Document Detail


Does autotitrating positive airway pressure therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome? A randomized controlled clinical trial.
MedLine Citation:
PMID:  23287823     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Obstructive sleep apnea has been associated with postoperative complications. We hypothesized that postoperative autotitrating positive airway pressure (APAP) applied to patients at high risk for obstructive sleep apnea would shorten hospital stay and reduce postoperative complications.
METHODS: Included were patients aged 18 to 100 years scheduled for elective total knee or hip arthroplasty who were able to give informed consent. Patients without contraindication to positive airway pressure therapy were divided into a high- or low-risk group on the basis of the Flemons sleep apnea clinical score. Low-risk patients received standard care. High-risk patients were randomized to receive standard care or standard care plus postoperative APAP. All patients were administered a predismissal cardiorespiratory sleep study. The primary end point was length of stay, and secondary end points were a range of postoperative complications.
RESULTS: One hundred thirty-eight patients were enrolled in the study (52 in the low-risk group, 86 in the high-risk group). Within the high-risk group, 43 were randomized to standard care and 43 to standard care plus postoperative APAP. There were no significant differences in the length of stay (P=.65) or any of the secondary end points between the randomized groups. On subgroup analysis of patients with an apnea-hypopnea index of ≥15, patients randomized to APAP had a longer postoperative stay (median, 5 vs 4 days; P=.02).
CONCLUSIONS: The role for empirical postoperative APAP requires further study, but the findings did not show benefit for APAP applied postoperatively to positive airway pressure-naive patients at high risk for sleep apnea.
Authors:
Susan M O'Gorman; Peter C Gay; Timothy I Morgenthaler
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Chest     Volume:  144     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-07-24     Completed Date:  2013-09-30     Revised Date:  2014-04-30    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  72-8     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Humans
Incidence
Length of Stay
Middle Aged
Positive-Pressure Respiration / methods*
Postoperative Complications / epidemiology*,  prevention & control*
Postoperative Period
Respiratory Therapy / methods*
Risk Factors
Sleep Apnea, Obstructive / epidemiology*,  prevention & control*
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
UL1 TR000135/TR/NCATS NIH HHS
Comments/Corrections
Comment In:
Chest. 2013 Dec;144(6):1973   [PMID:  24297137 ]
Chest. 2013 Dec;144(6):1972-3   [PMID:  24297136 ]
Chest. 2013 Jul;144(1):5-7   [PMID:  23880670 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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