Original Articles
Sleep apnea syndrome in patients undergoing total joint arthroplasty*,**

https://doi.org/10.1054/arth.2002.32701Get rights and content

Abstract

Sleep apnea syndrome (SAS) is a condition of repeated episodes of apnea and hypopnea during sleep. It can cause life-threatening morbidities, including cardiac arrhythmia and ischemia, hypertension, and respiratory arrest, and even death. In a retrospective study at our institution of patients who underwent hip or knee total joint arthroplasty (TJA) with a diagnosis of SAS, we hypothesized that avoiding factors that exacerbate SAS in the perioperative period would minimize adverse outcomes. There were 19 patients with a preoperative diagnosis of moderate or severe SAS; 15 patients received continuous positive airway pressure or bilevel positive airway pressure noninvasive ventilation, 1 patient experienced respiratory arrest secondary to intraoperative propafol, and 2 patients developed postoperative respiratory depression. Avoidance of opioids and sedative drugs, awareness of the possibility of acute airway obstruction, and close monitoring during and after surgery are vital in patients with SAS. Copyright 2002, Elsevier Science (USA). All rights reserved.

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.

    **

    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]

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