Severe OSA predisposes to cardiovascular events after major surgery

• OSA raises cardiovascular event risk in general population, yet most cases are undiagnosed.
• Previous meta-analysis examining postoperative outcomes had important limitations.

Key results

• Primary outcome with OSA vs without:
  • Overall population: adjusted HR (aHR), 1.49 (95% CI, 1.19-2.01; P=.01).
  • Severe OSA: aHR, 2.23 (1.49-3.34; P=.001).
  • Moderate OSA: aHR, 1.47 (0.98-2.09; P=.07). 
  • Mild OSA: aHR, 1.36 (0.97-1.91; P=.08). 
• On post hoc analysis, severe OSA correlated with higher risks for:
  • Cardiac death: aHR, 13.66 (95% CI, 1.63-114.19), 
  • Myocardial injury: aHR, 1.80 (1.17-2.77), 
  • Congestive heart failure: aHR, 6.55 (1.71-25.06), and 
  • Afib: aHR, 3.96 (1.24-12.60).

Study design

• Prospective multinational cohort POSA study (n=1218).
• Participants were aged ≥45 years, without OSA diagnosis, undergoing major noncardiac surgery, and had ≥1 cardiovascular risk factor.
• They underwent preoperative sleep testing.
• Outcome: composite of 30-day postoperative cardiovascular events.
• Funding: University, government, nonprofit sources in Hong Kong, Canada, New Zealand.

Limitations

• Opioid use not assessed.
• Over half of patients were Chinese, so generalizability unclear.