Postoperative complications in patients with obstructive sleep apnea: a meta-analysis |
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| Affiliation: | 1. The Veterans Affairs Western New York Healthcare System, Western New York, Buffalo, NY 14215–1199, USA;2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14260, USA;3. Department of Anesthesiology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14260, USA;4. Department of Social Preventive Medicine, University at Buffalo School of Medicine Biomedical Sciences, Buffalo, NY 14214, USA;1. Department of Anesthesiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY 10467, USA;2. Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY 10467, USA;3. Department of Anesthesiology, Rutgers-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA;1. Department of Anesthesiology and Pain Management, Maine Medical Center, 22 Bramhall St., Portland, ME 04102, USA;2. Maine Medical Center Research Institute, 81 Research Dr., Scarborough, ME 04074, USA |
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| Abstract: | Study ObjectiveTo determine whether a diagnosis of obstructive sleep apnea (OSA) imparts an increased risk of postoperative respiratory failure, cardiac events, and intensive care unit (ICU) transfer than patients with no OSA diagnosis.DesignSystematic review and meta-analysis.SettingAcademic Veterans Affairs Medical Center.MeasurementsPubMed, EMBASE, CINAHL, and ISI Web of Knowledge databases were searched through April 2013 for studies that examined the relationship between OSA and postoperative respiratory and cardiac complications among adults. Either fixed or random-effects models were used to calculate the pooled risk estimates. Sensitivity analysis was conducted to examine the robustness of pooled outcomes.Main ResultsSeventeen studies with a total of 7,162 patients were included. Overall, OSA was associated with significant increase in risk of respiratory failure [odds ratio (OR) 2.42; 95% confidence intervals (CI) 1.53 - 3.84; P = 0.0002] and cardiac events postoperatively (OR = 1.63; 95% CI 1.16 - 2.29; P = 0.005). Heterogeneity was low for these outcomes (I2 = 5% and 0%, respectively). ICU transfer occurred also more frequently in patients with OSA (OR 2.46; 95% CI 1.29 - 4.68; P = 0.006). These results did not materially change in the sensitivity analyses according to various inclusion criteria.ConclusionsSurgical patients with OSA are at increased risk of postoperative respiratory failure, cardiac events, and ICU transfer. |
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