POSTOPERATIVE COMPLICATIONS OF OBSTRUCTIVE SLEEP APNEA

Jason Shiffermiller, MD, MPH

Outline

Effects of surgery on patients with obstructive sleep apnea More frequent apneas Longer-lasting apneas

Results of increased postoperative apneas Respiratory Cardiac other

Supine Positioning

REM Rebound

Opioids and Sedatives

More frequent apneas Increased sleep time Reduced upper airway tone

Longer-lasting apneas Termination of apneic events requires partial

arousal from sleep Opioids and sedatives blunt this arousal

response

Complications

15% of patients with Obstructive Sleep Apnea developed postoperative complications compared to 3% of controls

Type of complications Respiratory

Hypoxia and/or hypercapnia Atalectasis Wheezing

Cardiac Myocardial ischemia/infarction Hypotension Tachycardia

Other GI and procedure site bleeding Pulmonary embolus

Respiratory

Case series of patients with Obstructive Sleep Apnea published in 1997 Case 1: 41 y/o female, total hip arthroplasty, died

after developing respiratory arrest on POD#3 Case 2: 66 y/o male, bilateral knee arthroplasty,

found unresponsive and could not be resuscitated on POD#3

Case 3: 47 y/o female, hernia repair, found to be cyanotic on POD#2, initially resuscitated but later died

Retrospective review of patients with moderate to severe Obstructive Sleep Apnea published in 2002 3 of 19 developed postoperative respiratory arrest

Cardiac

Case report demonstrates hemodynamic changes associated with apneic episodes Pulse increase of up to40 bpm coinciding with

hypoxia Similar increases in SBP with levels above 180

mmHg coinciding with arousal Hemodynamic instability did not respond to

supplemental oxygen but resolved with CPAP

Postoperative nocturnal hypoxia precipitated myocardial ischemia in patients undergoing major vascular surgery

Other

Delirium Lower mean nocturnal oxygen saturation on the first two

postoperative nights correlates with lower mental status during the third postoperative day

P < 0.005 Unplanned transfer to the ICU

33.3% in patients with undiagnosed Obstructive Sleep Apnea 12.3% in patients with known Obstructive Sleep Apnea 6% in controls p = 0.003

Length of Stay 7.2 days in patients with Obstructive Sleep Apnea not using

CPAP 6.0 days if patients on CPAP 5.1 days for patients in the control group p = 0.007

References

Jain et al. Curr Opin Pulm Med 2004;10:482-8. Meoli et al. Sleep 2003;26:1060-5. Kaw et al. Chest 2006;129:198-205. Hwang et al. Chest 2008;133:1128-34. Ostermeier et al. Anesth Analg 1997;85:452-

60. Parikh et al. J Arthroplasty 2002;17:635-42. Reeder et al. Anaesthesia 1991;46:849-53. Reeder et al. Br J Anaesth 1991;67:626-31. Rosenberg et al. Surgery 1993;114:76-81. Gupta et al. Mayo Clin Proc 2001;76:897-905