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Association of Sleep-Disordered Breathing With Postoperative Complications^*

^* From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs. Hwang, Shakir, Limann, de Corla-Souza, Shulman, and Greenberg), the Biostatistics Unit (Dr. Sison), and the Department of Anesthesiology (Dr. Kalra), North Shore Long Island Jewish Health Systems, Mahasset, NY.

Correspondence to: Dennis Hwang, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, North Shore Long Island Jewish Health Systems, 410 Lakeville Rd, Suite 107, New Hyde Park, NY 11040; e-mail: dennis.hwang{at}nyumc.org

Abstract

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.

Key Words: oximetry • postoperative complications • sleep apnea syndromes • sleep-disordered breathing • surgery