Abstract：
BACKGROUND: Patients with obstructive sleep apnea (OSA) are at increased risk of postoperative cardiorespiratory complications and death. Attempts to stratify this risk have been inadequate, and predictors from large well-characterized cohort studies are needed.
OBJECTIVE: What is the relationship between OSA severity, defined by various polysomnography-derived metrics, and risk of postoperative cardiorespiratory complications or death, and which metrics best identify such risk?
METHODS: Cohort study of 6770 consecutive patients who underwent diagnostic polysomnography for possible OSA and a procedure involving general anesthesia within a period spanning 2 years before and at least 5 years after polysomnography. Participants were identified by linking polysomnography and health databases. Relationships between OSA severity measures and the composite primary outcome of cardiorespiratory complications or death within 30 days of hospital discharge were investigated using univariable and multivariable analyses.
RESULTS: The primary outcome was observed in 5.3% (n=361) of the cohort. While univariable analysis showed strong dose-response relationships between this outcome and multiple OSA severity measures, multivariable analysis showed its independent predictors were: age >65 years (OR 2.67 [95%CI 2.03-3.52], p<0.0001); age 55.1-65 years (OR 1.47 [1.09-1.98], p=0.0111); time between polysomnography and procedure ≥5 years (OR 1.32 [1.02-1.70], p=0.0331), body mass index ≥35kg/m2 (OR 1.43 [1.13-1.82], p=0.0032); presence of known cardiorespiratory risk factor (OR 1.63 [1.29-2.06], p<0.0001); >4.7% of sleep time at SpO2 less than 90% (T90) (OR 1.91 [1.51-2.42], p<0.0001); and cardiothoracic procedures (OR 7.95 [5.71-11.08], p<0.001). For non-cardiothoracic procedures, age, BMI, presence of known cardiorespiratory risk factor and T90 remained the significant predictors, and a risk score based on their odds ratios was predictive of outcome (area under receiver operating characteristic curve 0.7 [95%CI 0.64-0.75]).
CONCLUSIONS: These findings provide a basis for better identifying high-risk OSA patients and determining appropriate postoperative care.
OBJECTIVE: What is the relationship between OSA severity, defined by various polysomnography-derived metrics, and risk of postoperative cardiorespiratory complications or death, and which metrics best identify such risk?
METHODS: Cohort study of 6770 consecutive patients who underwent diagnostic polysomnography for possible OSA and a procedure involving general anesthesia within a period spanning 2 years before and at least 5 years after polysomnography. Participants were identified by linking polysomnography and health databases. Relationships between OSA severity measures and the composite primary outcome of cardiorespiratory complications or death within 30 days of hospital discharge were investigated using univariable and multivariable analyses.
RESULTS: The primary outcome was observed in 5.3% (n=361) of the cohort. While univariable analysis showed strong dose-response relationships between this outcome and multiple OSA severity measures, multivariable analysis showed its independent predictors were: age >65 years (OR 2.67 [95%CI 2.03-3.52], p<0.0001); age 55.1-65 years (OR 1.47 [1.09-1.98], p=0.0111); time between polysomnography and procedure ≥5 years (OR 1.32 [1.02-1.70], p=0.0331), body mass index ≥35kg/m2 (OR 1.43 [1.13-1.82], p=0.0032); presence of known cardiorespiratory risk factor (OR 1.63 [1.29-2.06], p<0.0001); >4.7% of sleep time at SpO2 less than 90% (T90) (OR 1.91 [1.51-2.42], p<0.0001); and cardiothoracic procedures (OR 7.95 [5.71-11.08], p<0.001). For non-cardiothoracic procedures, age, BMI, presence of known cardiorespiratory risk factor and T90 remained the significant predictors, and a risk score based on their odds ratios was predictive of outcome (area under receiver operating characteristic curve 0.7 [95%CI 0.64-0.75]).
CONCLUSIONS: These findings provide a basis for better identifying high-risk OSA patients and determining appropriate postoperative care.
摘要：
背景：阻塞性睡眠呼吸暂停（OSA）患者术后心肺并发症和死亡的风险增加。对这种风险进行分层的尝试是不够的，需要来自大型特征明确的队列研究的预测因子。
目的：OSA严重程度之间的关系是什么，由各种多导睡眠图衍生的指标定义，术后心肺并发症或死亡的风险，哪些指标最能识别这种风险？
方法：对6770例连续患者进行队列研究，这些患者在多导睡眠监测前2年和至少5年后接受了诊断性多导睡眠监测，并进行了涉及全身麻醉的手术。通过链接多导睡眠图和健康数据库来确定参与者。使用单变量和多变量分析研究了OSA严重程度指标与出院后30天内心肺并发症或死亡的复合主要结局之间的关系。
结果：在5.3%（n=361）的队列中观察到主要结局。单变量分析显示此结果与多种OSA严重程度指标之间存在强烈的剂量反应关系，多变量分析表明，其独立预测因素是：年龄>65岁(OR2.67[95CI2.03-3.52]，p<0.0001)；年龄55.1-65岁(OR1.47[1.09-1.98]，p=0.0111）；多导睡眠图与手术之间的时间≥5年（OR1.32[1.02-1.70]，p=0.0331),体重指数≥35kg/m2（OR1.43[1.13-1.82]，p=0.0032）；存在已知的心肺危险因素（OR1.63[1.29-2.06]，p<0.0001);>4.7%的睡眠时间,SpO2小于90%(T90)(OR1.91[1.51-2.42],p<0.0001）；和心胸手术（OR7.95[5.71-11.08]，p<0.001)。对于非心胸手术，年龄,BMI,已知心肺危险因素和T90的存在仍然是重要的预测因素，基于比值比的风险评分可预测结局(受试者工作特征曲线下面积0.7[95CI0.64-0.75]).
结论：这些发现为更好地识别高风险OSA患者和确定适当的术后护理提供了依据。
目的：OSA严重程度之间的关系是什么，由各种多导睡眠图衍生的指标定义，术后心肺并发症或死亡的风险，哪些指标最能识别这种风险？
方法：对6770例连续患者进行队列研究，这些患者在多导睡眠监测前2年和至少5年后接受了诊断性多导睡眠监测，并进行了涉及全身麻醉的手术。通过链接多导睡眠图和健康数据库来确定参与者。使用单变量和多变量分析研究了OSA严重程度指标与出院后30天内心肺并发症或死亡的复合主要结局之间的关系。
结果：在5.3%（n=361）的队列中观察到主要结局。单变量分析显示此结果与多种OSA严重程度指标之间存在强烈的剂量反应关系，多变量分析表明，其独立预测因素是：年龄>65岁(OR2.67[95CI2.03-3.52]，p<0.0001)；年龄55.1-65岁(OR1.47[1.09-1.98]，p=0.0111）；多导睡眠图与手术之间的时间≥5年（OR1.32[1.02-1.70]，p=0.0331),体重指数≥35kg/m2（OR1.43[1.13-1.82]，p=0.0032）；存在已知的心肺危险因素（OR1.63[1.29-2.06]，p<0.0001);>4.7%的睡眠时间,SpO2小于90%(T90)(OR1.91[1.51-2.42],p<0.0001）；和心胸手术（OR7.95[5.71-11.08]，p<0.001)。对于非心胸手术，年龄,BMI,已知心肺危险因素和T90的存在仍然是重要的预测因素，基于比值比的风险评分可预测结局(受试者工作特征曲线下面积0.7[95CI0.64-0.75]).
结论：这些发现为更好地识别高风险OSA患者和确定适当的术后护理提供了依据。
