Cumbersome though it may be, perioperative continuous positive airway pressure (CPAP) is a boon to obstructive sleep apnea (OSA) patients undergoing surgery, according to a meta-analysis. Researchers from Toronto Western Hospital found that CPAP reduces the perioperative Apnea–Hypopnea Index (AHI) and hospital length of stay (LOS) in this at-risk patient population.
“We already know that the prevalence of obstructive sleep apnea in the general population is very high,” said Mahesh Nagappa, MD, DNB, MNAMS, a fellow at the Toronto, Ontario institution. “The prevalence is not only higher in the surgical population than in the general population, but most OSA patients who come for surgery may be undiagnosed, untreated and have many coexisting diseases. All of these may lead to increased perioperative adverse events.”
“There are many treatments for OSA,” he continued. “In this study, we evaluated whether the administration of CPAP during the perioperative period, and its effect on the length of hospital stay and the Apnea–Hypopnea Index.”
Dr. Nagappa and his colleagues performed an English-language literature search for OSA studies of adult surgical patients who were either using or not using perioperative CPAP, with reported data on AHI and hospital LOS. A total of five manuscripts were analyzed.
As Dr. Nagappa reported at the 2014 annual meeting of the American Society of Anesthesiologists (abstract A4012), two studies provided data on preoperative (n=100) and postoperative (n=51) AHI in patients treated with CPAP. These studies revealed that CPAP significantly reduced the perioperative API. Indeed, the preoperative index of 37±19 events per hour fell to 12±16 events per hour (P<0.001).
“So we saw a decrease of about 25 events per hour when using CPAP,” Dr. Nagappa said. “It’s important to remember that 12 events every hour is still on the high side, so the CPAP was not completely effective in resolving sleep-breathing disorders.”
Three studies provided data on hospital LOS, revealing that CPAP patients (n=264) had a significantly shorter stay than their counterparts who did not receive CPAP (3.9±4.0 vs. 4.3±4 days; P>0.05).
“We also examined the data regarding the continued use of CPAP in these patients,” Dr. Nagappa said. “Among the studies, preoperative CPAP was as used by 278 patients, but only 117 patients used it in the postoperative period. So the compliance rate was very poor, only 42%.
“So the two important messages I want to convey is we really need to educate our patients as well as other health care professionals regarding the importance of using CPAP in the preoperative and postoperative period,” he said. “As we found, CPAP significantly decreased postoperative Apnea–Hypopnea Index, and significantly shortened length of hospital stay, too.”
Nevertheless, he pointed out that further research is required with respect to the use of perioperative CPAP. There is a need of larger trials with more patients.
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