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Postoperative Complications in Patients with Obstructive Sleep Apnea: Where Do We Stand?

O the last few decades, there has been increasing concern that a majority of patients with obstructive sleep apnea are undiagnosed and that untreated obstructive sleep apnea is an important contributing factor to increased postoperative complications. Because of convincing evidence of an association between sleep apnea and cardiovascular illness, complications related to cardiac and vascular procedures have been the focus of considerable attention. Such procedures are performed with extraordinary frequency. According to the most recent CDC data (http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm), in 2010, there were 51 million inpatient procedures of all types performed in the US. Of these, 1 million were cardiac catheterizations, 500,000 balloon angioplasties, 454,000 coronary stent placements, and 395,000 coronary artery bypass surgeries. Several studies have demonstrated a high prevalence of sleep disordered breathing in patients undergoing cardiovascular interventions, but data demonstrating an impact on perioperative complications have been surprisingly inconclusive. Abdelsattar et al.1 reported a large cohort study which included 2,646 general and vascular surgical patients with a suspected or confi rmed diagnosis of OSA of whom 1,465 were untreated. Untreated OSA was independently associated with more cardiopulmonary complications (risk-adjusted rates 6.7% versus 4.0%; adjusted odds ratio [aOR] = 1.8, p = 0.001), particularly unplanned reintubations (aOR = 2.5, p = 0.003) and myocardial infarction (aOR = 2.6, p = 0.031). A systematic review and meta-analysis reported by Kaw et al.2 identifi ed 13 studies (3,942 total patients) with data available for quantitative synthesis. OSA was associated with increased incidence of postoperative desaturation, respiratory failure, postoperative cardiac events, and ICU transfers. On the other hand, Memtsoudis et al.3 found an increase in complications but no impact of OSA on in-hospital mortality in an analysis of nationwide hospital discharge data. Another large national study demonstrated an independent association between OSA and cardiopulmonary complications but found no association with an increased rate of in-hospital death. Sleep-disordered breathing had an inconsistent impact on length of stay.4 Postoperative Complications in Patients with Obstructive Sleep Apnea: Where Do We Stand? Commentary on Foldvary-Schaefer et al. Prevalence of undetected sleep apnea in patients undergoing cardiovascular surgery and impact on postoperative outcomes. J Clin Sleep Med 2015;11:1083–1089.