Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Department of Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
J Clin Sleep Med. 2018 Apr 15;14(4):593-602. doi: 10.5664/jcsm.7052.
The presence of obstructive sleep apnea (OSA) in ambulatory surgical patients causes significant perioperative concern; however, few data exist to guide clinicians' management decisions. The objective of this study was to measure changes in perioperative sleep parameters among an ambulatory surgery population.
This study is a prospective, observational study of ambulatory patients undergoing orthopedic surgery on an extremity. Study subjects completed three unattended home sleep apnea tests: baseline before surgery, the first night after surgery (N1), and third night after surgery (N3). Anesthesia and surgical teams were blinded to study participation and patients received routine perioperative care.
Two hundred three subjects were enrolled and 166 completed the baseline home sleep test. Sixty-six (40.0%) had OSA at baseline, 35 patients received a new diagnosis, and 31 patients had a previous diagnosis of OSA. Of those with a previous diagnosis, 20 (64.5%) were compliant with continuous positive airway pressure therapy. Respiratory event index and SpO nadir did not significantly change postoperatively from baseline. Cumulative percentage of time oxygen saturation < 90% significantly increased N1 as compared to baseline for all patients except for those with moderate to severe OSA.
Ambulatory surgery had minimal effect on sleep parameters and there was no increase in adverse events among patients with either treated or untreated OSA.
Registry: ClinicalTrials.gov; Title: Evaluation of Sleep Disordered Breathing Following Ambulatory Surgery; Identifier: NCT01851798; URL: https://clinicaltrials.gov/ct2/show/study/NCT01851798.
门诊手术患者存在阻塞性睡眠呼吸暂停（OSA）会引起围手术期的显著关注；然而，目前几乎没有数据可以指导临床医生的管理决策。本研究的目的是测量门诊手术人群围手术期睡眠参数的变化。
这是一项针对在四肢接受骨科手术的门诊患者的前瞻性、观察性研究。研究对象完成了三次无人值守的家庭睡眠呼吸暂停测试：手术前基线、手术后第一晚（N1）和手术后第三晚（N3）。麻醉和手术团队对研究参与情况不知情，患者接受常规围手术期护理。
共有 203 名患者入组，其中 166 名患者完成了基线家庭睡眠测试。66 名（40.0%）患者在基线时有 OSA，35 名患者新诊断出 OSA，31 名患者以前曾诊断出 OSA。在以前诊断为 OSA 的患者中，20 名（64.5%）患者依从性较好，持续气道正压通气治疗。术后与基线相比，呼吸事件指数和 SpO2 最低值均无显著变化。除中重度 OSA 患者外，所有患者在 N1 时，氧饱和度<90%的累计时间百分比显著增加。
门诊手术对睡眠参数的影响很小，无论 OSA 患者是否接受治疗，都没有增加不良事件。
注册号：ClinicalTrials.gov；标题：评估门诊手术后睡眠呼吸紊乱；标识符：NCT01851798；网址：https://clinicaltrials.gov/ct2/show/study/NCT01851798。
