Patel Samir V, Gill Harmeet, Shahi Diwas, Rajabalan Ajai, Patel Palak, Sonani Rajesh, Bhatt Parth, Rodriguez Rafael David, Bautista Manuel, Deshmukh Abhishek, Gonzalez Juan Viles, Patel Sanjay
Department of Medicine, Sparks Health Systems, Fort Smith, AR, USA.
Department of Medicine, Western Reserve Health Education/NEOMED, Youngstown, OH, USA.
Sleep Breath. 2018 Dec;22(4):1117-1124. doi: 10.1007/s11325-018-1645-3. Epub 2018 Feb 19.
Obstructive sleep apnea hypopnea syndrome (OSAHS) is highly prevalent in patients undergoing coronary artery bypass surgery (CABG). OSAHS is a risk factor for the development of atrial fibrillation (AF), but the risk of AF in patients who are high risk for OSAHS is unclear.
A retrospective study was conducted on consecutive patients undergoing CABG from 2013 to 2015 without AF pre-operatively. Patients were categorized as low risk for OSAHS, high risk for OSAHS, or diagnosed OSAHS based on medical records review. All diagnosed OSAHS patients were on active treatment with positive airway pressure. Outcomes assessed were postoperative AF (POAF), postoperative length of stay, re-intubation, in-hospital mortality, and cost of hospitalization.
Out of 209 eligible patients, 66.5% were low-risk for OSAHS, 18.7% high-risk for OSAHS, and 14.8% diagnosed/treated for OSAHS. POAF developed in 96 patients (45.9%) with greater frequency in high-risk OSAHS patients (69.2% high risk, 41.9% low risk, 40.3% diagnosed/treated, p = 0.01). In analyses adjusted for age, sex, ethnicity and comorbidities, high risk for OSAHS was associated with 2.9 greater odds (95% CI [1.2, 7.3], p = 0.02) for POAF while diagnosed/treated OSAHS was not associated with elevated risk (OR = 1.4, 95% CI [0.6, 3.6], p = 0.50) compared to patients at low risk for OSAHS.
High risk for OSAHS is an independent predictor for POAF in patients undergoing CABG. In contrast, patients diagnosed and treated for their OSAHS are not at elevated risk of POAF. These findings support evaluation of a standardized OSAHS screening and treatment program as part of the pre-operative evaluation for elective CABG.
阻塞性睡眠呼吸暂停低通气综合征（OSAHS）在接受冠状动脉旁路移植术（CABG）的患者中非常普遍。OSAHS是心房颤动（AF）发生的一个危险因素，但OSAHS高危患者发生AF的风险尚不清楚。
对2013年至2015年连续接受CABG且术前无AF的患者进行回顾性研究。根据病历审查，将患者分为OSAHS低风险、OSAHS高风险或确诊为OSAHS。所有确诊为OSAHS的患者均接受持续气道正压通气积极治疗。评估的结果包括术后房颤（POAF）、术后住院时间、再次插管、院内死亡率和住院费用。
在209例符合条件的患者中，66.5%为OSAHS低风险，18.7%为OSAHS高风险，14.8%确诊/治疗为OSAHS。96例患者（45.9%）发生了POAF，在OSAHS高风险患者中发生率更高（高风险组为69.2%，低风险组为41.9%，确诊/治疗组为40.3%，p = 0.01）。在对年龄、性别、种族和合并症进行校正的分析中，与OSAHS低风险患者相比，OSAHS高风险与POAF的发生几率高2.9倍相关（95%CI[1.2, 7.3]，p = 0.02），而确诊/治疗的OSAHS与风险升高无关（OR = 1.4，95%CI[0.6, 3.6]，p = 0.50）。
OSAHS高风险是接受CABG患者发生POAF的独立预测因素。相比之下，确诊并接受治疗的OSAHS患者发生POAF的风险并未升高。这些发现支持将标准化的OSAHS筛查和治疗方案评估作为择期CABG术前评估的一部分。
