Seet Edwin, Waseem Rida, Chan Matthew T V, Wang Chew Yin, Liao Vanessa, Suen Colin, Chung Frances
Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117559, Singapore.
Department of Anaesthesia, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore.
J Pers Med. 2022 Sep 20;12(10):1543. doi: 10.3390/jpm12101543.
Surgical patients with obstructive sleep apnea (OSA) have increased risk of perioperative complications. The primary objective is to determine the characteristics of surgical patients with unrecognized OSA requiring oxygen therapy for postoperative hypoxemia. The secondary objective is to investigate the characteristics of patients who were responsive to oxygen therapy. This was a post-hoc multicenter study involving patients with cardiovascular risk factors undergoing major non-cardiac surgery. Patients ≥45 years old underwent Type 3 sleep apnea testing and nocturnal oximetry preoperatively. Responders to oxygen therapy were defined as individuals with ≥50% reduction in oxygen desaturation index (ODI) on postoperative night 1 versus preoperative ODI. In total, 624 out of 823 patients with unrecognized OSA required oxygen therapy. These were mostly males, had larger neck circumferences, higher Revised Cardiac Risk Indices, higher STOP-Bang scores, and higher ASA physical status, undergoing intraperitoneal or vascular surgery. Multivariable regression analysis showed that the preoperative longer cumulative time SpO2 < 90% or CT90% (adjusted p = 0.03), and lower average overnight SpO2 (adjusted p < 0.001), were independently associated with patients requiring oxygen therapy. Seventy percent of patients were responders to oxygen therapy with ≥50% ODI reduction. Preoperative ODI (19.0 ± 12.9 vs. 14.1 ± 11.4 events/h, p < 0.001), CT90% (42.3 ± 66.2 vs. 31.1 ± 57.0 min, p = 0.038), and CT80% (7.1 ± 22.6 vs. 3.6 ± 8.7 min, p = 0.007) were significantly higher in the responder than the non-responder. Patients with unrecognized OSA requiring postoperative oxygen therapy were males with larger neck circumferences and higher STOP-Bang scores. Those responding to oxygen therapy were likely to have severe OSA and worse preoperative nocturnal hypoxemia. Preoperative overnight oximetry parameters may help in stratifying patients.
患有阻塞性睡眠呼吸暂停（OSA）的外科手术患者围手术期并发症风险增加。主要目的是确定因术后低氧血症需要吸氧治疗的未被识别的OSA外科手术患者的特征。次要目的是研究对吸氧治疗有反应的患者的特征。这是一项事后多中心研究，涉及有心血管危险因素且正在接受非心脏大手术的患者。年龄≥45岁的患者术前接受3型睡眠呼吸暂停测试和夜间血氧饱和度测定。对吸氧治疗有反应者定义为术后第1晚的氧饱和度下降指数（ODI）较术前ODI降低≥50%的个体。在823例未被识别的OSA患者中，共有624例需要吸氧治疗。这些患者大多为男性，颈围较大，修订心脏风险指数较高，STOP-Bang评分较高，美国麻醉医师协会（ASA）身体状况分级较高，接受的是腹腔内或血管手术。多变量回归分析显示，术前SpO2<90%的累计时间较长或CT90%（校正p=0.03）以及夜间平均SpO2较低（校正p<0.001）与需要吸氧治疗的患者独立相关。70%的患者对吸氧治疗有反应，ODI降低≥50%。有反应者的术前ODI（19.0±12.9次/小时对14.1±11.4次/小时，p<0.001）、CT90%（42.3±66.2分钟对31.1±57.0分钟，p=0.038）和CT80%（7.1±22.6分钟对3.6±8.7分钟，p=0.007）显著高于无反应者。需要术后吸氧治疗的未被识别的OSA患者为颈围较大且STOP-Bang评分较高的男性。对吸氧治疗有反应者可能患有严重OSA且术前夜间低氧血症更严重。术前夜间血氧饱和度测定参数可能有助于对患者进行分层。
