Association of obstructive sleep apnea and postoperative cardiac complications: A systematic review and meta-analysis with trial sequential analysis

• Main Authors: Ng, Ka Ting, Lee, Zong Xuan, Ang, Eshen, Teoh, Wan Yi, Wang, Chew Yin
• Format: Article
• Published: Elsevier 2020
• Subjects: R Medicine (General)
• Online Access: http://eprints.um.edu.my/36666/
• Institution: Universiti Malaya

Objectives: The repetitive hypoxic and hypercapnia events of obstructive sleep apnea (OSA) are believed to adversely affect cardiopulmonary function, which make them vulnerable to a higher incidence of postoperative complications. The primary aim of this systematic review and meta-analysis was to examine the association of OSA and the composite endpoints of postoperative cardiac or cerebrovascular complications in adult undergoing non-cardiac surgery. Data sources: MEDLINE, EMBASE and CENTRAL were systematically searched from its inception until May 2019. Review methods: All observational studies were included. Results: Twenty-two studies (n = 3,033,814; 184,968 OSA vs 2,848,846 non-OSA) were included for quantitative meta-analysis. In non-cardiac surgery, OSA was significantly associated with a higher incidence of the composite endpoints of postoperative cardiac or cerebrovascular complications (odd ratio: 1.44, 95%CI: 1.17 to 1.78, rho = 0.007, trial sequential analysis= conclusive; certainty of evidence = very low). In comparison to nonOSA, OSA patients were reported to have nearly 2.5-fold risk of developing pulmonary complications (odd ratio: 2.52, 95%CI: 1.92 to 3.31,. < 0.001, certainty of evidence = very low), postoperative delirium (odd ratio: 2.45, 95%CI: 1.50 to 4.01,. < 0.001, certainty of evidence = low) and acute kidney injury (odd ratio: 2.41, 95%CI: 1.93 to 3.02,. < 0.001, certainty of evidence = very low). Conclusions: This meta-analysis of 22 comparative studies demonstrated that OSA is a potential risk factor to postoperative adverse complications in adults undergoing non-cardiac surgery. However, the conclusions need to be interpreted with caution due to the nature of included observational studies with significant heterogeneity and low quality of evidence.