TY - JOUR
T1 - Postoperative outcomes in patients with treatment-emergent central sleep apnea
T2 - a case series
AU - Barman, Ross A.
AU - Fields, Amanda R.
AU - Eells, Austin J.
AU - Kouri, Ioanna
AU - Mansukhani, Meghna P.
AU - Gali, Bhargavi
AU - Sprung, Juraj
AU - Weingarten, Toby N.
N1 - Funding Information:
Financial support was provided by the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic.
Funding Information:
MPM is the principal investigator on a research grant funded by ResMed Foundation to study the effects of adaptive servoventilation therapy of central sleep apnea syndromes on healthcare utilization; a subset of this cohort was assessed in the current study. MPM is the recipient of the Paul and Ruby Tsai and Family Career Development Award at Mayo Clinic, Rochester, Minnesota, that is unrelated to the current study. TNW currently serves as a consultant to Medtronic in the role as chairman of the Clinical Endpoint Committee for the Prodigy Trial; has received research support from Respiratory Motion (study equipment) and unrestricted investigator-initiated grants from Merck (active) and Baxter (completed).
PY - 2020/12
Y1 - 2020/12
N2 - Purpose: Treatment-emergent central sleep apnea (TECSA) is a central sleep-related breathing disorder, characterized by either the persistence or emergence of central sleep apnea during the initiation of positive airway pressure therapy for obstructive sleep apnea. The purpose of this study was to review the perioperative course of patients diagnosed with TECSA. Methods: We reviewed medical records of patients with TECSA who had a procedure or surgery with general anesthesia between January 1, 2009 and May 1, 2018. We describe postoperative outcomes including respiratory complications, unplanned intensive care unit (ICU) admissions, and other postoperative outcomes. Results: We identified 150 (116 male, 34 female) patients with TECSA. Of these, 39 (26%) had their anesthesia recovery associated with moderate to profound sedation, 22 (14.7%) required unplanned transfer to ICU (8 for hypoxemia). Compared to patients without ICU admissions, patients with unplanned ICU admissions had higher rates of cardiovascular disease, Charlson comorbid scores, and perioperative benzodiazepines. Within the first 30 postoperative days there were 23 (16%) hospital re-admissions, and 7 (4.6%) deaths. Conclusion: Patients with TECSA have high rates of postoperative complications, characterized by an increased rate of unplanned intensive care admissions and both high 30-day readmission and mortality rates. When dealing with these patients perioperative physicians should implement an increased level of respiratory monitoring, and early postoperative use of their home prescribed non-invasive ventilation devices.
AB - Purpose: Treatment-emergent central sleep apnea (TECSA) is a central sleep-related breathing disorder, characterized by either the persistence or emergence of central sleep apnea during the initiation of positive airway pressure therapy for obstructive sleep apnea. The purpose of this study was to review the perioperative course of patients diagnosed with TECSA. Methods: We reviewed medical records of patients with TECSA who had a procedure or surgery with general anesthesia between January 1, 2009 and May 1, 2018. We describe postoperative outcomes including respiratory complications, unplanned intensive care unit (ICU) admissions, and other postoperative outcomes. Results: We identified 150 (116 male, 34 female) patients with TECSA. Of these, 39 (26%) had their anesthesia recovery associated with moderate to profound sedation, 22 (14.7%) required unplanned transfer to ICU (8 for hypoxemia). Compared to patients without ICU admissions, patients with unplanned ICU admissions had higher rates of cardiovascular disease, Charlson comorbid scores, and perioperative benzodiazepines. Within the first 30 postoperative days there were 23 (16%) hospital re-admissions, and 7 (4.6%) deaths. Conclusion: Patients with TECSA have high rates of postoperative complications, characterized by an increased rate of unplanned intensive care admissions and both high 30-day readmission and mortality rates. When dealing with these patients perioperative physicians should implement an increased level of respiratory monitoring, and early postoperative use of their home prescribed non-invasive ventilation devices.
KW - Anesthetic management
KW - Central sleep apnea
KW - Postoperative complications
KW - Sleep-disordered breathing
KW - Treatment-emergent central sleep apnea
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U2 - 10.1007/s00540-020-02828-1
DO - 10.1007/s00540-020-02828-1
M3 - Article
AN - SCOPUS:85088302272
VL - 34
SP - 841
EP - 848
JO - Journal of Anesthesia
JF - Journal of Anesthesia
SN - 0913-8668
IS - 6
ER -