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Obstructive sleep apnoea predicted by the STOP-BANG questionnaire is not associated with higher rates of post-operative complications among a high-risk surgical cohort

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The purpose of this study is to establish if obstructive sleep apnoea (OSA) predicted by the STOP-BANG questionnaire would be associated with higher rates of post-operative cardiac, respiratory or neurological complications among a selected high-risk population with established major comorbidities undergoing major surgery. We hypothesise that a cohort selected for major comorbidities will show a higher post-operative complication rate that may power any potential association with co-existent OSA and identify an important target group for OSA screening and treatment pathways in preparation for major surgery.

Methods

Patients attending a high-risk preadmission clinic prior to major surgery from May 2015 to November 2015 were prospectively screened for OSA using the STOP-BANG questionnaire. Patients with treated OSA were excluded. Patient data and complications were attained from the pre-admission clinic and subsequent inpatient medical record at discharge.

Results

Three-hundred-and-ten patients were included in the study (age 68.6 ± 13.1 years, body mass index [BMI] 30.6 ± 7.4 kg/m2; 52.9% female). Sixty-four patients (20.6%) experienced 82 post-operative complications. Seventy-five percent of the cohort had a STOP-BANG ≥ 3. There was no association between the STOP-BANG score (unadjusted and adjusted for comorbidity) with the development of post-operative complications.

Conclusions

OSA predicted by the STOP-BANG score was not associated with higher rates of post-operative complications in patients with major comorbidities undergoing high-risk surgery. As the findings from this cohort contrast with other observational studies, more definitive studies are required to establish a causative link between OSA and post-operative complications and determine whether treating OSA reduces this complication rate.

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References

  1. Narkiewicz K, Somers VK (1997) The sympathetic nervous system and obstructive sleep apnea: implications for hypertension. J Hypertens 15(12 Pt 2):1613–1619

    Article  CAS  Google Scholar 

  2. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81

    Article  Google Scholar 

  3. Knauert M, Naik S, Gillespie MB, Kryger M (2015) Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngol Head Neck Surg 1(1):17–27

    Article  Google Scholar 

  4. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053

    Article  Google Scholar 

  5. Yu J, Zhou Z, McEvoy R et al (2017) Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. Jama. 318(2):156–166

    Article  Google Scholar 

  6. Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, Bottros M, Selvidge JA, Jacobsohn E, Pulley D, Duntley S, Becker C, Avidan MS (2009) Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 10(7):753–758

    Article  Google Scholar 

  7. Chung F, Liao P, Elsaid H, Shapiro CM, Kang W (2014) Factors associated with postoperative exacerbation of sleep-disordered breathing. Anesthesiology. 120(2):299–311

    Article  Google Scholar 

  8. Gupta RM, Parvizi J, Hanssen AD, Gay PC (2001) Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 76(9):897–905

    Article  CAS  Google Scholar 

  9. Abdelsattar ZM, Hendren S, Wong SL, Campbell DA Jr, Ramachandran SK (2015) The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep. 38(8):1205–1210

    Article  Google Scholar 

  10. Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J (2008) Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 107(1):138–143

    Article  Google Scholar 

  11. Ursavaş A, Güven T, Coskun F, Ege E, Yılmazlar A (2013) Association between self reported snoring, STOP questionnaire and postoperative pulmonary complications in patients submitted to ortophaedic surgery. Multidiscip Respir Med 8(1):3

    Article  Google Scholar 

  12. Hai F, Porhomayon J, Vermont L, Frydrych L, Jaoude P, El-Solh AA (2014) Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth 26(8):591–600

    Article  Google Scholar 

  13. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV (2012) Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth 109(6):897–906

    Article  CAS  Google Scholar 

  14. Liao P, Luo Q, Elsaid H, Kang W, Shapiro CM, Chung F (2013) Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial. Anesthesiology. 119(4):837–847

    Article  Google Scholar 

  15. O'Gorman SM, Gay PC, Morgenthaler TI (2013) Does autotitrating positive airway pressure therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome? A randomized controlled clinical trial. Chest. 144(1):72–78

    Article  Google Scholar 

  16. Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 108(5):768–775

    Article  CAS  Google Scholar 

  17. Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C (2017) Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth Sleepiness Scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 36:57–70

    Article  Google Scholar 

  18. Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, Markov D, Reiter D, Kraft WK, Witkowski T (2010) Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 136(10):1020–1024

