Wang Shuo, Li Shiyong, Zhao Yilin, Zhao Xiaoping, Zhou Zhiqiang, Hao Quanshui, Luo Ailin, Sun Rao
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
J Clin Anesth. 2022 Aug;79:110692. doi: 10.1016/j.jclinane.2022.110692. Epub 2022 Feb 23.
To determine the association between postoperative complications and a high versus low risk of obstructive sleep apnea (OSA) as determined via screening tools.
Systematic review and meta-analysis of cohort studies. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched from their inception to January 5, 2021.
Operating room, postoperative recovery area, and ward.
Adult patients scheduled for surgery.
We used Review Manager 5.4 to pool the data. The quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation system.
The primary outcome was the composite endpoint of postoperative respiratory complications. The secondary outcomes were postoperative cardiac and neurological complications, intensive care unit (ICU) admission, and mortality.
Twenty-six studies with 50,592 patients were included. A STOP-Bang score ≥ 3 (versus <3) was associated with higher incidences of postoperative respiratory (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.66-2.68) and neurological complications (OR, 3.60; 95% CI, 1.56-8.31). A STOP-Bang score ≥ 5 (versus <5) was associated with higher incidences of postoperative respiratory (OR, 2.37; 95% CI, 1.11-5.04) and cardiac complications (OR, 4.95; 95% CI, 1.22-20.00) and higher in-hospital mortality (OR, 26.39; 95% CI, 2.89-241.30). A Berlin score ≥ 2 (versus <2) was not associated with the incidence of postoperative complications, ICU admission, or mortality. The quality of evidence for all outcomes was very low.
Very low-quality evidence suggested that a high risk of OSA, as assessed using the STOP-Bang questionnaire, was associated with a higher incidence of postoperative respiratory complications, and may also be associated with higher incidences of postoperative cardiac and neurological complications than a low risk of OSA. Since most of the included studies did not adjust for confounding factors, our findings need to be interpreted with caution. PROSPERO registration number: CRD42021220236.
通过筛查工具确定术后并发症与阻塞性睡眠呼吸暂停（OSA）高风险和低风险之间的关联。
队列研究的系统评价和荟萃分析。检索了PubMed、EMBASE、Web of Science和Cochrane图书馆自建库至2021年1月5日的文献。
手术室、术后恢复区和病房。
计划接受手术的成年患者。
我们使用Review Manager 5.4对数据进行汇总。采用推荐分级、评估、制定与评价系统对证据质量进行评级。
主要结局是术后呼吸并发症的复合终点。次要结局包括术后心脏和神经并发症、重症监护病房（ICU）入院情况及死亡率。
纳入了26项研究，共50592例患者。STOP-Bang评分≥3（对比<3）与术后呼吸并发症（比值比[OR]，2.11；95%置信区间[CI]，1.66-2.68）和神经并发症（OR，3.60；95%CI，1.56-8.31）的发生率较高相关。STOP-Bang评分≥5（对比<5）与术后呼吸并发症（OR，2.37；95%CI，1.11-5.04）和心脏并发症（OR，4.95；95%CI，1.22-20.00）的发生率较高以及院内死亡率较高（OR，26.39；95%CI，2.89-241.30）相关。Berlin评分≥2（对比<2）与术后并发症、ICU入院情况或死亡率的发生率无关。所有结局的证据质量都非常低。
质量极低的证据表明，使用STOP-Bang问卷评估的OSA高风险与术后呼吸并发症的发生率较高相关，并且与OSA低风险相比，术后心脏和神经并发症的发生率可能也较高。由于大多数纳入研究未对混杂因素进行调整，我们的研究结果需谨慎解读。PROSPERO注册号：CRD42021220236。
