Ramachandran Satya Krishna, Pandit Jaideep, Devine Scott, Thompson Aleda, Shanks Amy
From the *Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School at Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts; †Nuffield Department of Anaesthesia, University of Oxford, Oxford, United Kingdom; and ‡Center for Observational & Real World Evidence, Merck, Sharpe and Dohme, Whitehouse Station, New Jersey.
Anesth Analg. 2017 Jul;125(1):272-279. doi: 10.1213/ANE.0000000000002132.
Obstructive sleep apnea (OSA) is a prevalent condition that is associated with early postoperative respiratory complications (PRCs). As the majority of patients with OSA are undiagnosed, preoperative screening remains the most efficient method to identify suspected OSA.
This retrospective study was performed on patients undergoing anesthesia in a single academic medical center. We assigned OSA risk class retrospectively to all patients in the study by using the Perioperative Sleep Apnea Prediction (PSAP) score. We evaluated the relationship between PSAP categories and early postoperative invasive airway placement after adjusting for several preoperative and intraoperative factors (including surgical risk) previously associated with PRC occurrence.
A total of 108,479 patients were included in the final analysis with an incidence of PRC was 0.3% (n = 280). High PSAP score was associated with postoperative intubation (adjusted odds ratio, 2.3; 95% confidence interval, 1.5-3.7). Several risk factors reflecting anesthetic agents, neuromuscular blocking agents, and opioids were also independently associated with early PRC.
We report that suspected OSA based on the PSAP score is independently associated with increased risk of early PRC. Specific anesthetic agents are independently associated with early PRC, pointing to the potential for examining risk modification through these exposures in future studies.
阻塞性睡眠呼吸暂停（OSA）是一种常见病症，与术后早期呼吸并发症（PRC）相关。由于大多数OSA患者未被诊断出来，术前筛查仍然是识别疑似OSA的最有效方法。
本回顾性研究针对在单一学术医疗中心接受麻醉的患者进行。我们通过使用围手术期睡眠呼吸暂停预测（PSAP）评分，对研究中的所有患者进行OSA风险分级的回顾性评估。在调整了先前与PRC发生相关的几个术前和术中因素（包括手术风险）后，我们评估了PSAP类别与术后早期侵入性气道放置之间的关系。
共有108479例患者纳入最终分析，PRC发生率为0.3%（n = 280）。高PSAP评分与术后插管相关（调整后的优势比为2.3；95%置信区间为1.5 - 3.7）。反映麻醉剂、神经肌肉阻滞剂和阿片类药物的几个风险因素也与早期PRC独立相关。
我们报告，基于PSAP评分的疑似OSA与早期PRC风险增加独立相关。特定麻醉剂与早期PRC独立相关，这表明在未来研究中通过这些暴露因素来研究风险修正具有可能性。
