Abstract：
BACKGROUND: Obstructive sleep apnea (OSA) has been linked to multiple adverse health outcomes and postoperative complications. Despite the high prevalence of OSA in patients undergoing total joint arthroplasty (TJA), few studies have evaluated the postoperative course of OSA patients after joint arthroplasty surgery.
METHODS: PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, and COMPENDEX) were used to conduct a systematic review of articles from inception to July 2023. Primary studies comparing postoperative outcomes following TJA between patients who had and did not have OSA were included. Postoperative medical complications, utilization of critical care, hospital stay, and mortality data were extracted. Descriptive statistics and random-effects meta-analysis models were used to analyze the available data. Included studies were evaluated for methodological risks of bias using the risk of bias in non-randomized studies of interventions. This review was registered on the International Prospective Register of Systematic Reviews (ID: CRD42023447610).
RESULTS: There were 7 studies with a total of 20,977 patients (9,425 hip; 11,137 knee; 415 hip or knee) that were included. Pulmonary complications were most frequently studied, followed by thromboembolic events. Cardiac, gastrointestinal, hematologic, genitourinary, and delirium events were also reported across studies. Meta-analysis revealed that OSA patients had 4-fold increased odds of overall medical complications (OR [odds ratio], 4.23; 95% confidence interval (CI), 2.97 to 6.04; P < .001; I2 = 0%), 4-fold increased odds of pulmonary complications (OR, 4.31; 95% CI, 2.82 to 6.60; P < .001; I2 = 0%), 2-fold increased odds of thromboembolic complications (OR, 1.92; 95% CI, 1.22 to 3.03; P = .005; I2 = 9%), and 4-fold increased odds of delirium (OR, 3.94; 95% CI, 1.72 to 9.04; P = .001; I2 = 0%).
CONCLUSIONS: A significant association was found between OSA and overall medical, pulmonary, and thromboembolic complications. These patients also had a higher incidence of postoperative delirium. The present findings underscore the need for comprehensive perioperative strategies to mitigate these risks in OSA patients who elect to undergo TJA.
METHODS: PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, and COMPENDEX) were used to conduct a systematic review of articles from inception to July 2023. Primary studies comparing postoperative outcomes following TJA between patients who had and did not have OSA were included. Postoperative medical complications, utilization of critical care, hospital stay, and mortality data were extracted. Descriptive statistics and random-effects meta-analysis models were used to analyze the available data. Included studies were evaluated for methodological risks of bias using the risk of bias in non-randomized studies of interventions. This review was registered on the International Prospective Register of Systematic Reviews (ID: CRD42023447610).
RESULTS: There were 7 studies with a total of 20,977 patients (9,425 hip; 11,137 knee; 415 hip or knee) that were included. Pulmonary complications were most frequently studied, followed by thromboembolic events. Cardiac, gastrointestinal, hematologic, genitourinary, and delirium events were also reported across studies. Meta-analysis revealed that OSA patients had 4-fold increased odds of overall medical complications (OR [odds ratio], 4.23; 95% confidence interval (CI), 2.97 to 6.04; P < .001; I2 = 0%), 4-fold increased odds of pulmonary complications (OR, 4.31; 95% CI, 2.82 to 6.60; P < .001; I2 = 0%), 2-fold increased odds of thromboembolic complications (OR, 1.92; 95% CI, 1.22 to 3.03; P = .005; I2 = 9%), and 4-fold increased odds of delirium (OR, 3.94; 95% CI, 1.72 to 9.04; P = .001; I2 = 0%).
CONCLUSIONS: A significant association was found between OSA and overall medical, pulmonary, and thromboembolic complications. These patients also had a higher incidence of postoperative delirium. The present findings underscore the need for comprehensive perioperative strategies to mitigate these risks in OSA patients who elect to undergo TJA.
摘要：
背景：阻塞性睡眠呼吸暂停（OSA）与多种不良健康结局和术后并发症有关。尽管在接受全关节置换术（TJA）的患者中OSA的患病率很高，很少有研究评估关节置换术后OSA患者的术后病程。
方法：PubMed(MEDLINE)和Scopus(EMBASE，MEDLINE,COMPENDEX）用于对从开始到2023年7月的文章进行系统审查。包括比较TJA后有和没有OSA的患者的术后结局的主要研究。术后内科并发症，利用重症监护，住院,并提取死亡率数据。描述性统计和随机效应元分析模型用于分析现有数据。使用非随机干预研究中的偏倚风险评估纳入的研究的方法学偏倚风险。该综述已在国际前瞻性系统评价登记册（ID：CRD42023447610）上注册。结果：纳入了7项研究，共20,977例患者（9,425例髋关节；11,137例膝关节；415例髋关节或膝关节）。肺部并发症是最常见的研究，其次是血栓栓塞事件.心脏,胃肠,血液学，泌尿生殖系统。所有研究也报告了谵妄事件.荟萃分析显示，OSA患者发生总体医疗并发症的几率增加了4倍（OR[优势比]，4.23；95%CI[置信区间]，2.97至6.04；P<0.001；I2=0%），肺部并发症的几率增加4倍(OR，4.31；95%CI，2.82~6.60；P<0.001；I2=0%），血栓栓塞并发症的几率增加2倍（OR，1.92；95%CI，1.22至3.03；P=0.005；I2=9%），谵妄的几率增加了4倍(或，3.94；95%CI，1.72至9.04；P=0.001；I2=0%）。
结论：发现OSA与整体医疗之间存在显着关联，肺,和血栓栓塞并发症。这些患者术后谵妄的发生率也较高。本研究结果强调了选择接受TJA的OSA患者需要全面的围手术期策略来减轻这些风险。
方法：PubMed(MEDLINE)和Scopus(EMBASE，MEDLINE,COMPENDEX）用于对从开始到2023年7月的文章进行系统审查。包括比较TJA后有和没有OSA的患者的术后结局的主要研究。术后内科并发症，利用重症监护，住院,并提取死亡率数据。描述性统计和随机效应元分析模型用于分析现有数据。使用非随机干预研究中的偏倚风险评估纳入的研究的方法学偏倚风险。该综述已在国际前瞻性系统评价登记册（ID：CRD42023447610）上注册。结果：纳入了7项研究，共20,977例患者（9,425例髋关节；11,137例膝关节；415例髋关节或膝关节）。肺部并发症是最常见的研究，其次是血栓栓塞事件.心脏,胃肠,血液学，泌尿生殖系统。所有研究也报告了谵妄事件.荟萃分析显示，OSA患者发生总体医疗并发症的几率增加了4倍（OR[优势比]，4.23；95%CI[置信区间]，2.97至6.04；P<0.001；I2=0%），肺部并发症的几率增加4倍(OR，4.31；95%CI，2.82~6.60；P<0.001；I2=0%），血栓栓塞并发症的几率增加2倍（OR，1.92；95%CI，1.22至3.03；P=0.005；I2=9%），谵妄的几率增加了4倍(或，3.94；95%CI，1.72至9.04；P=0.001；I2=0%）。
结论：发现OSA与整体医疗之间存在显着关联，肺,和血栓栓塞并发症。这些患者术后谵妄的发生率也较高。本研究结果强调了选择接受TJA的OSA患者需要全面的围手术期策略来减轻这些风险。
