Hersch Nicole, Girgis Samira, Marks Guy Barrington, Smith Frances, Buchanan Peter R, Williamson Jonathan P, Garden Frances, Vedam Hima
Respiratory and Sleep Medicine Department, Liverpool Hospital, Sydney, New South Wales, Australia.
South Western Clinical School, University of New South Wales, Liverpool Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2025 Feb;55(2):241-248. doi: 10.1111/imj.16595. Epub 2024 Dec 10.
Unrecognised obstructive sleep apnoea (OSA) has been associated with adverse cardiorespiratory perioperative outcomes. However, with changing anaesthetic and perioperative management, there is ongoing uncertainty about the importance of OSA as a risk factor for post-operative complications.
A cohort study involving subjects undergoing elective surgery was conducted. OSA was diagnosed with a limited channel sleep monitor. In subjects undergoing routine perioperative care, complications were identified based on the assessment of the attending clinical team. The primary outcome was a composite end-point of cardiorespiratory outcomes comprising myocardial infarction, atrial fibrillation, other arrhythmias, bradycardia, need for inotropic support, unplanned intensive care unit admission, pneumonia or respiratory failure.
Four hundred seventy-two subjects were recruited, with 356 being included in the analyses; 281 (79%) had OSA and 66 (19%) had severe OSA. Subjects with OSA did not have a significantly higher incidence of complications (5.7%) compared to those without (2.7%, adjusted relative risk 1.89 (0.23-15.67)). Additionally, complications were not increased in those with severe OSA.
Unrecognised OSA was not associated with an increase in clinically evident cardiorespiratory complications in this cohort. The lower complication rates compared with earlier studies suggest that increased use of less invasive surgical techniques, improved pain management and increased awareness of OSA have had an impact in reducing postoperative complications in this group. Further research is needed to clarify the impact of severe OSA on post-operative outcomes in different surgical cohorts with varying risk profiles in order to develop optimal perioperative pathways.
未被识别的阻塞性睡眠呼吸暂停（OSA）与不良的围手术期心肺结局相关。然而，随着麻醉和围手术期管理的变化，OSA作为术后并发症危险因素的重要性仍存在不确定性。
进行了一项涉及接受择期手术患者的队列研究。采用有限通道睡眠监测仪诊断OSA。在接受常规围手术期护理的患者中，根据主治临床团队的评估确定并发症。主要结局是一个包括心肌梗死、心房颤动、其他心律失常、心动过缓、需要使用血管活性药物支持、意外入住重症监护病房、肺炎或呼吸衰竭的心心肺结局复合终点。
招募了472名受试者，其中356名纳入分析；281名（79%）患有OSA，66名（19%）患有重度OSA。与未患OSA的患者相比，OSA患者的并发症发生率（5.7%）没有显著更高（2.7%，调整后的相对风险为1.89（0.23 - 15.67））。此外，重度OSA患者的并发症也没有增加。
在该队列中，未被识别的OSA与临床上明显的心心肺并发症增加无关。与早期研究相比，较低的并发症发生率表明，微创外科技术的更多使用、疼痛管理的改善以及对OSA认识的提高对降低该组患者的术后并发症产生了影响。需要进一步研究以阐明重度OSA对不同手术队列、具有不同风险特征的术后结局的影响，以便制定最佳的围手术期方案。
