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J Clin Anesth. 2020 Jun;62:109731. doi: 10.1016/j.jclinane.2020.109731. Epub 2020 Jan 25.

Association of obstructive sleep apnea and postoperative cardiac complications: A systematic review and meta-analysis with trial sequential analysis.

Author information

1
Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Malaysia. Electronic address: katingng1@gmail.com.
2
University Hospital of Wales, Health Park, Cardiff CF14 4XN, United Kingdom.
3
University of Liverpool, School of Medicine, Cedar House, Ashton Street, Liverpool L69 3GE, United Kingdom.
4
Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Malaysia.

Abstract

OBJECTIVES:

The repetitive hypoxic and hypercapnia events of obstructive sleep apnea (OSA) are believed to adversely affect cardiopulmonary function, which make them vulnerable to a higher incidence of postoperative complications. The primary aim of this systematic review and meta-analysis was to examine the association of OSA and the composite endpoints of postoperative cardiac or cerebrovascular complications in adult undergoing non-cardiac surgery.

DATA SOURCES:

MEDLINE, EMBASE and CENTRAL were systematically searched from its inception until May 2019.

REVIEW METHODS:

All observational studies were included.

RESULTS:

Twenty-two studies (n = 3,033,814; 184,968 OSA vs 2,848,846 non-OSA) were included for quantitative meta-analysis. In non-cardiac surgery, OSA was significantly associated with a higher incidence of the composite endpoints of postoperative cardiac or cerebrovascular complications (odd ratio: 1.44, 95%CI: 1.17 to 1.78, ρ = 0.007, trial sequential analysis = conclusive; certainty of evidence = very low). In comparison to non-OSA, OSA patients were reported to have nearly 2.5-fold risk of developing pulmonary complications (odd ratio: 2.52, 95%CI: 1.92 to 3.31, ρ < 0.001, certainty of evidence = very low), postoperative delirium (odd ratio: 2.45, 95%CI: 1.50 to 4.01, ρ < 0.001, certainty of evidence = low) and acute kidney injury (odd ratio: 2.41, 95%CI: 1.93 to 3.02, ρ < 0.001, certainty of evidence = very low).

CONCLUSIONS:

This meta-analysis of 22 comparative studies demonstrated that OSA is a potential risk factor to postoperative adverse complications in adults undergoing non-cardiac surgery. However, the conclusions need to be interpreted with caution due to the nature of included observational studies with significant heterogeneity and low quality of evidence.

PROSPERO:

CRD42019136564.

KEYWORDS:

Cardiac complications; Meta-analysis; Mortality; Obstructive sleep apnea; Oximetry; Sleep study

Conflict of interest statement

Declaration of competing interest All authors have declared that they do not have any conflicts of interest in this review. No funding was received in support of this project.

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