title: Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea.
abstract: BACKGROUND
  Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA.
  
  
  METHODS
  After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture.
  
  
  RESULTS
  Of the 58 patients completed the study, 38 patients had OSA (apnea hypopnea index [AHI] >5) with median preoperative AHI of 18 events per hour and 20 non-OSA patients had median preoperative AHI of 2. AHI was increased after surgery in both OSA and non-OSA patients (P < 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P < 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery.
  
  
  CONCLUSIONS
  Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.
authors.affiliation: From the Sleep Research Unit (F.C., P.L., W.K.) and the Department of Anesthesia (B.Y.) and the Department of Psychiatry and Sleep Research Unit (C.M.S.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
authors.forename: Pu
authors.initials: P
authors.lastname: Liao
authors.forename: Balaji
authors.initials: B
authors.lastname: Yegneswaran
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.forename: Weimin
authors.initials: W
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010149:Postoperative Pain / Q000628:therapy; D017286:Polysomnography; D011183:Postoperative Complications / Q000503:physiopathology*; D057234:Preoperative Period; D011446:Prospective Studies; D018401:Sample Size; D012891:Sleep Apnea Syndromes / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology*; D012894:Sleep Stages / Q000502:physiology*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010100:Oxygen