From the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (A.T., C.E., A.F., I.G., Y.E., R.G., D.I.S.); Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio (J.Y.); Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (A.K., S.B., S.Q., L.A.); Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California (A.G.D.); and Outcomes Research Consortium, Cleveland, Ohio (A.G.D.). Current affiliations: Boston University, Boston, Massachusetts (C.E.); Department of Anesthesiology, Oregon Health and Science University, Portland, Oregon (A.F.); Department of Anesthesiology, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio (Y.E.); and Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio (R.G.).
Anesthesiology. 2015 Jan;122(1):64-71. doi: 10.1097/ALN.0000000000000457.
Recurrent nocturnal hypoxemia in obstructive sleep apnea enhances sympathetic function, decreases baroreceptor sensitivity, and weakens peripheral vascular responses to adrenergic signals. The authors hypothesized that the percentage of total sleep time spent at oxyhemoglobin saturation (SaO2) less than 90% and minimum nocturnal SaO2 on preoperative polysomnography are associated with decreased intraoperative mean arterial pressure.
The authors examined the records of all patients who had laparoscopic bariatric surgery at Cleveland Clinic between 2005 and 2009 and an available polysomnography study. The authors assessed the relationships between the percentage of total sleep time spent at SaO2 less than 90% and minimum nocturnal SaO2, and the time-weighted average of mean arterial pressure. The authors used multivariable regression models to adjust for prespecified clinical confounders.
Two hundred eighty-one patients were included in the analysis. The average change in the time-weighted average of mean arterial pressure was -0.02 (97.5% CI, -0.08, 0.04) mmHg for each 1% absolute increase in the percentage of sleep time spent at SaO2 less than 90% (P = 0.50). The average change was -0.13 (97.5% CI, -0.27, 0.01) mmHg, for each 1% absolute decrease in the minimum SaO2 (P = 0.04 > significance criterion of 0.025, Bonferroni correction). An unplanned analysis estimated 1% absolute decrease in minimum SaO2 was associated with -0.22 (98.75% CI, -0.39, -0.04) mmHg, change in mean arterial pressure (P = 0.002) in the time period between endotracheal intubation and trocar insertion.
Recurrent nocturnal hypoxemia in obstructive sleep apnea is not a risk marker for intraoperative hypotension.
阻塞性睡眠呼吸暂停患者夜间反复出现低氧血症会增强交感神经功能，降低压力感受器敏感性，并减弱外周血管对肾上腺素信号的反应。作者假设，术前多导睡眠图上总睡眠时间中血氧饱和度（SaO2）低于 90%的比例和最低夜间 SaO2与术中平均动脉压降低有关。
作者检查了 2005 年至 2009 年克利夫兰诊所接受腹腔镜减重手术且有可用多导睡眠图研究的所有患者的记录。作者评估了总睡眠时间中 SaO2 低于 90%的比例和最低夜间 SaO2与平均动脉压时间加权平均值之间的关系。作者使用多变量回归模型来调整预定的临床混杂因素。
281 例患者纳入分析。SaO2 低于 90%的睡眠时间每增加 1%，平均动脉压时间加权平均值的平均变化为-0.02mmHg（97.5%CI，-0.08，0.04）（P=0.50）。最低 SaO2 每降低 1%，平均动脉压的平均变化为-0.13mmHg（97.5%CI，-0.27，0.01）（P=0.04>0.025 的显著性标准，Bonferroni 校正）。一项未计划的分析估计，最低 SaO2 绝对降低 1%与气管内插管和套管插入之间的平均动脉压变化（P=0.002）-0.22mmHg（98.75%CI，-0.39，-0.04）相关。
阻塞性睡眠呼吸暂停患者夜间反复出现低氧血症不是术中低血压的风险标志物。
