Association of sleep-disordered breathing with postoperative complications

Dennis Hwang, Nawaid Shakir, Baba Limann, Cristina Sison, Sumeet Kalra, Lawrence Shulman, Andre De Corla Souza, Harly Greenberg

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Background: Obstructive sleep apnea (OSA) is associated with increased perioperative risk, but the incidence of postoperative complications and the severity of OSA associated with increased risk have not been established. We investigated the relationship between intermittent hypoxemia measured by home nocturnal oximetry with the occurrence of postoperative complications in patients with clinical signs of OSA identified during preoperative assessment for elective surgery. Methods: This study was performed at a tertiary care hospital. Home nocturnal oximetry was performed on elective surgical patients with clinical features of OSA. The number of episodes per hour of oxygen desaturation (or oxygen desaturation index) of ≥ 4% (ODI4%) was determined. Subjects with five or more desaturations per hour (ODI4%≥ 5) were compared to those with less than five desaturations per hour (ODI4%< 5). Hospital records were reviewed to assess the incidence and type of postoperative complications. Results: A total of 172 patients were investigated as part of this study. No significant differences were observed between groups in terms of age, body mass index, number of medical comorbidities, or smoking history. Patients with an ODI4%≥ 5 had a significantly higher rate of postoperative complications than those with ODI4%< 5 (15.3% vs 2.7%, respectively [p < 0.01]; adjusted odds ratio, 7.2; 95% confidence interval, 1.5 to 33.3 [p = 0.012]). The complication rate also increased with increasing ODI severity (patients with an ODI4% of 5 to 15 events per hour, 13.8%; patients with an ODI4% of ≥ 15 events per hour, 17.5%; p = 0.01) Complications were respiratory (nine patients), cardiovascular (five patients), GI (one patient), and bleeding (two patients). The hospital length of stay was similar in both groups. Conclusion: An ODI4%≥ 5, determined by home nocturnal oximetry, in patients with clinical features of OSA is associated with an increased rate of postoperative complications.

Original languageEnglish (US)
Pages (from-to)1128-1134
Number of pages7
JournalChest
Volume133
Issue number5
DOIs
StatePublished - May 2008

Fingerprint

Sleep Apnea Syndromes
Oxygen
Obstructive Sleep Apnea
Oximetry
Length of Stay
Hospital Records
Incidence
Tertiary Healthcare
Tertiary Care Centers
Comorbidity
Body Mass Index
Smoking
History
Odds Ratio
Confidence Intervals
Hemorrhage

Keywords

  • Oximetry
  • Postoperative complications
  • Sleep apnea syndromes
  • Sleep-disordered breathing
  • Surgery

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Hwang, D., Shakir, N., Limann, B., Sison, C., Kalra, S., Shulman, L., ... Greenberg, H. (2008). Association of sleep-disordered breathing with postoperative complications. Chest, 133(5), 1128-1134. https://doi.org/10.1378/chest.07-1488

Association of sleep-disordered breathing with postoperative complications. / Hwang, Dennis; Shakir, Nawaid; Limann, Baba; Sison, Cristina; Kalra, Sumeet; Shulman, Lawrence; De Corla Souza, Andre; Greenberg, Harly.

In: Chest, Vol. 133, No. 5, 05.2008, p. 1128-1134.

Research output: Contribution to journalArticle

Hwang, D, Shakir, N, Limann, B, Sison, C, Kalra, S, Shulman, L, De Corla Souza, A & Greenberg, H 2008, 'Association of sleep-disordered breathing with postoperative complications', Chest, vol. 133, no. 5, pp. 1128-1134. https://doi.org/10.1378/chest.07-1488
Hwang D, Shakir N, Limann B, Sison C, Kalra S, Shulman L et al. Association of sleep-disordered breathing with postoperative complications. Chest. 2008 May;133(5):1128-1134. https://doi.org/10.1378/chest.07-1488
Hwang, Dennis ; Shakir, Nawaid ; Limann, Baba ; Sison, Cristina ; Kalra, Sumeet ; Shulman, Lawrence ; De Corla Souza, Andre ; Greenberg, Harly. / Association of sleep-disordered breathing with postoperative complications. In: Chest. 2008 ; Vol. 133, No. 5. pp. 1128-1134.
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abstract = "Background: Obstructive sleep apnea (OSA) is associated with increased perioperative risk, but the incidence of postoperative complications and the severity of OSA associated with increased risk have not been established. We investigated the relationship between intermittent hypoxemia measured by home nocturnal oximetry with the occurrence of postoperative complications in patients with clinical signs of OSA identified during preoperative assessment for elective surgery. Methods: This study was performed at a tertiary care hospital. Home nocturnal oximetry was performed on elective surgical patients with clinical features of OSA. The number of episodes per hour of oxygen desaturation (or oxygen desaturation index) of ≥ 4{\%} (ODI4{\%}) was determined. Subjects with five or more desaturations per hour (ODI4{\%}≥ 5) were compared to those with less than five desaturations per hour (ODI4{\%}< 5). Hospital records were reviewed to assess the incidence and type of postoperative complications. Results: A total of 172 patients were investigated as part of this study. No significant differences were observed between groups in terms of age, body mass index, number of medical comorbidities, or smoking history. Patients with an ODI4{\%}≥ 5 had a significantly higher rate of postoperative complications than those with ODI4{\%}< 5 (15.3{\%} vs 2.7{\%}, respectively [p < 0.01]; adjusted odds ratio, 7.2; 95{\%} confidence interval, 1.5 to 33.3 [p = 0.012]). The complication rate also increased with increasing ODI severity (patients with an ODI4{\%} of 5 to 15 events per hour, 13.8{\%}; patients with an ODI4{\%} of ≥ 15 events per hour, 17.5{\%}; p = 0.01) Complications were respiratory (nine patients), cardiovascular (five patients), GI (one patient), and bleeding (two patients). The hospital length of stay was similar in both groups. Conclusion: An ODI4{\%}≥ 5, determined by home nocturnal oximetry, in patients with clinical features of OSA is associated with an increased rate of postoperative complications.",
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T1 - Association of sleep-disordered breathing with postoperative complications

