Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States.
J Clin Anesth. 2023 Aug;87:111109. doi: 10.1016/j.jclinane.2023.111109. Epub 2023 Mar 21.
Atrial fibrillation and delirium are common complications after cardiac surgery. Both are associated with increased Intensive Care Unit (ICU) and hospital length of stay, functional decline, 30-day mortality and increase in health care costs. Obstructive Sleep Apnea (OSA) induces deleterious effects in the cardiovascular and nervous systems. We hypothesized that adult patients with preoperative OSA have a higher incidence of postoperative atrial fibrillation and delirium than patients without OSA, after cardiac surgery.
Sub-analysis of the DECADE trial at Cleveland Clinic hospitals. Our exposure was OSA, defined by STOP-BANG questionnaire score higher than 5 and/or a preoperative diagnosis of OSA. The primary outcome was atrial fibrillation, defined by clinician diagnosis or documented arrhythmia. The secondary outcome was delirium assessed twice during the initial five postoperative days using the Confusion Assessment Method for ICU. We assessed the association between OSA, and atrial fibrillation and delirium using a logistic regression model adjusted for confounders using inverse probability of treatment weighting.
590 patients were included in the final analysis. 133 were diagnosed with OSA and 457 had no OSA. Satisfactory balance between groups for most confounders (absolute standardized difference < 0.10) was achieved after weighting. The atrial fibrillation incidence was 37% (n = 49) in the patients with OSA and 33% (n = 150) in the non-OSA patients. OSA was not associated with atrial fibrillation with an estimated odds ratio of 1.22 (95% CI: 0.75,1.99;p = 0.416). The delirium incidence was 17% (n = 22) in patients with OSA and 15% (n = 67) in the non-OSA patients. OSA was not associated with delirium with an estimated odds ratio of 0.93 (95% CI: 0.51,1.69;p = 0.800).
In adult patients having cardiac surgery, OSA is not associated with a higher incidence of postoperative atrial fibrillation and delirium. These results suggest different prominent factors rather than OSA affect the incidence of these postoperative outcomes.
心房颤动和谵妄是心脏手术后常见的并发症。两者均与重症监护病房（ICU）和住院时间延长、功能下降、30 天死亡率增加以及医疗保健费用增加有关。阻塞性睡眠呼吸暂停（OSA）会对心血管和神经系统造成有害影响。我们假设术前患有 OSA 的成年患者在心脏手术后发生术后心房颤动和谵妄的发生率高于没有 OSA 的患者。
克利夫兰诊所医院 DECADE 试验的亚组分析。我们的暴露因素是 OSA，通过 STOP-BANG 问卷评分高于 5 分和/或术前诊断为 OSA 来定义。主要结局是由临床医生诊断或记录的心律失常定义的心房颤动。次要结局是在最初的 5 天术后期间使用 ICU 意识混乱评估方法进行两次评估的谵妄。我们使用逆概率治疗加权法调整混杂因素的逻辑回归模型评估 OSA 与心房颤动和谵妄之间的关联。
590 例患者纳入最终分析。133 例被诊断为 OSA，457 例没有 OSA。经过加权后，大多数混杂因素（绝对标准化差异<0.10）在两组之间达到了令人满意的平衡。患有 OSA 的患者中心房颤动的发生率为 37%（n=49），而没有 OSA 的患者中为 33%（n=150）。OSA 与心房颤动无关，估计比值比为 1.22（95%CI：0.75，1.99；p=0.416）。患有 OSA 的患者中谵妄的发生率为 17%（n=22），而没有 OSA 的患者中为 15%（n=67）。OSA 与谵妄无关，估计比值比为 0.93（95%CI：0.51，1.69；p=0.800）。
在接受心脏手术的成年患者中，OSA 与术后心房颤动和谵妄的发生率增加无关。这些结果表明，影响这些术后结局发生率的是不同的突出因素而不是 OSA。
