Preoperative oximetry-derived hypoxemia predicts postoperative cardiovascular events in surgical patients with unrecognized obstructive sleep apnea

Chung F 1 , Waseem R 2 , Wang CY 3 , Seet E 4 , Suen C 2 , Chan MTV 5 Show all authors , Postoperative Vascular Complications in Unrecognised Obstructive Sleep Apnea (POSA) Study Investigators

Affiliations 

  • 1 Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. Electronic address: frances.chung@uhn.ca
  • 2 Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
  • 3 University of Malaya, Kuala Lumpur, Malaysia
  • 4 Khoo Teck Puat Hospital, National Healthcare Group, Singapore
  • 5 The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
J Clin Anesth, 2022 Feb 04;78:110653.
PMID: 35131555 DOI: 10.1016/j.jclinane.2022.110653

Abstract

STUDY OBJECTIVE: Obstructive sleep apnea (OSA) is known to be associated with postoperative cardiovascular events in patients undergoing major non-cardiac surgery. The objective of the study is to determine whether preoperative oximetry-derived hypoxemia predicts postoperative cardiovascular events in surgical patients with unrecognized obstructive sleep apnea.

DESIGN AND SETTING: The study was a planned post hoc analyses of a multicenter prospective cohort study.

PATIENTS: The inclusion criteria were patients ≥45 years old undergoing major non-cardiac surgery with cardiovascular risk factors.

INTERVENTIONS AND MEASUREMENTS: All patients underwent pre-operative pulse oximetry (PULSOX-300i, Konica-Minolta Sensing, Inc). The severity of OSA was classified based on oxygen desaturation index (ODI) (mild: ≥5 to <15, moderate: ≥15 to <30, and severe OSA: ≥30 events/h). The 30 days cardiovascular events were a composite of myocardial injury, cardiac death, congestive heart failure, thromboembolism, atrial fibrillation, and stroke.

MAIN RESULTS: For 1218 patients with mild, moderate, or severe OSA (mean age: 67.2 ± 9.3 years; body mass index: 27.0 ± 5.3 kg/m2), the rate of postoperative cardiovascular events was 16.4%, 25.2%, and 29.8% respectively. The multivariable analysis showed that preoperative oxygen desaturation index (ODI) ≥30 events per hour {adjusted hazard ratio (aHR) 1.63 [95% confidence interval (CI): 1.05-2.53]}, and cumulative time spent during sleep with oxygen saturation below 80% (CT80) ≥10 min {aHR 1.79 [95% CI: 1.28-2.50]} were independent predictors of 30-day postoperative cardiovascular events.

CONCLUSIONS: Preoperative ODI ≥30 events per hour and CT80 ≥ 10 min are associated with increased risk of postoperative cardiovascular events. Preoperative screening using oximetry helps in risk stratification for unrecognized sleep apnea.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01494181.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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