title: Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) may worsen postoperatively. The objective of this randomized open-label trial is to determine whether perioperative auto-titrated continuous positive airway pressure (APAP) treatment decreases postoperative apnea hypopnea index (AHI) and improves oxygenation in patients with moderate and severe OSA.
  
  
  METHODS
  The consented patients with AHI of more than 15 events/h on preoperative polysomnography were randomized into the APAP or control group (receiving routine care). The APAP patients received APAP for 2 or 3 preoperative, and 5 postoperative nights. All patients were monitored with oximetry for 7 to 8 nights (N) and underwent polysomnography on postoperative N3. The primary outcome was AHI on the postoperative N3.
  
  
  RESULTS
  One hundred seventy-seven OSA patients undergoing orthopedic and other surgeries were enrolled (APAP: 87 and control: 90). There was no difference between the two groups in baseline data. One hundred six patients (APAP: 40 and control: 66) did polysomnography on postoperative N3, and 100 patients (APAP: 39 and control: 61) completed the study. The compliance rate of APAP was 45%. The APAP usage was 2.4-4.6 h/night. In the APAP group, AHI decreased from preoperative baseline: 30.1 (22.1, 42.5) events/h (median [25th, 75th percentile]) to 3.0 (1.0, 12.5) events/h on postoperative N3 (P < 0.001), whereas, in the control group, AHI increased from 30.4 (23.2, 41.9) events/h to 31.9 (13.5, 50.2) events/h, P = 0.302. No significant change occurred in the central apnea index.
  
  
  CONCLUSIONS
  The trial showed the feasibility of perioperative APAP for OSA patients. Perioperative APAP treatment significantly reduced postoperative AHI and improved oxygen saturation in the patients with moderate and severe OSA.
authors.affiliation: * Research Analyst, † Research Fellow, ‡ Registered Polysomnography Technologist, Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. § Professor, Department of Psychiatry, ‖ Professor, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Pu
authors.initials: P
authors.lastname: Liao
authors.forename: Quanwei
authors.initials: Q
authors.lastname: Luo
authors.forename: Hisham
authors.initials: H
authors.lastname: Elsaid
authors.forename: Weimin
authors.initials: W
authors.lastname: Kang
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D017286:Polysomnography / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery / Q000628:therapy*; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome