Prevalence of undetected sleep apnea in patients undergoing cardiovascular surgery and impact on postoperative outcomes

Nancy Foldvary-Schaefer, Roop Kaw, Nancy Collop, Noah D. Andrews, James Bena, Lu Wang, Tracey Smith Stierer, Marc Gillinov, Matt Tarler, Hani Kayyali

Research output: Contribution to journalArticle

Abstract

Study Objectives: We examined the prevalence of obstructive sleep apnea (OSA) among patients undergoing cardiac surgery and its impact on postoperative outcomes. Methods: Subjects were recruited from inpatient cardiovascular surgery units at two tertiary care centers. Crystal Monitor 20-H recorded polysomnograms preoperatively. Regression analyses were performed to explore associations between OSA using different apnea-hypopnea index (AHI) cutoffs and postoperative outcomes adjusting for key covariates. Prevalence of postoperative outcomes was compared among groups defi ned by AHI and left ventricle ejection fraction (LVEF) median cutoffs. Results: Of 107 participants, the AHI was ≥ 5 in 79 (73.8%), ≥ 10 in 63 (58.9%), ≥ 15 in 51(47.7%), and ≥ 30 in 29 (27.1%). Patients with AHI ≥ 15 had signifi cantly lower LVEF (p <0.001). Logistic regression analyses with OSA cutoffs as above adjusting for age, gender, race, BMI, and LVEF found no signifi cant increase in odds for any postoperative outcomes. No signifi cant differences were found in %Total sleep time (TST) with SpO2 <90% between AHI or LVEF groups, or by presence/absence of complications. Patients with any amount of TST with SpO2 <90% had greater BMI, longer OR tube time, and greater prevalence of prolonged intubation (p = 0.007, 0.035, 0.038, respectively). Conclusions: OSA is highly prevalent in patients undergoing cardiovascular surgery. It could not be shown that OSA was signifi cantly associated with adverse postoperative outcomes, but this may have been due to an insuffi cient number of subjects. AHI ≥ 15 was associated with lower LVEF. Larger samples are required to explore the impact of OSA on key postoperative outcomes that have clinical and economic importance in the care of cardiovascular surgery populations. Commentary: A commentary on this article appears in this issue on page 1081.

Original languageEnglish (US)
Pages (from-to)1083-1089A
JournalJournal of Clinical Sleep Medicine
Volume11
Issue number10
DOIs
StatePublished - 2015

Fingerprint

Sleep Apnea Syndromes
Obstructive Sleep Apnea
Apnea
Heart Ventricles
Sleep
Regression Analysis
Intubation
Tertiary Care Centers
Thoracic Surgery
Inpatients
Logistic Models
Economics
Population

Keywords

  • Cardiovascular surgery
  • Polysomnography
  • Postoperative outcomes
  • Sleep apnea

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Foldvary-Schaefer, N., Kaw, R., Collop, N., Andrews, N. D., Bena, J., Wang, L., ... Kayyali, H. (2015). Prevalence of undetected sleep apnea in patients undergoing cardiovascular surgery and impact on postoperative outcomes. Journal of Clinical Sleep Medicine, 11(10), 1083-1089A. https://doi.org/10.5664/jcsm.5076

Prevalence of undetected sleep apnea in patients undergoing cardiovascular surgery and impact on postoperative outcomes. / Foldvary-Schaefer, Nancy; Kaw, Roop; Collop, Nancy; Andrews, Noah D.; Bena, James; Wang, Lu; Smith Stierer, Tracey; Gillinov, Marc; Tarler, Matt; Kayyali, Hani.

In: Journal of Clinical Sleep Medicine, Vol. 11, No. 10, 2015, p. 1083-1089A.

Research output: Contribution to journalArticle

Foldvary-Schaefer, N, Kaw, R, Collop, N, Andrews, ND, Bena, J, Wang, L, Smith Stierer, T, Gillinov, M, Tarler, M & Kayyali, H 2015, 'Prevalence of undetected sleep apnea in patients undergoing cardiovascular surgery and impact on postoperative outcomes', Journal of Clinical Sleep Medicine, vol. 11, no. 10, pp. 1083-1089A. https://doi.org/10.5664/jcsm.5076
Foldvary-Schaefer, Nancy ; Kaw, Roop ; Collop, Nancy ; Andrews, Noah D. ; Bena, James ; Wang, Lu ; Smith Stierer, Tracey ; Gillinov, Marc ; Tarler, Matt ; Kayyali, Hani. / Prevalence of undetected sleep apnea in patients undergoing cardiovascular surgery and impact on postoperative outcomes. In: Journal of Clinical Sleep Medicine. 2015 ; Vol. 11, No. 10. pp. 1083-1089A.
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abstract = "Study Objectives: We examined the prevalence of obstructive sleep apnea (OSA) among patients undergoing cardiac surgery and its impact on postoperative outcomes. Methods: Subjects were recruited from inpatient cardiovascular surgery units at two tertiary care centers. Crystal Monitor 20-H recorded polysomnograms preoperatively. Regression analyses were performed to explore associations between OSA using different apnea-hypopnea index (AHI) cutoffs and postoperative outcomes adjusting for key covariates. Prevalence of postoperative outcomes was compared among groups defi ned by AHI and left ventricle ejection fraction (LVEF) median cutoffs. Results: Of 107 participants, the AHI was ≥ 5 in 79 (73.8{\%}), ≥ 10 in 63 (58.9{\%}), ≥ 15 in 51(47.7{\%}), and ≥ 30 in 29 (27.1{\%}). Patients with AHI ≥ 15 had signifi cantly lower LVEF (p <0.001). Logistic regression analyses with OSA cutoffs as above adjusting for age, gender, race, BMI, and LVEF found no signifi cant increase in odds for any postoperative outcomes. No signifi cant differences were found in {\%}Total sleep time (TST) with SpO2 <90{\%} between AHI or LVEF groups, or by presence/absence of complications. Patients with any amount of TST with SpO2 <90{\%} had greater BMI, longer OR tube time, and greater prevalence of prolonged intubation (p = 0.007, 0.035, 0.038, respectively). Conclusions: OSA is highly prevalent in patients undergoing cardiovascular surgery. It could not be shown that OSA was signifi cantly associated with adverse postoperative outcomes, but this may have been due to an insuffi cient number of subjects. AHI ≥ 15 was associated with lower LVEF. Larger samples are required to explore the impact of OSA on key postoperative outcomes that have clinical and economic importance in the care of cardiovascular surgery populations. Commentary: A commentary on this article appears in this issue on page 1081.",
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