The effectiveness of positive airway pressure therapy in reducing postoperative adverse outcomes in surgical patients with obstructive sleep apnea: A systematic review and meta-analysis

Linor Berezin; Mahesh Nagappa; Khashayar Poorzargar; Aparna Saripella; Jennita Ariaratnam; Nina Butris; Marina Englesakis; Frances Chung

doi:10.1016/j.jclinane.2022.110993

The effectiveness of positive airway pressure therapy in reducing postoperative adverse outcomes in surgical patients with obstructive sleep apnea: A systematic review and meta-analysis

J Clin Anesth. 2023 Feb:84:110993. doi: 10.1016/j.jclinane.2022.110993. Epub 2022 Nov 5.

Authors

Linor Berezin¹, Mahesh Nagappa², Khashayar Poorzargar³, Aparna Saripella¹, Jennita Ariaratnam¹, Nina Butris³, Marina Englesakis⁴, Frances Chung⁵

Affiliations

¹ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
² Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre and St. Joseph Healthcare, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
³ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada.
⁴ Library & Information Services, University Health Network, Toronto, ON, Canada.
⁵ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre and St. Joseph Healthcare, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Electronic address: frances.chung@uhn.ca.

PMID: 36347195
DOI: 10.1016/j.jclinane.2022.110993

Abstract

Importance: Obstructive sleep apnea (OSA) is prevalent in surgical patients and is associated with an increased risk of adverse perioperative events.

Study objective: To determine the effectiveness of positive airway pressure (PAP) therapy in reducing the risk of postoperative complications in patients with OSA undergoing surgery.

Design: Systematic review and meta-analysis searching Medline and other databases from inception to October 17, 2021. The search terms included: "positive airway pressure," "surgery," "post-operative," and "obstructive sleep apnea." The inclusion criteria were: 1) adult patients with OSA undergoing surgery; (2) patients using preoperative and/or postoperative PAP; (3) at least one postoperative outcome reported; (4) control group (patients with OSA undergoing surgery without preoperative and/or postoperative PAP therapy); and (5) English language articles.

Patients: Twenty-seven studies included 30,514 OSA patients undergoing non-cardiac surgery and 837 OSA patients undergoing cardiac surgery.

Intervention: PAP therapy MAIN RESULTS: In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a decreased risk of postoperative respiratory complications (2.3% vs 3.6%; RR: 0.72, 95% CI: 0.51-1.00, asymptotic P = 0.05) and unplanned ICU admission (0.12% vs 4.1%; RR: 0.44, 95% CI: 0.19-0.99, asymptotic P = 0.05). No significant differences were found for all-cause complications (11.6% vs 14.4%; RR: 0.89, 95% CI: 0.74-1.06, P = 0.18), postoperative cardiac and neurological complications, in-hospital length of stay, and in-hospital mortality between the two groups. In patients with OSA undergoing cardiac surgery, PAP therapy was associated with decreased postoperative cardiac complications (33.7% vs 50%; RR: 0.63, 95% CI: 0.51-0.77, P < 0.0001), and postoperative atrial fibrillation (40.1% vs 66.7%; RR: 0.59, 95% CI 0.45-0.77, P < 0.0001).

Conclusion: In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a 28% reduction in the risk of postoperative respiratory complications and 56% reduction in unplanned ICU admission. In patients with OSA undergoing cardiac surgery, PAP therapy decreased the risk of postoperative cardiac complications and atrial fibrillation by 37% and 41%, respectively.

Keywords: Adverse outcomes; Obstructive sleep apnea; Positive airway pressure; Postoperative complications; Surgery.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Atrial Fibrillation* / etiology
Cardiac Surgical Procedures* / adverse effects
Heart Diseases* / etiology
Humans
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / prevention & control
Postoperative Period
Risk Factors
Sleep Apnea, Obstructive* / surgery
Sleep Apnea, Obstructive* / therapy