Characteristics of Patients with Unrecognized Sleep Apnea Requiring Postoperative Oxygen Therapy

Edwin Seet; Rida Waseem; Matthew T V Chan; Chew Yin Wang; Vanessa Liao; Colin Suen; Frances Chung

doi:10.3390/jpm12101543

Characteristics of Patients with Unrecognized Sleep Apnea Requiring Postoperative Oxygen Therapy

J Pers Med. 2022 Sep 20;12(10):1543. doi: 10.3390/jpm12101543.

Authors

Edwin Seet^{1

2

3}, Rida Waseem⁴, Matthew T V Chan⁵, Chew Yin Wang⁶, Vanessa Liao^{4

7}, Colin Suen⁴, Frances Chung^{4

8}

Affiliations

¹ Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117559, Singapore.
² Department of Anaesthesia, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore.
³ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 637718, Singapore.
⁴ Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON M5T 1R8, Canada.
⁵ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong SAR 999077, China.
⁶ Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
⁷ University of Western Ontario, London, ON N6A 3K7, Canada.
⁸ University of Toronto, Toronto, ON M5S 3E5, Canada.

Abstract

Surgical patients with obstructive sleep apnea (OSA) have increased risk of perioperative complications. The primary objective is to determine the characteristics of surgical patients with unrecognized OSA requiring oxygen therapy for postoperative hypoxemia. The secondary objective is to investigate the characteristics of patients who were responsive to oxygen therapy. This was a post-hoc multicenter study involving patients with cardiovascular risk factors undergoing major non-cardiac surgery. Patients ≥45 years old underwent Type 3 sleep apnea testing and nocturnal oximetry preoperatively. Responders to oxygen therapy were defined as individuals with ≥50% reduction in oxygen desaturation index (ODI) on postoperative night 1 versus preoperative ODI. In total, 624 out of 823 patients with unrecognized OSA required oxygen therapy. These were mostly males, had larger neck circumferences, higher Revised Cardiac Risk Indices, higher STOP-Bang scores, and higher ASA physical status, undergoing intraperitoneal or vascular surgery. Multivariable regression analysis showed that the preoperative longer cumulative time SpO2 < 90% or CT90% (adjusted p = 0.03), and lower average overnight SpO2 (adjusted p < 0.001), were independently associated with patients requiring oxygen therapy. Seventy percent of patients were responders to oxygen therapy with ≥50% ODI reduction. Preoperative ODI (19.0 ± 12.9 vs. 14.1 ± 11.4 events/h, p < 0.001), CT90% (42.3 ± 66.2 vs. 31.1 ± 57.0 min, p = 0.038), and CT80% (7.1 ± 22.6 vs. 3.6 ± 8.7 min, p = 0.007) were significantly higher in the responder than the non-responder. Patients with unrecognized OSA requiring postoperative oxygen therapy were males with larger neck circumferences and higher STOP-Bang scores. Those responding to oxygen therapy were likely to have severe OSA and worse preoperative nocturnal hypoxemia. Preoperative overnight oximetry parameters may help in stratifying patients.

Keywords: hypoxemia; obstructive sleep apnea; oximetry parameters; oxygen therapy; personalized medicine; phenotypes; postoperative care.

Abstract

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