. 2018 Oct 22;155(4):855–867. doi: 10.1016/j.chest.2018.09.030

Table 1.

Sleep Study and Oximetry Parameters Associated With Postoperative Outcomes

Study/Year	No. of Patients	Study Design	Sleep Study Type	Monitoring Device	PAP Use	Parameter (Oxygen Desaturation Criteria)	Outcome	Findings (Complications vs No Complications)
Upper airway surgery
Asha’ari et al²⁷/2017	95	Cohort-R	Lab-PSG	Crystal Sapphire (CleveMed)	Yes, if using preop	AHI	Postop Cx	NS
						Minimum Spo₂	Postop Cx	OR 1.03 for per 5% decrease,^a mean 68% vs 79%^a
						Longest apnea duration	Postop Cx	OR 1.03 per 5-s increase,^a mean 51 vs 39 s^a
Kandasamy et al²⁵/2013	345	Cohort-R	Lab-PSG	NR	Not routine	AHI	O₂ in PACU	OR 2.2 for AHI ≥ 22 vs < 22^a
							O₂ on ward	37.4 vs 31.4^a
Kezirian et al²⁴/2006	255	Nested case-control	Lab-PSG	NR	NR	AHI	Postop Cx	Mean 53 vs 39^a
Kim et al⁴¹/2005	153	Cohort-R	Lab-PSG	NR	NR	AHI	Postop Cx	Mean 68 vs 49^a
Pang et al²⁶/2012	487 (6)^b	Cohort-R	Level III oximetry	WatchPAT 100 (Itamar Medical)	50% preop CPAP trial for 1-2 wk	AHI	Postop Spo₂ desaturation	Mean AHI 67 vs 47
						Minimum Spo₂	Postop Spo₂ desaturation	Mean 61% vs 75%
Cardiac surgery
Foldvary-Schaefer et al³⁹/2015	107	Cohort-P	Lab-PSG	Crystal Monitor 20H	Preop PAP use excluded	AHI (≥ 3%)	Postop Cx	NS
							LVEF (baseline)	Mean 44% vs 53% in patients with AHI ≥ 15 vs < 15^a
							LVEF	NS
						CT90		CT90 > 0 associated with significantly greater BMI, longer intraop ET time, and more prolonged intubation
Kaw et al³²/2017	190	Cohort-R	Lab-PSG	Nihon Kohden	24% preop use	AHI (≥ 3%)		OR 1.06 per 5-unit increase in AHI^a in unadjusted analysis (OR 1.04 in adjusted analysis; P > .05)
							AF	Effect modification with BMI > 32 kg/m²
						ODI 3%	AF	NS
						ODI 4%	AF	NS
						Minimum Spo₂	Postop Cx	NS
						Minimum Spo₂	Postop Cx	71% vs 78%^a
Kua et al³⁴/2016	150	Cohort-P	Level III oximetry	WatchPAT 200 (Itamar Medical)	Preop PAP use excluded	AHI	AHI	OR 2.9 for AHI ≥ 15^a
Roggenbach et al³³/2014	92	Cohort-P	Level III oximetry	MiniScreen 4 (Heinen and Löwenstein)	Postop CPAP if needed	AHI (≥ 3%)	Delirium	OR 6.04 for AHI ≥ 19^a
						Mean Spo₂	Delirium	NS
						Minimum Spo₂	Delirium	NS
						CT90	Delirium	NS
Unosawa et al⁵¹/2012	89	Cohort-P	Level IV oximetry	SAS-2100 (Nihon Kohden)	No	AHI (postop)	AF	NS
							PVC	19.2% vs 3.2% between AHI ≥ 15 vs < 15^a
							Minimum Spo₂	Minimum Spo₂ 78% vs 87% between postop AHI ≥ 15 vs < 15^a
Vascular surgery
Utriainen et al³⁵/2014	82	Cohort-P	Lab-PSG	Embla/Somnologica (Natus)	No	AHI (≥ 4%)	MACCE	HR 5.1 AHI ≥ 20 vs AHI < 20 for a median follow-up of 52 mo^a
Bariatric surgery
Turan et al⁴⁰/2015	218	Cohort-R	Lab-PSG	NR	63% using preop CPAP	CT90	Opioid consumption	Decrease in median postop opioid consumption by 16% per 5% increase in CT90^a
						Minimum Spo₂	Opioid consumption	NS
						AHI	Opioid consumption	NS
Weingarten et al³⁰/2011	797	Cohort-R	Lab-PSG	NR	82% using preop PAP; postop PAP applied if preop use	AHI (≥ 2 or 4)	Postop Cx	NS among AHI categories (mild 5 ≤ AHI < 15, moderate 15 ≤ AHI < 30, severe AHI ≥ 30)
