Friday, May 17, 2019

Obstructive Sleep Apnea May Raise Post-Op Heart Risk

Obstructive sleep apnea (OSA), a condition in which the soft tissues of the throat relax and narrow the airways during sleep, may raise the risk of developing heart problems after surgery, according to research published this week in JAMA. In OSA, breathing stops and starts multiple times during sleep, resulting in snoring, gasping for air, poor sleep quality, morning headaches, daytime fatigue, irritability, and difficulty concentrating.

The study, led by Matthew T. V. Chan, Ph.D., M.B.B.S., of the Chinese University of Hong Kong included 1,218 patients aged 45 years or older who had abdominal, vascular, or major orthopedic surgeries and were at risk for post-surgery heart-related complications. The patients underwent sleep studies at home or in the hospital the night before their procedures.

Although none of the patients had been diagnosed with OSA previously, the sleep studies revealed that 67.6% of them had the condition. Among all patients, 11.2% had a severe form of OSA in which their breathing stopped and started at least 30 times during the night.

In the 30 days after their surgeries, 21.7% of the participants with OSA developed heart and blood vessel complications, such as injury to their heart muscles, congestive heart failure, atrial fibrillation (an irregular, fluttering heartbeat), and thromboembolism (clots that block blood vessels). Only 14.2% of those without OSA developed these complications. This represents a 50% greater risk in people with OSA, regardless of the condition’s severity. However, after the researchers accounted for other factors, they determined the increased risk to be statistically significant only in patients with severe OSA, not mild or moderate OSA. Those with severe OSA had more than double the risk of those without OSA. Severe OSA was also associated with a nearly 14-fold increase in cardiac death, a nearly 7-fold higher risk of heart failure, and an 80% higher risk of heart injury.

The researchers noted that episodes of apnea and higher sedation either during or after the surgeries may have prompted health care professionals to make adjustments to the patients’ care such as lowering doses of opioids or keeping the patients on supplemental oxygen longer than usual.

“It is unclear how these interventions may affect perioperative outcomes. Nevertheless, the event rates reported in this study would represent the expected perioperative outcomes associated with untreated OSA in contemporary anesthetic practice for major noncardiac surgery,” the researchers wrote.

For more information, see the Psychiatric News article “Sleep Apnea Linked With Hard-to-Treat High Blood Pressure in Blacks.”

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