Anesthésie et recherche clinique
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Abstrait

Preoperative Use of Continuous Positive Airway Pressure is related to Postoperative Respiratory Complications in Patients with Obstructive Sleep Apnea Undergoing Endoscopic Sinus Surgery

Arata Endo, Yuki Kuwabara, Kentaro Yamakawa, Daisuke Sakamaki, Akihiro Suzuki, Ichiro Kondo, Yasushi Mio and Shoichi Uezono

Backgrounds: Patients with obstructive sleep apnea (OSA) undergoing endoscopic sinus surgery (ESS) are considered at risk of postoperative respiratory complications because postoperative nasal packing often delays resumption of preoperative continuous positive airway pressure (CPAP) therapy. Our hospital implemented a policy in 2011 that all patients with OSA undergoing ESS be admitted to the intensive care unit (ICU) for at least 1 night for postoperative respiratory monitoring. We conducted the present study to evaluate the policy by examining the incidence of postoperative respiratory complications and to identify risk factors for postoperative respiratory complications in these patients.
Methods: All patients with OSA scheduled for ESS from 2011 to 2015 were included in this retrospective chart review. Postoperative respiratory complication was defined as decrease of the percutaneous arterial oxygen saturation (SpO₂) greater than 3% from each baseline or apnea for more than 20 seconds. We examined the incidence of respiratory complications and conducted multiple logistic regression analysis to determine risk factors for those of complications.
Results: A total of 152 patients were analyzed. Postoperative respiratory complications were observed in 27 patients (17.8%) and the minimum value of SpO₂ was 84%. None of these patients experienced severe sequelae. Multiple logistic regression analysis showed that preoperative CPAP use was an independent risk factor for postoperative respiratory complications (odds ratio=4.1; 95% CI=1.1–14.7).
Conclusion: This retrospective study revealed a relatively high incidence of postoperative respiratory complications after ESS in patients with OSA. Our hospital policy of continuous respiratory monitoring in the ICU for at least 1 night postoperatively appears to be valid for these patients.