AU - Hwang, Dennis

AU - Shakir, Nawaid

AU - Limann, Baba

AU - Sison, Cristina

AU - Kalra, Sumeet

AU - Shulman, Lawrence

AU - De Corla Souza, Andre

AU - Greenberg, Harly

PY - 2008/5

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N2 - Background: Obstructive sleep apnea (OSA) is associated with increased perioperative risk, but the incidence of postoperative complications and the severity of OSA associated with increased risk have not been established. We investigated the relationship between intermittent hypoxemia measured by home nocturnal oximetry with the occurrence of postoperative complications in patients with clinical signs of OSA identified during preoperative assessment for elective surgery. Methods: This study was performed at a tertiary care hospital. Home nocturnal oximetry was performed on elective surgical patients with clinical features of OSA. The number of episodes per hour of oxygen desaturation (or oxygen desaturation index) of ≥ 4% (ODI4%) was determined. Subjects with five or more desaturations per hour (ODI4%≥ 5) were compared to those with less than five desaturations per hour (ODI4%< 5). Hospital records were reviewed to assess the incidence and type of postoperative complications. Results: A total of 172 patients were investigated as part of this study. No significant differences were observed between groups in terms of age, body mass index, number of medical comorbidities, or smoking history. Patients with an ODI4%≥ 5 had a significantly higher rate of postoperative complications than those with ODI4%< 5 (15.3% vs 2.7%, respectively [p < 0.01]; adjusted odds ratio, 7.2; 95% confidence interval, 1.5 to 33.3 [p = 0.012]). The complication rate also increased with increasing ODI severity (patients with an ODI4% of 5 to 15 events per hour, 13.8%; patients with an ODI4% of ≥ 15 events per hour, 17.5%; p = 0.01) Complications were respiratory (nine patients), cardiovascular (five patients), GI (one patient), and bleeding (two patients). The hospital length of stay was similar in both groups. Conclusion: An ODI4%≥ 5, determined by home nocturnal oximetry, in patients with clinical features of OSA is associated with an increased rate of postoperative complications.

AB - Background: Obstructive sleep apnea (OSA) is associated with increased perioperative risk, but the incidence of postoperative complications and the severity of OSA associated with increased risk have not been established. We investigated the relationship between intermittent hypoxemia measured by home nocturnal oximetry with the occurrence of postoperative complications in patients with clinical signs of OSA identified during preoperative assessment for elective surgery. Methods: This study was performed at a tertiary care hospital. Home nocturnal oximetry was performed on elective surgical patients with clinical features of OSA. The number of episodes per hour of oxygen desaturation (or oxygen desaturation index) of ≥ 4% (ODI4%) was determined. Subjects with five or more desaturations per hour (ODI4%≥ 5) were compared to those with less than five desaturations per hour (ODI4%< 5). Hospital records were reviewed to assess the incidence and type of postoperative complications. Results: A total of 172 patients were investigated as part of this study. No significant differences were observed between groups in terms of age, body mass index, number of medical comorbidities, or smoking history. Patients with an ODI4%≥ 5 had a significantly higher rate of postoperative complications than those with ODI4%< 5 (15.3% vs 2.7%, respectively [p < 0.01]; adjusted odds ratio, 7.2; 95% confidence interval, 1.5 to 33.3 [p = 0.012]). The complication rate also increased with increasing ODI severity (patients with an ODI4% of 5 to 15 events per hour, 13.8%; patients with an ODI4% of ≥ 15 events per hour, 17.5%; p = 0.01) Complications were respiratory (nine patients), cardiovascular (five patients), GI (one patient), and bleeding (two patients). The hospital length of stay was similar in both groups. Conclusion: An ODI4%≥ 5, determined by home nocturnal oximetry, in patients with clinical features of OSA is associated with an increased rate of postoperative complications.

KW - Oximetry

KW - Postoperative complications

KW - Sleep apnea syndromes

KW - Sleep-disordered breathing

KW - Surgery

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