Chest
Volume 133, Issue 5, May 2008, Pages 1128-1134
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Original Research: Sleep Medicine
Association of Sleep-Disordered Breathing With Postoperative Complications

https://doi.org/10.1378/chest.07-1488Get rights and content

Background

Obstructive sleep apnea (OSA) is associated with increased perioperative risk, but the incidence of postoperative complications and the severity of OSA associated with increased risk have not been established. We investigated the relationship between intermittent hypoxemia measured by home nocturnal oximetry with the occurrence of postoperative complications in patients with clinical signs of OSA identified during preoperative assessment for elective surgery.

Methods

This study was performed at a tertiary care hospital. Home nocturnal oximetry was performed on elective surgical patients with clinical features of OSA. The number of episodes per hour of oxygen desaturation (or oxygen desaturation index) of ≥ 4% (ODI4%) was determined. Subjects with five or more desaturations per hour (ODI4%≥ 5) were compared to those with less than five desaturations per hour (ODI4%< 5). Hospital records were reviewed to assess the incidence and type of postoperative complications.

Results

A total of 172 patients were investigated as part of this study. No significant differences were observed between groups in terms of age, body mass index, number of medical comorbidities, or smoking history. Patients with an ODI4%≥ 5 had a significantly higher rate of postoperative complications than those with ODI4%< 5 (15.3% vs 2.7%, respectively [p < 0.01]; adjusted odds ratio, 7.2; 95% confidence interval, 1.5 to 33.3 [p = 0.012]). The complication rate also increased with increasing ODI severity (patients with an ODI4% of 5 to 15 events per hour, 13.8%; patients with an ODI4% of ≥ 15 events per hour, 17.5%; p = 0.01) Complications were respiratory (nine patients), cardiovascular (five patients), GI (one patient), and bleeding (two patients). The hospital length of stay was similar in both groups.

Conclusion

An ODI4%≥ 5, determined by home nocturnal oximetry, in patients with clinical features of OSA is associated with an increased rate of postoperative complications.

Section snippets

Patients

We reviewed the medical records of elective surgery patients who were at least 18 years of age (performed on an inpatient or outpatient basis) who underwent preoperative screening for SDB based on an established clinical protocol at North Shore University Hospital, a tertiary care hospital in New York, between July 2004 and November 2006. During preoperative assessment in the preanesthesia testing unit, patients without a prior diagnosis of OSA but with at least two clinical features suggestive

Statistical Analysis

The Fisher exact test was used to determine whether there was a statistically significant difference in perioperative complication rates between the ODI4% ≥ 5 and ODI4% < 5 groups. The Fisher exact test and Mann-Whitney test were used to determine which of the candidate risk factors were individually associated with a perioperative complication. The Cochran-Armitage trend test was used to test for trends across the ODI4% severity groups. The asymptotic test for the Somer D(C/R), which measures

Results

A total of 172 patients aged 27 to 85 years were evaluated. The overall mean (± SD) age was 54.5 ± 13.6 years. Other relevant demographics are included in Table 1 and Table 2; the categories of surgical procedures are included in Table 3.

Home nocturnal oximetry testing revealed that 98 patients (57%) had an ODI4% with five or more desaturations per hour (ODI4%≥ 5) and 74 patients (43%) had an ODI4% with less than five desaturations per hour (ODI4%< 5). There were 58 patients (33.7%) with an ODI

Discussion

While OSA is a prevalent condition with the potential to cause significant adverse effects in the perioperative setting, the majority of patients remain without a diagnosis.3 This necessitates screening during preoperative assessment to facilitate the implementation of strategies to minimize the postoperative risk. Since clinical history is an unreliable indicator of the presence of OSA, a more effective screening modality is necessary.6 Overnight polysomnography is the “gold standard” for the

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