Several recent reviews suggest that Sleep Disordered Breathing (SDB) is a risk factor for anesthetic mortality and morbidity. Expert opinion suggests that preoperative evaluation should assess the likelihood of SDB. Nocturnal oximetry (Nox) can detect patients with SDB severe enough to justify nasal continuous positive airway pressure (nCPAP) therapy. We reviewed whether severely obese patients (SOPs) ( body mass index (BMI)>34)screened and treated before cardiac surgery for SDB had better outcomes than similar not screened patients.
Out of 36 consecutive male, SOPs scheduled for elective myocardial revascularization, 18 (group1) were screened with Nox preoperatively (depending on the request or not of Nox by the anesthesiologist in charge, the availability and feasibility of Nox).Oximetries were read by an anesthesiologist with high interest in sleep medicine.Those suggestive of SDB were reviewed by a sleep physician. If deemed necessary and if available a polysomnography (PSG) was performed and a treatment instituted. If PSG was requested but not available or if surgery was urgent and Nox suggestive of SDB, then treatment was instituted and its efficacy checked with Nox for 3 days. The remaining 18 patients (group2) were evaluated and cared for following the current standards of the institution (which do not include Nox/PSG as part of routine preoperative evaluation in SOPs).
The 2 groups were comparable for age, BMI, ejection fraction, history chronic obstructive pulmonary disease, hypertension, diabetes. Aortic clamping time, bypass time, number of grafted vessels were similar in both groups. Goup1 patients had less pulmonary and infectious morbidity and fewer tansfusions. There was no statistical difference in intensive care (ICU) and postoperative hospital stay, nor in total hospital costs between group1 and group2.
SOPs screened preoperatively with Nox for SDB endured less pulmonary and infectious complications.
Unexpensive Nox could be a valuable method for preoperative screening of SOPs for SDB. Provided adequate treatment ensues, preoperative Nox could decrease pulmonary and infectious morbidity for SOPs submitted to cardiac surgery.
Characteristics and postoperative data of 36 SOPsGroup 1 (n=18) with NoxGroup 2 (n= 18) without NoxAge * (years)60.6 ± 9.261.3 ± 9.1Body Mass Index * (kg.m-2)38.5 ± 4.136.3 ± 1.6Left Ventricular ejection fraction *54.5 ± 13.463 ± 12.4Chronic Obstructive Pulmonary Disease**n = 3n = 3Systemic Hypertension **n = 16n = 13Diabetes **n = 12n = 8Number of diseased vessels ** 3 Vessels 2 Vesselsn = 15 n = 3n = 14 n = 4Aortic Clamping Time * (minutes)73.1 ± 20.877.5 ± 35.6Cardiopulmonary bypass time * (minutes)108 ± 22.5116.8 ± 57.3Infectious complications ** :n = 0n = 5 †Pulmonary complications **n = 5n = 15 †Transfusion ** Total units of blood transfused517ICU stay * (days)2.3 ± 0.974.8 ± 6.8Postoperative stay * (days)9.2 ± 2.613.2 ± 12.2Total Hospital cost * (€)14939.57 ± 303416565.30 ± 8933Mortality *n = 0n = 1†
p < 0.05 by T-test or Chi-square test*
Values expressed as mean ± SD**
Values expressed as number of patients (n)
M. Momeni, None.