Adverse respiratory events after general anesthesia in patients at high risk of obstructive sleep apnea syndrome
Open accessAbstract
Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia. This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011. Primary outcome was the development of adverse respiratory events. Demographics data, perioperative variables, and postoperative length of stay in the Post-Anesthesia Care Unit and in hospital were recorded. The Mann–Whitney test, the chi-square test and the Fisher exact test were used for comparisons. Subjects in both pairs of study subjects had a median age of 56 years, including 25% males, and 59% were submitted to intra-abdominal surgery. High risk of obstructive sleep apnea patients had a higher median body mass index (31 versus 24 kg/m2, p < 0.001) and had more frequently co-morbidities, including hypertension (58% versus 24%, p < 0.001), dyslipidemia (46% versus 17%, p < 0.001) and insulin-treated diabetes mellitus (17% versus 2%, p = 0.004). These patients were submitted more frequently to bariatric surgery (20% versus 2%, p = 0.002). Patients with high risk of obstructive sleep apnea had more frequently adverse respiratory events (39% versus 10%, p < 0.001), mild to moderate desaturation (15% versus 0%, p = 0.001) and inability to breathe deeply (34% versus 9%, p = 0.001). After general anesthesia high risk of obstructive sleep apnea patients had an increased incidence of postoperative respiratory complications. Os pacientes com escore STOP-BANG > 3 possuem alto risco de desenvolver apneia obstrutiva do sono. O objetivo deste estudo foi avaliar as complicações respiratórias no pós-operatório imediato em adultos com escore STOP-BANG > 3 após anestesia geral. Estudo prospectivo de dupla-coorte, comparando 59 pares de pacientes adultos com escore STOP-BANG > 3 (alto risco de apneia obstrutiva do sono) e pacientes com escore STOP-BANG < 3 (baixo risco de apneia obstrutiva do sono), similares no que diz respeito ao gênero, idade e tipo de cirurgia, admitidos após a cirurgia eletiva em sala de recuperação pós-anestésica (SRPA) em maio de 2011. O desfecho primário foi o desenvolvimento de eventos respiratórios adversos. Dados demográficos, variáveis no perioperatório e tempos de permanência na SRPA e no hospital após a cirurgia foram registrados. Os testes de Mann-Whitney, qui-quadrado e exato de Fisher foram usados para comparação. Os indivíduos de ambos os grupos de pacientes do estudo tinham uma média de idade de 56 anos, 25% eram do sexo masculino e 59% foram submetidos à cirurgia intra-abdominal. Os pacientes com alto risco de apneia obstrutiva do sono apresentavam uma mediana maior do índice de massa corporal (31 versus 24 kg/m2, p < 0,001) e comorbidades mais frequentes, como hipertensão (58% vs. 24%, p < 0,001), dislipidemia (46% vs. 17%, p < 0,001) e diabetes melito dependente de insulina (17% vs. 2%, p = 0,004). Esses pacientes foram submetidos com mais frequência à cirurgia bariátrica (20% vs. 2%, p = 0,002). Os pacientes com alto risco de apneia obstrutiva do sono apresentaram mais eventos respiratórios adversos (39% vs. 10%, p < 0,001), dessaturação de leve a moderada (15% vs. 0%, p = 0,001) e incapacidade de respirar profundamente (34% vs. 9%, p = 0,001). Após a anestesia geral, os pacientes com alto risco de apneia obstrutiva do sono apresentaram um aumento da incidência de complicações respiratórias no período pós-operatório.
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Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
Screening using the STOP-BANG criteria seemed to be predictive of postoperative complications in several observational studies.
“Nevertheless, screening using the STOP-BANG criteria seemed to be predictive of postoperative complications in several observational studies [3, 4, 8, 9, 47, 48, 52, 53].”
Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain hypoxemia (WMD −3.8%, 95% CI −5.4% to −2.2%).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
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Cites
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“Respiratory complications in the immediate postoperative period can lead to increased morbidity and mortality.32 Pulmonary and pharyngeal physiology may be affected by perioperative factors that may have detrimental effects in patients with OSA.33,34 Impairment of the activity of pharyngeal muscles promoted by pharmac…”
BackgroundInfluentialResidual Neuromuscular Blockade and Critical Respiratory Events in the Postanesthesia Care Unit
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“Respiratory complications in the immediate postoperative period can lead to increased morbidity and mortality.32 Pulmonary and pharyngeal physiology may be affected by perioperative factors that may have detrimental effects in patients with OSA.33,34 Impairment of the activity of pharyngeal muscles promoted by pharmac…”
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“Many tools for screening patients for OSA have been proposed -- such as the Berlin questionnaire, the STOP questionnaire and the American Society of Anesthesiologists (ASA) checklist -- and their use improves the likelihood of identifying OSA preoperatively.(1,9,13,15) The STOP-BANG questionnaire (Table 1), which was…”
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Ancoli‐Israel, S., Ancoli‐Israel, S., Kripke, T. F., Kripke, T. F., Klauber, M. R., Mason, W. J., Mason, W. J., Fell, R., Fell, R., & Kaplan, O. (1991) · SLEEP · doi:10.1093/sleep/14.6.496 · Cited by 448 · see citing works
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“Respiratory complications in the immediate postoperative period can lead to increased morbidity and mortality.32 Pulmonary and pharyngeal physiology may be affected by perioperative factors that may have detrimental effects in patients with OSA.33,34 Impairment of the activity of pharyngeal muscles promoted by pharmac…”
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“As the clinical history is an unreliable indicator of the presence of OSA, and PSG is not available for all surgical patients, it is necessarily an effective screening modality.(24) The STOP questionnaire was validated in surgical patients at preoperative clinics as a screening tool and it has demonstrated a high sens…”
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“Respiratory complications in the immediate postoperative period can lead to increased morbidity and mortality.(32) Pulmonary and pharyngeal physiology may be affected by perioperative factors that may have detrimental effects in patients with OSA.”
