- Undiagnosed severe obstructive sleep apnea (OSA) correlates with worse cardiovascular outcomes after major noncardiac surgery.
- Editorial : “results provide further evidence to support preoperative screening for OSA," while optimum interventions remain unclear.
Why this matters
- OSA raises cardiovascular event risk in general population, yet most cases are undiagnosed.
- Previous meta-analysis examining postoperative outcomes had important limitations.
- 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).
- 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.
- Opioid use not assessed.
- Over half of patients were Chinese, so generalizability unclear.