Does Obstructive Sleep Apnea Influence Perioperative Outcome? A Qualitative Systematic Review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing.
Obstructive sleep apnea (OSA) is a commonly encountered problem in the perioperative setting even though many patients remain undiagnosed at the time of surgery. The objective of this systematic review was to evaluate whether the diagnosis of OSA has an impact on postoperative outcomes. We performed a systematic review of studies published in PubMed-MEDLINE, MEDLINE In-Process, and other nonindexed citations, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment up to November 2014. Studies of adult patients with a diagnosis of OSA or high risk thereof, published in the English language, undergoing surgery or procedures under anesthesia care, and reporting ≥1 postoperative outcome were included. Overall, the included studies reported on 413,304 OSA and 8,556,279 control patients. The majority reported worse outcomes for a number of events, including pulmonary and combined complications, among patients with OSA versus the reference group. The association between OSA and in-hospital mortality varied among studies; 9 studies showed no impact of OSA on mortality, 3 studies suggested a decrease in mortality, and 1 study reported increased mortality. In summary, the majority of studies suggest that the presence of OSA is associated with an increased risk of postoperative complications.
From the *Department of Anesthesiology, Hospital for Special Surgery, New York, New York; †Department of Anesthesiology, Paracelsus Medical University, Salzburg, Austria; ‡Department of Surgical Sciences, University of Parma, Parma, Italy; §Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois; ‖Departments of Hospital Medicine and Anesthesia Outcomes Research, Cleveland Clinic, Cleveland, Ohio; ¶Division of Pulmonary, Critical Care, and Sleep Medicine, Metro Health Medical Center, Case Western Reserve Hospital, Cleveland, Ohio; and #Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.
Mathias
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Opperer
Crispiana
C
Cozowicz
Dario
D
Bugada
Babak
B
Mokhlesi
Roop
R
Kaw
Dennis
D
Auckley
Frances
F
Chung
Stavros G
SG
Memtsoudis
D000758:Anesthesia / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome