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Original Research: Sleep Disorders |

Postoperative Oxygen Therapy in Patients With OSA: A Randomized Controlled Trial

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

FUNDING/SUPPORT: The study was supported by grants from the University Health Network Foundation, Toronto, ON, Canada; and the Department of Anesthesia, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.

aDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

bDepartment of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

cDepartment of Sleep Medicine, Brigham and Women's Hospital, Boston, MA

dDepartment of Medicine, Harvard Medical School, Boston, MA

CORRESPONDENCE TO: Frances Chung, MBBS, Room 405, 2McL Wing, Department of Anesthesia, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada


Copyright 2017, The Authors. All Rights Reserved.


Chest. 2017;151(3):597-611. doi:10.1016/j.chest.2016.12.005
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Background  Surgical patients with OSA are at increased risk for perioperative complications. Postoperative supplemental oxygen is commonly used, but it may contribute to respiratory depression in patients with OSA receiving opioids. The objective of the study is to investigate the effect of postoperative supplemental oxygen on arterial oxygen saturation (Sao2), sleep respiratory events, and CO2 level in patients with untreated OSA.

Methods  Consented patients with an apnea hypopnea index (AHI) > 5 events per hour on a preoperative polysomnography were randomized (1:1) to oxygen (O2 group) or no oxygen (control group). The O2 group received oxygen at 3 L/min via nasal prongs for three postoperative nights. The primary outcomes were polysomnographic parameters measuring Sao2, sleep respiratory events, and Pco2 measured by transcutaneous CO2 monitor (PtcCO2) on nights 1 through 3. The intention-to-treat and per protocol analysis were completed.

Results  There were 123 patients randomized (O2 group: n = 62; control group: n = 61). On night 3, the O2 vs control group had a higher average Sao2 (95.2% ± 3% vs 91.4% ± 4%, respectively; P < .001) and lower oxygen desaturation index (median, 2.3; 25th-75th percentile, 0.2-13.8 vs median, 18.5; 25th-75th percentile, 8.2-45.9 events per hour, respectively; P < .0001). The O2 group had a decreased AHI (median, 8.0; 25th-75th percentile, 2.1-19.9 vs median, 15.6; 25th-75th percentile, 9.5-45.8, respectively; P = .016), hypopnea index (P < .001), and central apnea index (P = .026) and a shortened longest apnea hypopnea duration (P = .002). Although time percentage with PtcCO2 ≥ 55 mm Hg ≥ 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 oxygen was found to improve oxygenation and decrease the AHI without increasing the duration of apnea-hypopnea event or PtcCO2 level. A small number of patients had significant CO2 retention while receiving supplemental oxygen.

Trial Registry  ClinicalTrials.gov; No.: NCT01552304; URL: www.clinicaltrials.gov

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