From the Department of Anesthesia (F.C., P.L., H.E., W.K.) and the Department of Psychiatry (C.M.S.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Anesthesiology. 2014 Feb;120(2):299-311. doi: 10.1097/ALN.0000000000000041.
The knowledge on the mechanism of the postoperative exacerbation of sleep-disordered breathing may direct the perioperative management of patients with obstructive sleep apnea. The objective of this study is to investigate the factors associated with postoperative severity of sleep-disordered breathing.
After obtaining approvals from Institutional Review Boards, consenting patients underwent portable polysomnography preoperatively, and on postoperative nights 1 and 3 in hospital or at home. The primary outcomes were polysomnography parameters measuring the sleep-disordered breathing. They were treated as repeated measurement variables and analyzed for associated factors by mixed models.
Three hundred seventy-six patients, 168 men and 208 women, completed polysomnography on preoperative and postoperative night 1. Age was 59 ± 12 yr (mean ± SD). Preoperative apnea-hypopnea index (AHI) was 12 (4, 26) (median [25th, 75th percentile]) events per hour. Thirty-five patients had minor surgeries, 292 intermediate surgeries, and 49 major surgeries, with 210 general anesthesia and 166 regional anesthesia. The 72-h opioid dose was 55 (14, 85) mg intravenous morphine-equivalent dose. Preoperative AHI, age, and 72-h opioid dose were associated with postoperative AHI. Preoperative central apnea index, male sex, and general anesthesia were associated with postoperative central apnea index. Slow wave sleep percentage was inversely associated with postoperative AHI and central apnea index.
Patients with a higher preoperative AHI were predicted to have a higher postoperative AHI. Preoperative AHI, age, and 72-h opioid dose were positively associated with postoperative AHI. Preoperative central apnea, male sex, and general anesthesia were associated with postoperative central apnea index.
了解睡眠呼吸障碍术后加重的机制可能有助于指导阻塞性睡眠呼吸暂停患者的围手术期管理。本研究旨在探讨与睡眠呼吸障碍术后严重程度相关的因素。
在获得机构审查委员会的批准后，患者同意在术前、术后第 1 天和第 3 天在医院或家中进行便携式多导睡眠图检查。主要结局是测量睡眠呼吸障碍的多导睡眠图参数。这些参数被视为重复测量变量，并通过混合模型分析其相关因素。
376 例患者（168 例男性，208 例女性）完成了术前和术后第 1 天的多导睡眠图检查。年龄为 59 ± 12 岁（均值 ± 标准差）。术前呼吸暂停低通气指数（apnea-hypopnea index，AHI）为 12（4，26）（中位数[25 百分位数，75 百分位数]）/小时。35 例患者行小手术，292 例患者行中手术，49 例患者行大手术，210 例患者接受全身麻醉，166 例患者接受区域麻醉。72 小时阿片类药物剂量为 55（14，85）mg 静脉吗啡等效剂量。术前 AHI、年龄和 72 小时阿片类药物剂量与术后 AHI 相关。术前中枢性呼吸暂停指数、男性和全身麻醉与术后中枢性呼吸暂停指数相关。慢波睡眠百分比与术后 AHI 和中枢性呼吸暂停指数呈负相关。
术前 AHI 较高的患者术后 AHI 较高。术前 AHI、年龄和 72 小时阿片类药物剂量与术后 AHI 呈正相关。术前中枢性呼吸暂停、男性和全身麻醉与术后中枢性呼吸暂停指数相关。
