title: Symptomless Multi-Variable Apnea Prediction Index Assesses Obstructive Sleep Apnea Risk and Adverse Outcomes in Elective Surgery.
abstract: To validate that the symptomless Multi-Variable Apnea Prediction index (sMVAP) is associated with Obstructive Sleep Apnea (OSA) diagnosis and assess the relationship between sMVAP and adverse outcomes in patients having elective surgery. We also compare associations between Bariatric surgery, where preoperative screening for OSA risk is mandatory, and non-Bariatric surgery groups who are not screened routinely for OSA.
  
  
  
  Using data from 40 432 elective inpatient surgeries, we used logistic regression to determine the relationship between sMVAP and previous OSA, current hypertension, and postoperative complications: extended length of stay (ELOS), intensive-care-unit-stay (ICU-stay), and respiratory complications (pulmonary embolism, acute respiratory distress syndrome, and/or aspiration pneumonia).
  
  
  
  Higher sMVAP was associated with increased likelihood of previous OSA, hypertension and all postoperative complications (p < .0001). The top sMVAP quintile had increased odds of postoperative complications compared to the bottom quintile. For ELOS, ICU-stay, and respiratory complications, respective odds ratios (95% CI) were: 1.83 (1.62, 2.07), 1.44 (1.32, 1.58), and 1.85 (1.37, 2.49). Compared against age-, gender- and BMI-matched patients having Bariatric surgery, sMVAP was more strongly associated with postoperative complications in non-Bariatric surgical groups, including: (1) ELOS (Orthopedics [p < .0001], Gastrointestinal [p = .024], Neurosurgery [p = .016], Spine [p = .016]); (2) ICU-stay (Orthopedics [p = .0004], Gastrointestinal [p < .0001], and Otorhinolaryngology [p = .0102]); and (3) respiratory complications (Orthopedics [p =.037] and Otorhinolaryngology [p =.011]).
  
  
  
  OSA risk measured by sMVAP correlates with higher risk for select postoperative complications. Associations are stronger for non-Bariatric surgeries, where preoperative screening for OSA is not routinely performed. Thus, preoperative screening may reduce OSA-related risk for adverse postoperative outcomes.
authors.affiliation: Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA.
authors.forename: M Melanie
authors.initials: MM
authors.lastname: Lyons
authors.affiliation: Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA.
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Keenan
authors.affiliation: Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA.
authors.forename: Junxin
authors.initials: J
authors.lastname: Li
authors.affiliation: Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Khan
authors.affiliation: Section of Orthopedic Anesthesiology, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Elkassabany
authors.affiliation: Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Walsh
authors.affiliation: Penn Metabolic and Bariatric Surgery Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|William T. Fitts Surgery Education Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.affiliation: Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA.|Global Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Allan I
authors.initials: AI
authors.lastname: Pack
authors.affiliation: Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|Penn Occupational Sleep Medicine; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|CMC VA Medical Center, Philadelphia, PA.
authors.forename: Indira
authors.initials: I
authors.lastname: Gurubhagavatula
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011300:Preoperative Care; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis*; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis
keywords: Adverse Outcomes.; Elective Surgery; Obstructive Sleep Apnea; Obstructive Sleep Apnea Risk; Postoperative Complications; Symptomless Multi-Variable Apnea Prediction