Original ArticlesSleep apnea syndrome in patients undergoing total joint arthroplasty*,**
Section snippets
Materials and methods
All patients with a diagnosis of SAS or who were at risk of SAS before undergoing elective TJA between January 1995 and January 1999 at our institution were identified. SAS was diagnosed in all the patients by the internist. The diagnosis of SAS was based on the number of episodes of apnea (cessation of airflow for ≥10 seconds) and hypopnea per hour of sleep (the apnea-hypopnea score), with a cutoff point of 5 [1]. The patients were categorized into stages, with those at risk at one end of the
Results
Sedative and opioid premedication was avoided in 17 patients. Two patients (patient Nos. 8 and 11) received 0.5 mg of midazolam as premedication. Twelve patients received spinal anesthesia, 3 received epidural anesthesia, and 4 received general anesthesia (GA). Intraoperative monitoring included electrocardiogram (ECG), pulse oximetry, end-tidal carbon dioxide, arterial cannulation for direct pressure monitoring, and blood gas analysis. All patients were closely monitored postoperatively.
Patient No. 11
Patient No. 11 was a 75-year-old man scheduled to undergo left THA. His past surgical history included right shoulder hemiarthroplasty (1990) and lumbar spinal fusion (1998). His significant medical history included SAS, hypertension, hepatitis B, hypercholesterolemia, angioplasty for coronary artery disease (1995), and gastroscopy for gastrointestinal bleeding (1995). He had a 10-year history of nocturnal snoring and daytime hypersomnolence. He also reported episodes of sleeping while driving,
Discussion
This is the first series, to our knowledge, examining the perioperative effects of SAS on patients undergoing TJA. SAS is a clinical disorder that arises from recurrent episodes of apnea (cessation of airflow for ≥10 seconds) during sleep. Approximately 1% to 4% of middle-aged adults have SAS; the male-to-female ratio is 2:1 [1]. There is strong evidence for a familial basis for SAS [12]. Symptoms relating to apnea are present with 2 to 6 times greater frequency in family members of affected
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No benefits or funds were received in support of this study.
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Reprint requests: Steven A. Stuchin, MD, Department of Orthopedics, NYU–Hospital For Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail: [email protected]