Obstructive sleep apnea-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

Jiayang Wang; Xinxin Wang; Wenyuan Yu; Kui Zhang; Yongxiang Wei

doi:10.21037/jtd-20-2037

Obstructive sleep apnea-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

J Thorac Dis. 2020 Oct;12(10):5603-5616. doi: 10.21037/jtd-20-2037.

Authors

Jiayang Wang^{1

2}, Xinxin Wang³, Wenyuan Yu¹, Kui Zhang¹, Yongxiang Wei⁴

Affiliations

¹ Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
² Center for Cardiac Intensive Care, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
³ Department of General Surgery, Chinese PLA general hospital, Beijing, China.
⁴ Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Abstract

Background: The aim of this study was to explore the underlying impact of obstructive sleep apnea (OSA) on postoperative parameters of multi-organ function among coronary heart disease (CHD) patients following elective coronary artery bypass grafting (CABG).

Methods: Electronic literature databases were searched manually and automatically for relevant English articles. All of the included articles focused on a comparison of the incidence of postoperative parameters of multi-organ function in CHD patients undergoing elective CABG with and without OSA. Studies were excluded if they met any one of the following criteria: (I) duplicate publication; (II) ongoing or unpublished studies; (III) only published as abstracts or conference proceedings; and (IV) less than 30 patients in the patient cohort.

Results: A total of 13 articles met our inclusion criteria. The current study demonstrated OSA significantly increased the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in CHD patients undergoing elective CABG compared with the controls [odds risk (OR), 1.97; 95% CI, 1.50 to 2.59, P<0.0001]. In addition, OSA was associated with an increased risk of new revascularization in CHD patients undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, P<0.0001). Moreover, reintubation and tracheostomy in the OSA group was increased 243% (OR, 3.43; 95% CI, 1.35 to 8.71; P=0.009) and 372% (OR, 4.72; 95% CI, 1.23 to 18.13; P=0.024), respectively, compared with the control group. Besides, we also confirmed OSA significantly increased the acute kidney injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P<0.0001).

Conclusions: OSA may contribute to postoperative multi-organ dysfunction among CHD patients undergoing elective CABG by increasing the incidence of MACCEs, especially new revascularization, as well as respiratory, and renal complications.

Keywords: Obstructive sleep apnea (OSA); coronary heart disease (CHD); elective coronary artery bypass grafting (CABG); postoperative multi-organ dysfunction.