Meta-analysis of the association between obstructive sleep apnea and postoperative complications

Xia Sun; Jintao Yu; Jia Luo; Shan Xu; Ning Yang; Yan Wang

doi:10.1016/j.sleep.2021.11.019

Meta-analysis of the association between obstructive sleep apnea and postoperative complications

Sleep Med. 2022 Mar:91:1-11. doi: 10.1016/j.sleep.2021.11.019. Epub 2022 Feb 11.

Authors

Xia Sun¹, Jintao Yu¹, Jia Luo², Shan Xu¹, Ning Yang¹, Yan Wang³

Affiliations

¹ Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
² Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
³ Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China. Electronic address: wangyanoto@cmu.edu.cn.

PMID: 35231774
DOI: 10.1016/j.sleep.2021.11.019

Abstract

Objective: To clarify the association between obstructive sleep apnea (OSA) and postoperative outcomes, investigate whether preoperative diagnosis and continuous positive airway pressure (CPAP) therapy reduce the risks and examine the impact of OSA severity on postoperative outcomes.

Methods: The PubMed, Cochrane Library and Embase databases were searched from inception until April 2021 for studies evaluating the association between OSA and postoperative adverse events. A random effects model was used to calculate the pooled outcome. Sensitivity analysis and publication bias were conducted to verify the robustness and reliability of the results.

Results: In total, 46 studies were eligible for further analysis. OSA was significantly associated with higher risks of postoperative respiratory complications (OR = 1.91; 95% CI = 1.54 to 2.36) and cardiac complications (OR = 1.74; 95% CI = 1.25 to 2.42), and the risks increased with OSA severity. OSA also increased the risk of intensive care unit (ICU) transfer (OR = 1.92; 95% CI = 1.32 to 2.80), increased the risk of postoperative delirium (OR = 1.83; 95% CI = 1.26 to 2.66) and prolonged the length of hospital stay (WMD = 0.48; 95% CI = 0.15 to 0.82). Subgroup analysis indicated that preoperative diagnosis and use of CPAP decrease the risk of postoperative respiratory complications (OR = 1.87; 95% CI = 1.43 to 2.43) and cardiac complications (OR = 1.17; 95% CI = 0.91 to 1.51).

Conclusions: Patients with OSA have a higher risk of postoperative cardiopulmonary complications, ICU transfer, delirium, pneumonia, bleeding and prolonged length of hospital stay. OSA severity is an important risk modifier for postoperative complications, preoperative diagnosis and CPAP therapy may attenuate the occurrence of postoperative complications. The conclusions need to be interpreted with caution due to the limitations in the data, despite this, the results indicate and inform the need for further and larger trials.

Prospero: CRD42021254374.

Keywords: Meta-analysis; Obstructive sleep apnea; Postoperative complications.

Publication types

Meta-Analysis

MeSH terms

Continuous Positive Airway Pressure
Delirium*
Humans
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Reproducibility of Results
Sleep Apnea, Obstructive* / complications