title: Obstructive Sleep Apnea Increases the Perioperative Risk of Cardiac Valve Replacement Surgery: A Prospective Single-Center Study.
abstract: Sleep apnea is common in patients referred for cardiac valve replacement (CVR). We aimed to determine the association of obstructive sleep apnea (OSA) and central sleep apnea (CSA) with perioperative events in CVR surgery in patients with rheumatic valvular heart disease (RVHD).
  
  
  
  Between April 2010 and April 2014, 290 patients with RVHD undergoing CVR were screened for sleep apnea 1 to 7 days before CVR. Baseline medications, cardiac function, sleep parameters, perioperative events, and related risk factors were evaluated.
  
  
  
  OSA patients had longer duration of intensive care unit (ICU) stay and mechanical ventilation compared with no sleep-disordered breathing and CSA patients. Patients with CSA had a higher rate of pacemaker use and higher first dose of dobutamine in ICU. NYHA Class and the presence of OSA were independently associated with overall worsening of postoperative recovery (ICU stay ≥ 25 h). Age, NYHA class, and the presence of OSA were independently associated with postoperative respiratory insufficiency (mechanical ventilation ≥ 20 h). Preoperative atrial fibrillation, pulmonary hypertension, and OSA were independently associated with postoperative pacemaker use.
  
  
  
  RVHD patients with OSA have an increased incidence of perioperative adverse events. OSA was independently associated with overall postoperative recovery, respiratory insufficiency, and higher rate of postoperative pacemaker use, while CSA was not associated with postoperative events.
authors.affiliation: Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Ding
authors.affiliation: Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Bu-Qing
authors.initials: BQ
authors.lastname: Ni
authors.affiliation: Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Wen-Xiao
authors.initials: WX
authors.lastname: Ding
authors.affiliation: Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Xue
authors.affiliation: Department of Geriatric Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lin
authors.affiliation: Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Kai
authors.affiliation: Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Shi-Jiang
authors.initials: SJ
authors.lastname: Zhang
authors.affiliation: Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xi-Long
authors.initials: XL
authors.lastname: Zhang
mesh_terms: D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012214:Rheumatic Heart Disease / Q000453:epidemiology* / Q000601:surgery*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*
keywords: cardiac valve replacement; central sleep apnea; obstructive sleep apnea; perioperative risk; rheumatic valvular heart disease