Severe OSA predisposes to cardiovascular events after major surgery

  • Chan MTV & al.
  • JAMA
  • 14 May 2019

  • International Clinical Digest
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Takeaway

  • 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.

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.

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