Other populations undergoing surgery
Chung et al²¹/2014	573	Cohort-P	Level IV oximetry	PULSOX-300i (Konica Minolta Sensing)	None, undiagnosed OSA	ODI 4	Postop Cx	OR 2.2 for ODI > 29^a
						CT90	Postop Cx	OR 2.6 for CT90 > 7%^a
						Mean Spo₂	Postop Cx	OR 2.8 for mean Spo₂ < 93%^a
Devaraj et al²²/2017	245	Cohort-P	Level III oximetry	ApneaLink Plus (ResMed)	None, undiagnosed OSA	AHI (≥ 3%)	Postop Cx	OR 3.6 for AHI ≥ 5 (within 7 d postop)^a
								OR 3.5 for AHI ≥ 5 (within 30 d postop)^a
							Postop desaturation	OR 6 for AHI ≥ 5
Hwang et al³⁷/2008	172	Cohort-P	Level IV oximetry	NR	None, undiagnosed OSA	ODI 4	Postop Cx	OR 7.0 for ODI ≥ 5^a
						CT90	Postop Cx	Mean 21% vs 10%^a
Kaw et al⁵³/2016	519	Cohort-R	Lab-PSG	NR	24% preop PAP use	AHI	ICU LOS	AHI (per 15-unit increase) associated with increased ICU LOS in OHS cohort (β coefficient, 0.009)^a
Mador et al⁴²/2013	284	Cohort-R	Lab-PSG	NR	Yes	AHI	Postop Cx	OR 2.0 for AHI ≥ 5 vs < 5^a
								OR 2.3 for AHI 5 to < 30 vs AHI < 5^a
								OR 1.92 for AHI 5 to <15 vs AHI < 5 (NS)
								OR 2.13 for AHI ≥ 30 vs AHI < 5 (NS)
							Respiratory Cx	OR 2.05 for AHI ≥ 5 vs < 5^a
								OR 2.18 for AHI 5 to < 15 vs AHI < 5^a
								OR 2.01 for AHI 15 to < 30 vs AHI < 5 (NS)
								OR 2.07 AHI ≥ 30 vs < 5 (NS)
							Cardiac Cx	NS
Mason et al³⁸/2017	122	Cohort-P	Level IV oximetry	PULSOX-300i (Konica Minolta Sensing)	NR	ODI 4	Postop Cx	OR 1.1 per increase by 1 unit^a NS for arrhythmia
							ICU LOS	NS
Mutter et al³¹/2014	20,442	Cohort-R	Lab-PSG	NR	NR	AHI	Respiratory Cx	OR 2.7 for AHI ≥ 30^a
	19,405	Cohort-R	Lab-PSG	NR	NR	AHI	Cardiac Cx	OR 2.2 for cardiac Cx undiagnosed OSA vs OR 0.75 for diagnosed OSA^a
								OR 2.7 for cardiac Cx in severe undiagnosed OSA + AHI ≥ 30 vs control group^a
Subramani et al¹²/2017	3	Case reports	Lab-PSG	NR	NR	AHI	Critical events	Mean AHI 30, all patients with AHI > 15

AF = atrial fibrillation; AHI = apnea-hypopnea index (expressed in events per hour); Cohort-P = prospective cohort; Cohort-R = retrospective cohort; CT90 = cumulative time percentage with Spo₂ < 90%; Cx = complication; ET = endotracheal tube; HR = hazard ratio; intraop = intraoperative; Lab = laboratory; LOS = length of stay; LVEF = left ventricular ejection fraction; MACCE = major adverse cardiac and cerebrovascular events (includes cardiac death, myocardial infarction, coronary revascularization, angina pectoris requiring hospitalization, and stroke as a combined end point); NR = not reported; NS = not significant; O₂ = oxygen; ODI = oxygen desaturation index; OHS = obesity hypoventilation syndrome; PACU = postanesthesia care unit; PAP = positive airway pressure; postop = postoperative; preop = preoperative; PSG = polysomnography; PVC = premature ventricular contraction; Spo₂ = oxyhemoglobin saturation.

P < .05 vs control group (no complication).

The number in parentheses indicates the number of patients with complications studied.