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October 14, 2014
10:00 AM - 11:30 AM
Room Room 245
Effects of CPAP on Apnea Hypopnea Index & Length of Hospital Stay in OSA Patients Undergoing Surgery: A Meta-analysis
Mahesh Nagappa, M.D., D.N.B., MNAMS, Babak Mokhlesi, M.D., Jean Wong, M.D., FRCPC, David T. Wong, M.D., Kaw Roop, M.D., Frances F. Chung, M.D.
Toronto Western Hospital, Toronto, Ontario, Canada

Background: Obstructive sleep apnea (OSA) may worsen postoperatively. This is associated with increased risk of postoperative adverse events and may prolong the hospital stay. Perioperative treatment of OSA with continuous positive airway pressure (CPAP) may decrease the risk of adverse events with a shorter hospital stay. The objective of this meta-analysis is to determine the effectiveness of CPAP in reducing perioperative Apnea Hypopnea Index (AHI) and decreasing the length of hospital stay (LOS) in OSA patients undergoing surgery.

Methods: A search of the literature databases Medline (from 1946 to 2013), Medline in-process and other non-indexed citations, Embase (from 1947 to 2013), Cochrane central register of controlled trials, Cochrane database of systematic reviews and Health technology assessment (4th Quarter 2013) was carried out. The search strategy yielded 1970 citations. Irrelevant papers were excluded by title, abstract and full text review, leaving 5 manuscripts. We reviewed the studies that included: 1) Adult surgical patients (> 18 yrs old) with information available on OSA; 2) Patients were using either perioperative CPAP or no perioperative CPAP; 3) Reported data on perioperative AHI and LOS; 4) All published studies in English language including case series reports. Statistical methods: The analysis of pooled AHI was based on dataset pooling original data from all studies. The pooled length of stay was estimated with weighted mean, pooled standard deviation, and inferred 95% confidence interval.

Results: Only two studies provided data on preoperative AHI (n=100) and postoperative AHI (n=51) in patients treated with CPAP both preoperatively and postoperatively. CPAP significantly reduced AHI perioperatively (preoperative AHI vs. postoperative AHI: 37±19 vs. 12±16 events/hr) (P<0.001) (Table 1). Out of the five studies, two studies provided data on LOS in median and three studies in mean±SD. Only the mean data was pooled for analysis. Length of stay was 3.9±4 days in the CPAP group (n=264) versus 4.3±4 days in the no-CPAP group (n=298) (P>0.05) (Figure 1).

Conclusion: The study suggests that perioperative CPAP significantly reduces perioperative AHI. The length of stay was not significantly shortened in OSA patients on CPAP undergoing surgery, but this may be due to the small number of patients in the analysis.

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