    Article  Google Scholar 

  19. Schaumburg I (2017) ASA physical status classification system; [approved 2014 Oct 15; cited 2017 Feb 6]; 1 screen. American Society of Anesthesiologists Clinical Information [Internet]

  20. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349

    Article  Google Scholar 

  21. Nagappa M, Mokhlesi B, Wong J, Wong DT, Kaw R, Chung F (2015) The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: a systematic review and meta-analysis. Anesth Analg 120(5):1013–1023

    Article  Google Scholar 

  22. Gali B, Whalen FX, Gay PC, Olson EJ, Schroeder DR, Plevak DJ et al (2007) Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. J Clin Sleep Med 3(6):582–588

    Article  Google Scholar 

  23. Lockhart EM, Willingham MD, Abdallah AB, Helsten DL, Bedair BA, Thomas J, Duntley S, Avidan MS (2013) Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Med 14(5):407–415

    Article  Google Scholar 

  24. Hwang D, Shakir N, Limann B, Sison C, Kalra S, Shulman L, Souza AC, Greenberg H (2008) Association of sleep-disordered breathing with postoperative complications. Chest. 133(5):1128–1134

    Article  Google Scholar 

  25. Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, Mazumdar M (2011) Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg 112(1):113–121

    Article  Google Scholar 

  26. Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample. Obes Surg 23(11):1842–1851

    Article  Google Scholar 

  27. Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest. 144(3):903–914

    Article  Google Scholar 

  28. Auckley D, Bolden N (2012) Preoperative screening and perioperative care of the patient with sleep-disordered breathing. Curr Opin Pulm Med 18(6):588–595

    Article  Google Scholar 

  29. Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, Patrawala S, Lam D, Kumar A, Joshi GP, Fleetham J, Ayas N, Collop N, Doufas AG, Eikermann M, Englesakis M, Gali B, Gay P, Hernandez AV, Kaw R, Kezirian EJ, Malhotra A, Mokhlesi B, Parthasarathy S, Stierer T, Wappler F, Hillman DR, Auckley D (2016) Society of Anesthesia and Sleep Medicine Guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg 123(2):452–473

    Article  Google Scholar 

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Acknowledgements

Dr. Ai-Ming Wong received an RTP stipend by Monash University for graduate research studies.

Author information

Authors and Affiliations

  1. Monash Lung and Sleep, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia

    Ai-Ming Wong, Daniel J. Garner, Sara Bowditch, Garun S. Hamilton & Darren R. Mansfield

  2. School of Clinical Sciences, Monash University, Melbourne, Australia

    Ai-Ming Wong & Garun S. Hamilton

  3. Monash School of Medicine, Monash University, Melbourne, Australia

    Michael Wang

  4. Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Eldho Paul

  5. Department of Anaesthesia and Perioperative Medicine, Monash Health, Monash Medical Centre, Melbourne, Australia

    Mark J. Adams

  6. School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia

    Darren R. Mansfield

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  1. Ai-Ming Wong
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  2. Michael Wang
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  3. Daniel J. Garner
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Corresponding author

Correspondence to Ai-Ming Wong.

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Conflict of interest

Associate Professor Garun Hamilton has received equipment to support research from Resmed, Phillips Respironics and Air Liquide Healthcare, outside the submitted work. All other co-authors including Dr. Ai-Ming Wong, Dr. Michael Wang, Dr. Daniel Garner, Ms. Sara Bowditch, Dr. Eldho Paul, Dr. Mark Adams and Associate Professor Darren Mansfield declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Monash Health, the National Health and Medical Research Council (NHMRC) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Glossary

ASAPS

American Society of Anesthesiologists Physical Status classification score

BMI

Body mass index

BPAP

Bilevel positive airway pressure

CPAP

Continuous positive airway pressure

ESS

Epworth Sleepiness Scale

HDU

High-dependency unit

ICU

Intensive care unit

NIV

Non-invasive ventilation

OSA

Obstructive sleep apnoea

RCT

Randomised controlled trials

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Wong, AM., Wang, M., Garner, D.J. et al. Obstructive sleep apnoea predicted by the STOP-BANG questionnaire is not associated with higher rates of post-operative complications among a high-risk surgical cohort. Sleep Breath 24, 135–142 (2020). https://doi.org/10.1007/s11325-019-01825-3

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  • DOI: https://doi.org/10.1007/s11325-019-01825-3

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