Obstructive Sleep Apnea and Postoperative Outcome

Abstract

PURPOSE: To examine the evidence linking the presence of OSA in patients undergoing elective surgery with perioperative complications. METHODS: A systematic review was conducted in Pubmed-Medline, Web of Science, Scopus, the Cochrane Database of Systematic Reviews & the Cochrane Central Register of Controlled Trials. Our search was restricted to cohort or casecontrol studies in adult (>18 years-old) patients until the end of October 2010, published in any language. Primary postoperative outcomes were postoperative desaturation, respiratory failure (RF), reintubation, myocardial infarction, and or ischemia, arrhythmias and cardiac arrest. Other major primary outcomes were ICU transfer and length of stay (LOS). Patients may have been diagnosed with OSA by a screening questionnaire, oximetry or Polysomnography. Studies without information on controls (patients without OSA), those involving upper airway surgery and those with diagnosis of OSA was on the basis of ICD-9 codes alone were excluded from the analysis. RESULTS: Out of 6247 records, 13 studies were included in the final analysis (n=3942). OSA was associated with significantly higher odds of any postoperative cardiac events (45 /1195 [3.76%] vs. 24 /1420 [1.69%],respectively; OR 2.07; 95% CI 1.23-3.50, p=0.007 & respiratory failure (33/1680 [1.96%] vs. 24/3421 [0.70%]; OR 2.43, 95% CI 1.34-4.39, p=0.003. Effects were not heterogeneous among studies for these outcomes(I2=0 to 15%, p>0.3). Presence of OSA was also significantly associated with a higher odds of desaturation (189/1764 [10.71%] vs. 105/1881 [5.58%]; OR 1.96, 95% CI 1.48-2.60, p<0.00001,and ICU transfer (105/2062 [5.09 %] vs. 58/3681 [1.57%],respectively; OR 2.29, 95% CI 1.62- 3.24,p