Chung Frances, Waseem Rida, Wang Chew Yin, Seet Edwin, Suen Colin, Chan Matthew T V
Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
J Clin Anesth. 2022 Jun;78:110653. doi: 10.1016/j.jclinane.2022.110653. Epub 2022 Feb 4.
Obstructive sleep apnea (OSA) is known to be associated with postoperative cardiovascular events in patients undergoing major non-cardiac surgery. The objective of the study is to determine whether preoperative oximetry-derived hypoxemia predicts postoperative cardiovascular events in surgical patients with unrecognized obstructive sleep apnea.
The study was a planned post hoc analyses of a multicenter prospective cohort study.
The inclusion criteria were patients ≥45 years old undergoing major non-cardiac surgery with cardiovascular risk factors.
All patients underwent pre-operative pulse oximetry (PULSOX-300i, Konica-Minolta Sensing, Inc). The severity of OSA was classified based on oxygen desaturation index (ODI) (mild: ≥5 to <15, moderate: ≥15 to <30, and severe OSA: ≥30 events/h). The 30 days cardiovascular events were a composite of myocardial injury, cardiac death, congestive heart failure, thromboembolism, atrial fibrillation, and stroke.
For 1218 patients with mild, moderate, or severe OSA (mean age: 67.2 ± 9.3 years; body mass index: 27.0 ± 5.3 kg/m), the rate of postoperative cardiovascular events was 16.4%, 25.2%, and 29.8% respectively. The multivariable analysis showed that preoperative oxygen desaturation index (ODI) ≥30 events per hour {adjusted hazard ratio (aHR) 1.63 [95% confidence interval (CI): 1.05-2.53]}, and cumulative time spent during sleep with oxygen saturation below 80% (CT80) ≥10 min {aHR 1.79 [95% CI: 1.28-2.50]} were independent predictors of 30-day postoperative cardiovascular events.
Preoperative ODI ≥30 events per hour and CT80 ≥ 10 min are associated with increased risk of postoperative cardiovascular events. Preoperative screening using oximetry helps in risk stratification for unrecognized sleep apnea.
ClinicalTrials.gov Identifier: NCT01494181.
已知阻塞性睡眠呼吸暂停（OSA）与接受非心脏大手术患者的术后心血管事件相关。本研究的目的是确定术前通过脉搏血氧饱和度测定得出的低氧血症是否可预测未被识别出阻塞性睡眠呼吸暂停的手术患者的术后心血管事件。
本研究是一项对多中心前瞻性队列研究进行的计划中的事后分析。
纳入标准为年龄≥45岁、有心血管危险因素且接受非心脏大手术的患者。
所有患者均接受术前脉搏血氧饱和度测定（使用柯尼卡美能达传感公司的PULSOX - 300i）。根据氧饱和度下降指数（ODI）对OSA的严重程度进行分类（轻度：≥5至<15，中度：≥15至<30，重度OSA：≥30次/小时）。30天心血管事件是心肌损伤、心源性死亡、充血性心力衰竭、血栓栓塞、心房颤动和中风的综合。
对于1218例患有轻度、中度或重度OSA的患者（平均年龄：67.2±9.3岁；体重指数：27.0±5.3kg/m²），术后心血管事件发生率分别为16.4%、25.2%和29.8%。多变量分析显示，术前氧饱和度下降指数（ODI）≥30次/小时{调整后风险比（aHR）1.63 [95%置信区间（CI）：1.05 - 2.53]}，以及睡眠期间血氧饱和度低于80%的累计时间（CT80）≥10分钟{aHR 1.79 [95% CI：1.28 - 2.50]}是术后30天心血管事件的独立预测因素。
术前ODI≥30次/小时和CT80≥10分钟与术后心血管事件风险增加相关。使用脉搏血氧饱和度测定进行术前筛查有助于对未被识别出的睡眠呼吸暂停进行风险分层。
ClinicalTrials.gov标识符：NCT01494181。
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