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

Pu Liao; Jean Wong; Mandeep Singh; David T Wong; Sazzadul Islam; Maged Andrawes; Colin M Shapiro; David P White; Frances Chung

doi:10.1016/j.chest.2016.12.005

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

Chest. 2017 Mar;151(3):597-611. doi: 10.1016/j.chest.2016.12.005. Epub 2016 Dec 19.

Authors

Pu Liao¹, Jean Wong¹, Mandeep Singh¹, David T Wong¹, Sazzadul Islam¹, Maged Andrawes¹, Colin M Shapiro², David P White³, Frances Chung⁴

Affiliations

¹ Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
² Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
³ Department of Sleep Medicine, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
⁴ Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. Electronic address: Frances.chung@uhn.ca.

PMID: 28007620
DOI: 10.1016/j.chest.2016.12.005

Abstract

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 (P_tcCO₂) 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 P_tcCO₂ ≥ 55 mm Hg ≥ 10% on postoperative night 1, 2, or 3 was found in 11.4% patients, there was no difference in P_tcCO₂ 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 P_tcCO₂ level. A small number of patients had significant CO₂ retention while receiving supplemental oxygen.

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

Keywords: hypoventilation; oxygen; sleep apnea; surgery.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Analgesics, Opioid / adverse effects
Apnea / epidemiology*
Blood Gas Monitoring, Transcutaneous
Female
Humans
Hypercapnia / epidemiology*
Logistic Models
Male
Middle Aged
Oximetry
Oxygen Inhalation Therapy / methods*
Pain, Postoperative / drug therapy
Polysomnography
Postoperative Care / methods*
Postoperative Complications / epidemiology*
Respiratory Insufficiency / chemically induced
Respiratory Insufficiency / epidemiology*
Sleep
Sleep Apnea, Obstructive*

Substances

Analgesics, Opioid

Associated data

ClinicalTrials.gov/NCT01552304