2017-18 HSC Section 3 Green Book

Perioperative Sleep Studies in OSA Patients

Table 4. Sleep Architecture in Patients

Preoperative Night

Postoperative Night 1

Postoperative Night 3

Postoperative Night 5

Postoperative Night 7

N

Total sleep time (min)*  Non-OSA 20

354±58 349±68

272±117‡ 341±98§

355±60 352±73

324±78 347±67

342±78 356±74

 OSA

38

Sleep efficiency (%)*  Non-OSA 20

89±8

62±23‡ 71±18‡

79±10‡ 79±12

79±11‡ 82±12

79±15‡ 83±10

 OSA

38

85±14

REM sleep (%)†  Non-OSA

20 38

24 (19, 27) 21 (17, 27)

4 (0, 10)‡ 3 (0, 12)‡

15 (11, 22)‡ 14 (8, 22)‡

22 (12, 25)‡ 20 (14, 26)

20.6 (16, 24)

 OSA

17 (11, 22)‡

Stage 1 (%)†  Non-OSA

20 38

3 (2, 4) 5 (3, 7)

7 (4, 11)‡ 6 (3, 10)

4 (3, 7) 4 (3, 7)

5 (3, 8) 5 (2, 8)

4 (2, 7) 5 (2, 6)

 OSA

Stage 2 (%)†  Non-OSA

20 38

57 (42, 67) 60 (51, 70)

80 (72, 88)‡ 77 (69, 91)‡

65 (59, 78)‡ 70 (58, 78)‡

60 (50, 70) 61 (47, 69)

53 (49, 59) 62 (53, 71)

 OSA

Slow-wave sleep (%)†  Non-OSA 20

15 (10, 26) 11 (4, 20)

2 (0, 14)‡ 1 (0, 11)‡

10 (2, 18)‡ 10 (4, 20)

16 (5, 22) 14 (5, 27)

21 (11, 26) 15 (9, 19)

 OSA

38

* Data presented as mean ± SD. † Data presented as median (25th, 75th percentile). ‡ Adjusted P < 0.05 vs. preoperative night. § Adjusted P < 0.05 for OSA vs. non-OSA on the same night. Non-OSA = patients without obstructive sleep apnea; OSA = patients with obstructive sleep apnea; REM = rapid eye movement.

was found between patients with or without oxygen therapy, 0.3 (0, 6.0) events per hour versus 1.8 (0, 3.4) events per hour ( P = 0.908). Compared with OSA patients without oxygen therapy, OSA patients with oxygen therapy had a lower AHI (13.9 [2.9, 37.9] events per hour vs. 29.5 [13.0, 43.4] events per hour) and hypopnea index (11.1 [2.2, 24.4] events per hour vs. 19.8 [14.0, 44.5] events per hour) on postoperative N1. How- ever, the difference was not statistically significant ( P = 0.201 and P = 0.394, respectively). In both OSA and non-OSA patients, no statistically significant differ- ence in REM AHI, AHI during non-REM sleep, central

apnea index, obstructive apnea index, and hypopnea index was found between patients with and without oxy- gen therapy. The patients receiving oxygen therapy had significantly decreased REM sleep in both OSA and non-OSA patients; 0% (0, 8.2) versus 10.9% (1.4, 18.3); P = 0.048 in OSA patients; and 0% (0, 3.9) versus 10.6% (7.0, 18.0); P = 0.005 in non-OSA patients. Discussion To date, this is the first comprehensive data collection in postoperative change of sleep-breathing disorders and sleep architecture up to postoperative night 7 (N7) in patients with

Fig. 4. Perioperative change in sleep architecture in all patients ( A ) and obstructive sleep apnea (OSA) versus non-OSA patients ( B ). The vertical lines represent the interquartile range and the points in middle represent median. *Adjusted P < 0.05 versus preoperative measurement; + adjusted P < 0.05 versus same parameter in non-OSA on same night. REM = rapid eye movement.

Chung et al.

Anesthesiology 2014; 120:287-98

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