Titu Ioana-Medeea, Vulturar Damiana Maria, Chis Ana Florica, Oprea Alexandru, Manea Alexandru, Todea Doina Adina
Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania.
Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania.
J Clin Med. 2025 Jul 17;14(14):5095. doi: 10.3390/jcm14145095.
: Obstructive sleep apnea is a prevalent, yet often underdiagnosed, condition characterized by recurrent upper airway obstruction during sleep, leading to significant perioperative risks in surgical patients. This systematic review aims to evaluate the incidence and impact of objectively diagnosed obstructive sleep apnea on postoperative outcomes across various surgical specialties-including bariatric, orthopedic, cardiac, and otorhinolaryngologic surgeries-and to assess the effectiveness of preoperative screening and perioperative management strategies. : A comprehensive literature search of PubMed was conducted for studies published between January 2013 and December 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies involved adult surgical patients with OSA confirmed by polysomnography or respiratory polygraphy. Studies were assessed for methodological quality using the Oxford Centre for Evidence-Based Medicine Levels of Evidence framework. : The findings consistently indicated that obstructive sleep apnea significantly increases the risk of postoperative complications, such as respiratory depression, atrial fibrillation, acute kidney injury, delirium, and prolonged hospital stay. Continuous positive airway pressure therapy demonstrated a protective effect in bariatric and cardiac surgeries, though its effectiveness in orthopedic and otorhinolaryngologic contexts was inconsistent, largely due to adherence variability and limited implementation. Preoperative screening tools such as the STOP-BANG questionnaire were widely used, but their utility depended on integration with confirmatory diagnostics. : Obstructive sleep apnea represents a significant, modifiable risk factor in surgical populations. Preoperative identification and risk-adapted perioperative management, including CPAP therapy and multimodal analgesia, may substantially reduce postoperative morbidity. However, further randomized trials and cost-effectiveness studies are needed to optimize care pathways and ensure consistent implementation across surgical disciplines.
阻塞性睡眠呼吸暂停是一种普遍存在但常被漏诊的病症，其特征是睡眠期间上呼吸道反复阻塞，这会给外科手术患者带来重大围手术期风险。本系统评价旨在评估经客观诊断的阻塞性睡眠呼吸暂停在包括减重手术、骨科手术、心脏手术和耳鼻咽喉科手术在内的各种外科专科术后结局中的发生率和影响，并评估术前筛查和围手术期管理策略的有效性。
按照系统评价和Meta分析的首选报告项目指南，对PubMed上2013年1月至2024年12月发表的研究进行了全面的文献检索。纳入的研究涉及经多导睡眠图或呼吸多导描记术确诊为阻塞性睡眠呼吸暂停的成年外科手术患者。使用牛津循证医学中心证据水平框架对研究的方法学质量进行评估。
研究结果一致表明，阻塞性睡眠呼吸暂停显著增加术后并发症的风险，如呼吸抑制、心房颤动、急性肾损伤、谵妄和住院时间延长。持续气道正压通气治疗在减重手术和心脏手术中显示出保护作用，尽管其在骨科和耳鼻咽喉科手术中的有效性并不一致，这主要是由于依从性差异和实施有限。像STOP-BANG问卷这样的术前筛查工具被广泛使用，但其效用取决于与确诊诊断方法的结合。
阻塞性睡眠呼吸暂停是手术人群中一个重要且可改变的风险因素。术前识别和根据风险调整围手术期管理，包括持续气道正压通气治疗和多模式镇痛，可能会大幅降低术后发病率。然而，需要进一步的随机试验和成本效益研究来优化护理路径，并确保在各外科领域一致实施。
