Chest
Original Research: Sleep DisordersPostoperative Complications in Patients With Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Noncardiac Surgery
Section snippets
Materials and Methods
The study protocol was approved by the Cleveland Clinic Institutional Review Board, #12-625.
Results
A total of 1,800 patients with BMI ≥ 30 kg/m2 who underwent PSG, NCS, and ABG analysis on more than one occasion were identified. One hundred ninety-four met criteria for possible or definite OHS per study protocol. Of these, 139 (72%) had OSA at the time of elective surgery, and the remaining patients (28%) received an OSA diagnosis after PSG within 1 to 5 years postsurgery. Another cohort of 325 had OSA around the time of NCS but either did not meet the ABG criteria for OHS or did not have an
Discussion
Among patients with OSA by PSG, significantly worse postoperative outcomes were noted if patients were previously known to be hypercapnic from OHS with or without overlap syndrome. In our experience, this study is the first to report perioperative outcomes in patients with known or suspected OHS. The only other time postoperative outcomes have been reported among patients with a high likelihood of OHS was with the use of the Obesity Surgery Mortality Risk Score in those undergoing bariatric
Conclusions
Among patients with OSA, a higher number of medical morbidities are known to be associated with those who have OHS compared with OSA alone. Consequently, a higher number of postoperative complications are expected in this group, regardless of BMI or AHI. The risk and frequency of postoperative complications are also higher in patients with OSA and COPD (overlap syndrome) and appear to be no different than that associated with OHS.
Acknowledgments
Author contributions: R. K. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. R. K. contributed to the study conception, data collection, data analysis and interpretation, and writing and final approval of the manuscript; P. B., H. P., A. R., and A. D. contributed to the data collection and approval of the final manuscript; A. V. H. contributed to the statistical analysis and writing and final approval
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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.