an increased rate of postoperative complications, mainly oxygen desaturation. In a retrospective study of 101 patients with OSA who were undergoing hip replacement or knee replacement, Gupta et al 22 demonstrated that patients with OSA have an increased incidence of total postoperative complications and major complications.…”

Section: Discussionsupporting

confidence: 64%

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

Liao

Yegneswaran

Vairavanathan

et al. 2009

Can J Anesth/J Can Anesth

276

149

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Purpose Obstructive sleep apnea (OSA) is presumed to be a risk factor for postoperative morbidity and mortality, but the current evidence is incomplete. This retrospective matched cohort study tested the hypothesis that OSA is a risk factor for the development of postoperative complications. Methods Hospital ethics approval was obtained for the conduct of this study. The patients who were selected for the study were [18 yr of age, diagnosed preoperatively with OSA, and scheduled to undergo elective surgery. A cohort of surgical patients without OSA was used as a comparator group based on a one-to-one match. Matching criteria included gender, age difference \5 yr, type of surgery, and a \5 yr difference between two surgery dates. Summary data are presented and conditional logistic regression was used to identify risk factors for postoperative complications.Results The 240 pairs of study subjects aged 57 ± 13 yr included 184 (77%) males and 56 (23%) females. The OSA patients had a higher mean body mass index relative to their non-OSA counterparts (35 ± 9 vs 28 ± 6 kg Á m -2 , respectively) and a higher frequency of co-morbidities, including hypertension (48% vs 36%, respectively) and obesity (61% vs 23%, respectively). Also, the incidence of postoperative complications in the OSA patients was significantly greater (44% OSA group vs 28% non-OSA

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Section: Discussionsupporting

confidence: 64%

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

Liao

Yegneswaran

Vairavanathan

et al. 2009

Can J Anesth/J Can Anesth

276

149

View full text Add to dashboard Cite

show abstract

“…Among a cohort of 234 patients with OSA who underwent ambulatory surgery and a similar number of matched control subjects, the odds of adverse events (OR 1.67; 95% CI 0.40 to 6.97) and unplanned admission to hospital (OR 1.36; 95% CI 0.77 to 2.46) did not differ significantly between OSA and control subjects. 12 In a more recent observational cohort study in over 3,500 patients undergoing ambulatory surgery, a questionnaire and propensity modelling were used to identify patients with known and suspected OSA (4.4% and 4.8%, respectively). This study identified positive associations between OSA and the number of intubation attempts, Cormack-Lehane laryngoscopy grade, and probability of vasoactive drug use, 13 but no relationship was found with major cardiorespiratory events or unplanned admission to hospital.…”

Section: Discussionmentioning

confidence: 99%

Unplanned admission after day surgery: A historical cohort study in patients with obstructive sleep apnea

Bryson

Gómez

Jee

et al. 2012

Can J Anesth/J Can Anesth

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“…106,107 These studies found that the presence of OSA did not increase the rate of unplanned hospital admissions in patients who underwent outpatient surgical procedures. Stierer et al used a prediction model in a cohort of ambulatory surgical population to assess the probability of sleep apnea.…”

Section: Nocturnal Pulse Oximetrymentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

211

147

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Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. OSAS has been shown to be associated with various healthrelated consequences, including increased rate of motor vehicle accidents, hypertension, diabetes mellitus, congestive heart failure, stroke, and all-cause mortality. [1][2][3][4][5][6][7][8][9] Recently, numerous studies have demonstrated that surgical patients with sleep apnea are at increased risk of having perioperative complications, including hypoxemia, pneumonia, diffi cult intubation, myocardial infarction, pulmonary embolism, atelectasis, cardiac arrhythmias, and unanticipated admission to the ICU. The majority of patients with OSA are undiagnosed upon admission and are at risk during the perioperative period, presumably due to their underlying sleep apnea. Therefore, it is very important to identify these patients preoperatively so that one can initiate appropriate perioperative measures. EpidemiologyOSAS is an extremely common sleep related breathing disorder, and its prevalence has been increasing throughout the world because of obesity and increasing age of the general population. Its prevalence is between 2% and 25% in the general population, depending upon how sleep apnea is defi ned. In an epidemiological study, Young et al. noted that the prevalence of sleep apnea, defi ned as apnea-hypopnea index (AHI) ≥ 5/h was 9% for women and 24% for men. 10 However, the prevalence of OSAS (defi ned as AHI ≥ 5/h and daytime sleepiness) was 2% in women and 4% in men. 10 The National Sleep Foundation (NSF) Sleep in America 2005Poll found that 1 in 4 Americans are at high risk of having sleep apnea based on the Berlin Questionnaire. 11 The prevalence of sleep apnea is much higher in surgical patients and depends on the type of surgery. In the bariatric surgery population, the prevalence of sleep apnea has been found to be > 70%. 12,13 It is the standard of care for these patients to get a formal sleep evaluation prior to undergoing the bariatric surgery. Howev...

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The Diagnosis of Obstructive Sleep Apnea as a Risk Factor for Unanticipated Admissions in Outpatient Surgery

Abstract: In patients scheduled for outpatient surgery in a large academic practice, the diagnosis of obstructive sleep apnea confirmed by polysomnography was not an independent risk factor for unanticipated hospital admission or for other adverse perioperative events.

Cited by 101 publications

References 23 publications

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

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

Unplanned admission after day surgery: A historical cohort study in patients with obstructive sleep apnea

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

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