PURPOSE: To determine if patients at high risk for obstructive sleep apnea (OSA) have a significant increase in postoperative morbidity & mortality after elective coronary artery bypass graft surgery (CABG).
METHODS: We prospectively screened 120 patients for OSA using the Berlin questionnaire (BQ). Subjects were considered high risk if BQ score was ≥2. We excluded patients undergoing emergent CABG and patients with OSA on treatment. Patients were followed postoperatively for 30 days or until discharge. Primary endpoints included new onset atrial fibrillation, significant cardiac arrhythmias, 30-day mortality, reintubation and/or mechanical ventilation lasting > 24 hours post surgery. Secondary endpoints included length of stay (LOS) in ICU & hospital. Secondary analysis was conducted based on well-established risk factors for OSA (BMI>30, age>50 years & male gender).
RESULTS: Primary endpoints for high risk [81 patients (67.5%)] vs. low risk groups were 16% vs. 25.6% for atrial fibrillation (p=0.16), 11.1% vs. 2.6% for reintubation (p=0.1), 8.6% vs. 7.7% for significant cardiac arrhythmias (p=0.7) & 11.1% vs. 10.3% for prolonged mechanical ventilation (p=0.67) respectively. There was no 30-day mortality in either group. Secondary endpoints were 9.8 vs. 8.1 days for hospital LOS (p=0.45) & 3.1 vs. 2.5 days for ICU LOS (p=0.46) respectively. Risk factor based analysis including age alone; sex alone; BMI alone and all possible combinations of these variables did not reach statistical significance for any of the above-mentioned endpoints. 15 patients underwent polysomnography after discharge, 13 (86%) had OSA.
CONCLUSION: In our study, there was no statistically significant increase in postoperative complications in patients undergoing CABG who are at high risk for OSA. The associations found, although statistically insignificant, need to be further studied with larger sample size.
CLINICAL IMPLICATIONS: Prevalence of OSA is high in patients with cardiovascular disease. The perioperative impact on morbidity & mortality of OSA in patients undergoing CABG warrants further evaluation to determine the need and cost effectiveness of routine screening and therapeutic strategies.
DISCLOSURE: Omar Albustami, No Financial Disclosure Information; No Product/Research Disclosure Information