Perioperative adherence to continuous positive airway pressure and its effect on postoperative nocturnal hypoxemia in obstructive sleep apnea patients: a prospective cohort study

Colin Suen; Jean Wong; Kahiye Warsame; Yamini Subramani; Tony Panzarella; Rida Waseem; Dennis Auckley; Rabail Chaudhry; Sazzadul Islam; Frances Chung

doi:10.1186/s12871-021-01371-0

Perioperative adherence to continuous positive airway pressure and its effect on postoperative nocturnal hypoxemia in obstructive sleep apnea patients: a prospective cohort study

BMC Anesthesiol. 2021 May 11;21(1):142. doi: 10.1186/s12871-021-01371-0.

Authors

Colin Suen¹, Jean Wong^{1

2}, Kahiye Warsame^{1

3}, Yamini Subramani⁴, Tony Panzarella⁵, Rida Waseem¹, Dennis Auckley⁶, Rabail Chaudhry¹, Sazzadul Islam¹, Frances Chung⁷

Affiliations

¹ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, MCL 2-405, 399 Bathurst St., Toronto, ON, M5T2S8, Canada.
² Department of Anesthesia and Pain Management, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Department of Anesthesia and Perioperative Medicine, London Health Science Centre, St. Joseph Health Care, Western University, London, ON, Canada.
⁵ Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
⁷ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, MCL 2-405, 399 Bathurst St., Toronto, ON, M5T2S8, Canada. frances.chung@uhn.ca.

Abstract

Background: Although continuous positive airway pressure (CPAP) is the first line treatment for obstructive sleep apnea (OSA) patients, the perioperative adherence rate is unclear. The objective of this study was to determine the perioperative adherence rate of patients with OSA with a CPAP prescription and the effect of adherence on nocturnal oxygen saturation.

Methods: This prospective cohort study included adult surgical patients with a diagnosis of OSA with CPAP prescription undergoing elective non-cardiac surgery. Patients were divided into CPAP adherent and non-adherent groups based on duration of usage (≥ 4 h/night). Overnight oximetry was performed preoperatively and on postoperative night 1 and 2 (N1, N2). The primary outcome was adherence rate and the secondary outcome was nocturnal oxygen saturation.

Results: One hundred and thirty-two patients completed the study. CPAP adherence was 61% preoperatively, 58% on postoperative N1, and 59% on N2. Forty-nine percent were consistently CPAP adherent pre- and postoperatively. Using a linear fixed effects regression, oxygen desaturation index (ODI) was significantly improved by CPAP adherence (p = 0.0011). The interaction term CPAP x N1 was significant (p = 0.0015), suggesting that the effect of CPAP adherence varied on N1 vs preoperatively. There was no benefit of CPAP adherence on postoperative mean SpO₂, minimum SpO₂, and percentage of sleep duration with SpO₂ < 90%. Use of supplemental oxygen therapy was much lower in the CPAP adherent group vs non-adherent group (9.8% vs 46.5%, p < 0.001).

Conclusions: Among patients with a preoperative CPAP prescription, approximately 50% were consistently adherent. CPAP adherence was associated with improved preoperative ODI and the benefit was maintained on N1. These modest effects may be underestimated by a higher severity of OSA in the CPAP adherent group and a higher rate of oxygen supplementation in the non-adherent group.

Trial registration: ClinicalTrials.Gov registry ( NCT02796846 ).

Keywords: Adherence; Continuous positive airway pressure; Nocturnal hypoxemia; Obstructive sleep apnea; Perioperative outcomes; Sleep disordered breathing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Continuous Positive Airway Pressure*
Female
Humans
Hypoxia / epidemiology*
Hypoxia / prevention & control
Male
Middle Aged
Patient Compliance*
Perioperative Care*
Postoperative Complications
Sleep Apnea, Obstructive / therapy*

Associated data

ClinicalTrials.gov/NCT02796846