#VisualAbstract: Association of Unrecognized Obstructive Sleep Apnea With Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery

1. In this prospective cohort study, severe but not moderate, unrecognized obstructive sleep apnea was associated with increased postoperative cardiovascular events in patients undergoing major non-cardiac surgery.

2. Mean cumulative oxyhemoglobin desaturation less than 80% during the first 3 postoperative nights was longer in those with cardiovascular complications.

Evidence Rating Level: 1 (Excellent)           

Study Rundown: Obstructive sleep apnea (OSA) is associated with an increased risk of hypertension, myocardial ischemia, heart failure, arrhythmias, stroke, and sudden cardiac failure. However, there is uncertainty on whether unrecognized OSA adversely affects postoperative outcomes. In this prospective cohort study, severe but not moderate, unrecognized OSA was significantly associated with increased postoperative cardiovascular events in patients undergoing major non-cardiac surgery. Mean cumulative oxyhemoglobin desaturation less than 80% during the first 3 postoperative nights was longer in those with cardiovascular complications. Further, anesthesia, postoperative opioids, and supplemental oxygen therapy did not change risk in patients with OSA for perioperative outcomes.

Overall, this study suggests that severe, unrecognized OSA likely puts surgical patients at risk of worse cardiovascular outcomes, though this study has some limitations. This study did not utilize electroencephalogram recordings in the preoperative sleep studies and may have underestimated the severity of OSA. Further, over half of the study population was ethnically Chinese, and so the findings may not generalize to other populations that are not predominantly Chinese due to potential differences in body mass index and craniofacial anatomy.

Click to read the study in JAMA