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BackgroundInfluentialAssociation of Sleep-Disordered Breathing With Postoperative Complications
Hwang, D., Shakir, N., Limann, B., Sison, C. P., Kalra, S., Shulman, L., de Corla-Souza, A., & Greenberg, H. E. (2008) · CHEST Journal · doi:10.1378/chest.07-1488 · Cited by 241 · see citing works
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“Other studies have demonstrated similar results regarding higher risk of hypoxia,(13,35,36) but a recent study in morbidly obese patients did not find a difference between OSA and non-OSA patients in the number of hypoxemic episodes after bariatric surgery.(37) The consequences of the ARE delaying PACU discharge are d…”
ResultUnrecognized Sleep Apnea in the Surgical Patient
Kaw, R. K., Michota, F. A., Jaffer, A. K., Ghamande, S. A., Auckley, D. H., & Golish, J. A. (2006) · CHEST Journal · doi:10.1378/chest.129.1.198 · Cited by 166 · see citing works
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“OSA has been recognized as a potential independent risk factor for adverse perioperative outcome.(18) OSA patients undergoing surgical procedures are vulnerable to postoperative airway obstruction,(18) myocardial ischemia, congestive heart failure, stroke and oxygen desaturation.”
BackgroundPredictive Factors of Immediate Postoperative Complications after Uvulopalatopharyngoplasty
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“Respiratory complications in the immediate postoperative period can lead to increased morbidity and mortality.32 Pulmonary and pharyngeal physiology may be affected by perioperative factors that may have detrimental effects in patients with OSA.33,34 Impairment of the activity of pharyngeal muscles promoted by pharmac…”
BackgroundInfluentialObstructive Sleep Apnea Syndrome: Are We Missing an At-Risk Population?
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“Different studies had already documented the association of OSA with comorbidities(8,28,29) and in our study HR-OSA patients had more frequently hypertension, dyslipidemia and renal failure, but we could not show the association between OSA and ischemic or congestive heart disease that was established by others.(28,29…”
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“Surgical patients with STOP-Bang scores of 3 or greater had significantly higher rates of difficult airway management, postoperative respiratory complications, and longer postanesthesia care unit lengths of stays.(12,13) The STOP-Bang questionnaire has also been used preoperatively to stratify patients at risk for per…”
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“11 of these studies only had a subpopulation of patients who underwent ENT surgeries [22–32].”
Obstructive sleep apnea (January 2016)
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“The study found that these high-risk patients experienced more frequent respiratory adverse events, such as mild to moderate hypoxia and an inability to breathe deeply (36).”
- Authors
- Xará, D., Mendonça, J., Pereira, H., Santos, A., & Abelha, F. J.
- Affiliations
- Hospital de São João (PT)
- Universidade do Porto (PT)
- Corresponding author
- Abelha, Fernando José
- Venue
- Brazilian Journal of Anesthesiology (English Edition)
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 65
- Issue
- 5
- Pages
- 359-366
- ISSN
- 0104-0014 (ISSN-L)
- OpenAlex
- W2070511883
- Cited by
- 22
- References
- 42
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2018: 3 · 2017: 4 · 2016: 7
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Brazilian Journal of Anesthesiology (English Edition) (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Americanae (AECID Library) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- obstructive sleep apnea, general anesthesia, postoperative pulmonary complications, STOP-BANG score, post-anesthesia care unit, oxygen desaturation, bariatric surgery, body mass index, intra-abdominal surgery, postoperative hospital stay, hypertension, diabetes mellitus, dyslipidemia, elective surgery, risk stratification
- MeSH terms
- Adult, Aged, Anesthesia, General, Female, Humans, Male, Middle Aged, Postoperative Complications, Prospective Studies, Respiratory Tract Diseases, Risk, Sleep Apnea, Obstructive
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