title: Factors associated with postoperative exacerbation of sleep-disordered breathing.
abstract: BACKGROUND
  The knowledge on the mechanism of the postoperative exacerbation of sleep-disordered breathing may direct the perioperative management of patients with obstructive sleep apnea. The objective of this study is to investigate the factors associated with postoperative severity of sleep-disordered breathing.
  
  
  METHODS
  After obtaining approvals from Institutional Review Boards, consenting patients underwent portable polysomnography preoperatively, and on postoperative nights 1 and 3 in hospital or at home. The primary outcomes were polysomnography parameters measuring the sleep-disordered breathing. They were treated as repeated measurement variables and analyzed for associated factors by mixed models.
  
  
  RESULTS
  Three hundred seventy-six patients, 168 men and 208 women, completed polysomnography on preoperative and postoperative night 1. Age was 59 ± 12 yr (mean ± SD). Preoperative apnea-hypopnea index (AHI) was 12 (4, 26) (median [25th, 75th percentile]) events per hour. Thirty-five patients had minor surgeries, 292 intermediate surgeries, and 49 major surgeries, with 210 general anesthesia and 166 regional anesthesia. The 72-h opioid dose was 55 (14, 85) mg intravenous morphine-equivalent dose. Preoperative AHI, age, and 72-h opioid dose were associated with postoperative AHI. Preoperative central apnea index, male sex, and general anesthesia were associated with postoperative central apnea index. Slow wave sleep percentage was inversely associated with postoperative AHI and central apnea index.
  
  
  CONCLUSIONS
  Patients with a higher preoperative AHI were predicted to have a higher postoperative AHI. Preoperative AHI, age, and 72-h opioid dose were positively associated with postoperative AHI. Preoperative central apnea, male sex, and general anesthesia were associated with postoperative central apnea index.
authors.affiliation: From the Department of Anesthesia (F.C., P.L., H.E., W.K.) and the Department of Psychiatry (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: Hisham
authors.initials: H
authors.lastname: Elsaid
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.forename: Weimin
authors.initials: W
authors.lastname: Kang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000758:Anesthesia; D001049:Apnea / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D017286:Polysomnography; D011183:Postoperative Complications / Q000503:physiopathology*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012737:Sex Factors; D012891:Sleep Apnea Syndromes / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D012894:Sleep Stages / Q000187:drug effects; D016683:Supine Position / Q000502:physiology
chemical_list: D000701:Analgesics, Opioid