Tuesday, 26 May 2015

The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: A systematic review and meta-analysis. Anesthesia Anaglesia May 2015.

The objective of this review was to investigate the effectiveness of continuous positive airway pressure (CPAP) in reducing the risk of postoperative adverse events in patients with OSA undergoing surgery, the perioperative Apnea-Hypopnea Index (AHI), and the hospital length of stay (LOS). This systematic review/meta-analysis is the first to examine the effectiveness of CPAP therapy on postoperative adverse events, postoperative AHI, and LOS in OSA patients under- going surgery.

6 studies (with 904 patients in total) (3 observational, 2 RCTs and 1 case series) were eligible. There was no significant difference in the postoperative adverse events between the 2 groups (CPAP vs non – CPAP). The preoperative baseline AHI with- out CPAP was reduced significantly with postoperative use of CPAP (preoperative AHI versus postoperative AHI, 37 ± 19 vs 12 ± 16 events per hour, P < 0.001). However only 2 studies investigated this in their trial. LOS showed a trend toward significance in the CPAP group versus the no-CPAP group (4.0 ± 4 vs 4.4 ± 8 days, P = 0.05).

The main reasons for the seeming lack of benefit may be because of the low compliance in the preoperative and postoperative period (only 33% used CPAP for >4h post op).

Another important issue highlighted by the study is the lacks of RCTs to provide quality information regarding the use of preoperative and/or postoperative CPAP in OSA patients. The RCTs in this meta-analysis were also small studies. The impact of reduction in AHI, shortened LOS, and the efficacy of CPAP in postoperative adverse events need further investigation.

EL

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