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Original Research |

Postoperative Oxygen Therapy in Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial OPEN ACCESS

Pu Liao, MD; Jean Wong, MD; Mandeep Singh, MBBS; David T. Wong, MD; Sazzadul Islam, MS; Maged Andrawes, MD; Colin M. Shapiro, FRCPC; David P. White, MD; Frances Chung, MBBS; Frances Chung
Author and Funding Information

Conflict of interest: None

Conflict of interest: None

Conflict of interest: No

Conflict of interest: No

Conflict of interest: None

Conflict of interest: None

Conflict of interest: None

Conflict of interest: Chief Medical Officer: Apnicure Inc Consultant: Philips Respironics and Night Balance

Conflict of interest: STOP-Bang is proprietary to University Health Network. Research grant support from ResMed Foundation, Acadia and Medtronics.

Sources of financial support for the work

The work was supported by grants from University Health Network Foundation, Toronto, Ontario, Canada and Department of Anesthesia, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

Clinical Trial Registration: NCT01552304 at http://clinicaltrials.gov.

Research analyst Department of Anesthesia Toronto Western Hospital University Health Network

Associate Professor, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto

Assistant Professor, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto

Professor, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto

Research Coordinator, Department of Anesthesia, Toronto Western Hospital, University Health Network

Resident, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto

Professor, Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto

Senior Physician, Sleep Medicine, Brigham and Women's Hospital, Professor of Medicine, Harvard Medical School, Boston, MA 02115

Professor, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto

Department of Anesthesia, Toronto Western Hospital, University Health Network 399 Bathurst Street, Toronto, Ontario Canada M5T 2S8

Corresponding Author Dr. Frances Chung Room 405, 2McL wing, Department of Anesthesia, Toronto Western Hospital, University Health Network 399 Bathurst Street, Toronto, Ontario Canada M5T 2S8


Copyright 2016, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2016.12.005
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Abstract

Background  Surgical patients with obstructive sleep apnea (OSA) are at increased risk for perioperative complications. Postoperative supplemental oxygen is commonly used but it may contribute to respiratory depression in OSA patients receiving opioids. The objective of the study is to investigate the effect of postoperative supplemental oxygen on SaO2, sleep respiratory events, and CO2 level in patients with untreated OSA.

Methods  Consented patients with an apnea hypopnea index (AHI) >5 events/h on a preoperative polysomnography were randomized (1:1) to oxygen (O2) or no oxygen (Control). Oxygen group received O2 at 3 l/min via nasal prongs for 3 postoperative nights. The primary outcomes were polysomnographic parameters measuring SaO2, sleep respiratory events, and PCO2 measured by transcutaneous CO2 monitor (PtcCO2) on night 1-3. The intention-to-treat and per protocol analysis were done.

Results  123 patients were randomized; O2-group:62, and Control-group:61. On night-3, the O2 vs. Control-group had a higher average SaO2: 95.2±3% vs. 91.4±4% (p<0.001) and lower oxygen desaturation index: 2.3(0.2, 13.8) vs. 18.5(8.2, 45.9) events/h [median (25th,75th percentile), p<0.0001]. The O2 group had a decreased AHI, 8.0(2.1, 19.9) vs, 15.6(9.5, 45.8) (p=0.016) ; hypopnea index (p<0.001), central apnea index (p=0.026) and a shortened longest apnea-hypopnea duration (p=0.002). Although PtcCO2-CT55 ≥ 10% on postoperative night 1, 2 or 3 was found in 11.4% patients, there was no difference in PtcCO2 between the groups.

Conclusions  Postoperative supplemental O2 was found to improve oxygenation and decrease AHI without increasing the duration of apnea-hypopnea event or PtcCO2 level. A small number of patients had significant CO2 retention while receiving supplemental O2.


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