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Postoperative Complications of Obstructive Sleep Apnea

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.

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Postoperative Complications of Obstructive Sleep Apnea

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  1. Postoperative Complications of Obstructive Sleep Apnea Jason Shiffermiller, MD, MPH

  2. Outline • Effects of surgery on patients with obstructive sleep apnea • More frequent apneas • Longer-lasting apneas • Results of increased postoperative apneas • Respiratory • Cardiac • other

  3. Supine Positioning

  4. REM Rebound

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. References • Jain et al. CurrOpinPulm 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. AnesthAnalg 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

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