Shin Christina H, Zaremba Sebastian, Devine Scott, Nikolov Milcho, Kurth Tobias, Eikermann Matthias
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Sleep Medicine, Department of Neurology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
BMJ Open. 2016 Jan 13;6(1):e008436. doi: 10.1136/bmjopen-2015-008436.
Obstructive sleep apnoea (OSA), the most common type of sleep-disordered breathing, is associated with significant immediate and long-term morbidity, including fragmented sleep and impaired daytime functioning, as well as more severe consequences, such as hypertension, impaired cognitive function and reduced quality of life. Perioperatively, OSA occurs frequently as a consequence of pre-existing vulnerability, surgery and drug effects. The impact of OSA on postoperative respiratory complications (PRCs) needs to be better characterised. As OSA is associated with significant comorbidities, such as obesity, pulmonary hypertension, myocardial infarction and stroke, it is unclear whether OSA or its comorbidities are the mechanism of PRCs. This project aims to (1) develop a novel prediction score identifying surgical patients at high risk of OSA, (2) evaluate the association of OSA risk on PRCs and (3) evaluate if pharmacological agents used during surgery modify this association.
Retrospective cohort study using hospital-based electronic patient data and perioperative data on medications administered and vital signs. We will use data from Partners Healthcare clinical databases, Boston, Massachusetts. First, a prediction model for OSA will be developed using OSA diagnostic codes and polysomnography procedural codes as the reference standard, and will be validated by medical record review. Results of the prediction model will be used to classify patients in the database as high, medium or low risk of OSA, and we will investigate the effect of OSA on risk of PRCs. Finally, we will test whether the effect of OSA on PRCs is modified by the use of intraoperative pharmacological agents known to increase upper airway instability, including neuromuscular blockade, neostigmine, opioids, anaesthetics and sedatives.
The Partners Human Research Committee approved this study (protocol number: 2014P000218). Study results will be made available in the form of manuscripts for publication and presentations at national and international meetings.
阻塞性睡眠呼吸暂停（OSA）是睡眠呼吸障碍最常见的类型，与严重的即时和长期发病相关，包括睡眠碎片化和日间功能受损，以及更严重的后果，如高血压、认知功能受损和生活质量下降。在围手术期，由于术前的易感性、手术和药物作用，OSA经常发生。OSA对术后呼吸并发症（PRC）的影响需要更好地加以描述。由于OSA与肥胖、肺动脉高压、心肌梗死和中风等重大合并症相关，目前尚不清楚OSA及其合并症是否是PRC的发病机制。本项目旨在：（1）开发一种新型预测评分，以识别OSA高危手术患者；（2）评估OSA风险与PRC的关联；（3）评估手术期间使用的药物是否会改变这种关联。
采用回顾性队列研究，利用基于医院的电子患者数据以及所使用药物和生命体征的围手术期数据。我们将使用马萨诸塞州波士顿Partners Healthcare临床数据库中的数据。首先，将以OSA诊断代码和多导睡眠图程序代码作为参考标准，开发OSA预测模型，并通过病历审查进行验证。预测模型的结果将用于将数据库中的患者分类为OSA高、中或低风险，我们将研究OSA对PRC风险的影响。最后，我们将测试OSA对PRC的影响是否会因使用已知会增加上气道不稳定性的术中药物而改变，这些药物包括神经肌肉阻滞剂、新斯的明、阿片类药物、麻醉剂和镇静剂。
Partners人类研究委员会批准了本研究（方案编号：2014P000218）。研究结果将以稿件形式发表，并在国内和国际会议上进行展示。
