Department of Anesthesiology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Sleep Health and Research, Toronto General Hospital, Toronto, ON, Canada.
Chest. 2019 Apr;155(4):855-867. doi: 10.1016/j.chest.2018.09.030. Epub 2018 Oct 22.
In the surgical setting, OSA is associated with an increased risk of postoperative complications. At present, risk stratification using OSA-associated parameters derived from polysomnography (PSG) or overnight oximetry to predict postoperative complications has not been established. The objective of this narrative review is to evaluate the literature to determine the association between parameters extracted from in-laboratory PSG, portable PSG, or overnight oximetry and postoperative adverse events. We obtained pertinent articles from Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, and Embase (2008 to December 2017). The search included studies with adult patients undergoing surgery who had OSA diagnosed with portable PSG, in-laboratory PSG, or overnight oximetry that reported on specific sleep parameters and at least one adverse outcome. The search was restricted to English-language articles. The search yielded 1,810 articles, of which 21 were included in the review. Preoperative apnea-hypopnea index (AHI) and measurements of nocturnal hypoxemia such as oxygen desaturation index (ODI), cumulative sleep time percentage with oxyhemoglobin saturation (Spo) < 90% (CT90), minimum Spo, mean Spo, and longest apnea duration were associated with postoperative complications. OSA is associated with postoperative complications in the population undergoing surgery. Clinically and statistically significant associations between AHI and postoperative adverse events exists. Complications may be more likely to occur in the category of moderate to severe OSA (AHI ≥ 15). Other parameters from PSG or overnight oximetry such as ODI, CT90, mean and minimal Spo, and longest apnea duration can be associated with postoperative complications and may provide additional value in risk stratification and minimization.
在外科环境中，阻塞性睡眠呼吸暂停（OSA）与术后并发症的风险增加有关。目前，尚未确定使用源自多导睡眠图（PSG）或夜间血氧仪的与 OSA 相关的参数进行风险分层，以预测术后并发症。本叙述性综述的目的是评估文献，以确定从实验室 PSG、便携式 PSG 或夜间血氧仪中提取的参数与术后不良事件之间的关联。我们从 Ovid MEDLINE、Ovid MEDLINE 正在处理和其他非索引引文以及 Embase（2008 年至 2017 年 12 月）中获取了相关文章。该搜索包括接受过手术的成年患者的研究，这些患者的 OSA 通过便携式 PSG、实验室 PSG 或夜间血氧仪诊断，并报告了特定的睡眠参数和至少一种不良结局。搜索仅限于英语文章。搜索产生了 1810 篇文章，其中 21 篇文章被纳入综述。术前呼吸暂停低通气指数（AHI）和夜间低氧血症的测量值，如氧减指数（ODI）、血氧饱和度（Spo）<90%的睡眠时间百分比（CT90）、最低 Spo、平均 Spo 和最长呼吸暂停持续时间与术后并发症相关。阻塞性睡眠呼吸暂停与接受手术的人群中的术后并发症相关。AHI 与术后不良事件之间存在临床和统计学上的显著关联。在中至重度 OSA（AHI≥15）类别中，并发症更有可能发生。PSG 或夜间血氧仪的其他参数，如 ODI、CT90、平均和最小 Spo 以及最长呼吸暂停持续时间，可能与术后并发症相关，并可能在风险分层和最小化方面提供额外的价值。
