postoperative complications of obstructive sleep apnea jason shiffermiller, md, mph
TRANSCRIPT
POSTOPERATIVE COMPLICATIONS OF OBSTRUCTIVE SLEEP APNEA
Jason Shiffermiller, MD, MPH
Outline
Effects of surgery on patients with obstructive sleep apnea More frequent apneas Longer-lasting apneas
Results of increased postoperative apneas Respiratory Cardiac other
Supine Positioning
REM Rebound
Opioids and Sedatives
More frequent apneas Increased sleep time Reduced upper airway tone
Longer-lasting apneas Termination of apneic events requires partial
arousal from sleep Opioids and sedatives blunt this arousal
response
Complications
15% of patients with Obstructive Sleep Apnea developed postoperative complications compared to 3% of controls
Type of complications Respiratory
Hypoxia and/or hypercapnia Atalectasis Wheezing
Cardiac Myocardial ischemia/infarction Hypotension Tachycardia
Other GI and procedure site bleeding Pulmonary embolus
Respiratory
Case series of patients with Obstructive Sleep Apnea published in 1997 Case 1: 41 y/o female, total hip arthroplasty, died
after developing respiratory arrest on POD#3 Case 2: 66 y/o male, bilateral knee arthroplasty,
found unresponsive and could not be resuscitated on POD#3
Case 3: 47 y/o female, hernia repair, found to be cyanotic on POD#2, initially resuscitated but later died
Retrospective review of patients with moderate to severe Obstructive Sleep Apnea published in 2002 3 of 19 developed postoperative respiratory arrest
Cardiac
Case report demonstrates hemodynamic changes associated with apneic episodes Pulse increase of up to40 bpm coinciding with
hypoxia Similar increases in SBP with levels above 180
mmHg coinciding with arousal Hemodynamic instability did not respond to
supplemental oxygen but resolved with CPAP
Postoperative nocturnal hypoxia precipitated myocardial ischemia in patients undergoing major vascular surgery
Other
Delirium Lower mean nocturnal oxygen saturation on the first two
postoperative nights correlates with lower mental status during the third postoperative day
P < 0.005 Unplanned transfer to the ICU
33.3% in patients with undiagnosed Obstructive Sleep Apnea 12.3% in patients with known Obstructive Sleep Apnea 6% in controls p = 0.003
Length of Stay 7.2 days in patients with Obstructive Sleep Apnea not using
CPAP 6.0 days if patients on CPAP 5.1 days for patients in the control group p = 0.007
References
Jain et al. Curr Opin Pulm Med 2004;10:482-8. Meoli et al. Sleep 2003;26:1060-5. Kaw et al. Chest 2006;129:198-205. Hwang et al. Chest 2008;133:1128-34. Ostermeier et al. Anesth Analg 1997;85:452-
60. Parikh et al. J Arthroplasty 2002;17:635-42. Reeder et al. Anaesthesia 1991;46:849-53. Reeder et al. Br J Anaesth 1991;67:626-31. Rosenberg et al. Surgery 1993;114:76-81. Gupta et al. Mayo Clin Proc 2001;76:897-905