Related Experiment Videos
Symptomless Multi-Variable Apnea Prediction Index Assesses Obstructive Sleep Apnea Risk and Adverse Outcomes in
M Melanie Lyons1, Brendan T Keenan1, Junxin Li1
1Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA.
Study Objective:
To validate that the symptomless Multi-Variable Apnea Prediction index (sMVAP) is associated with Obstructive Sleep Apnea (OSA) diagnosis and assess the relationship between sMVAP and adverse outcomes in patients having elective surgery. We also compare associations between Bariatric surgery, where preoperative screening for OSA risk is mandatory, and non-Bariatric surgery groups who are not screened routinely for OSA.
Methods:
Using data from 40 432 elective inpatient surgeries, we used logistic regression to determine the relationship between sMVAP and previous OSA, current hypertension, and postoperative complications: extended length of stay (ELOS), intensive-care-unit-stay (ICU-stay), and respiratory complications (pulmonary embolism, acute respiratory distress syndrome, and/or aspiration pneumonia).
Results:
Higher sMVAP was associated with increased likelihood of previous OSA, hypertension and all postoperative complications (p < .0001). The top sMVAP quintile had increased odds of postoperative complications compared to the bottom quintile. For ELOS, ICU-stay, and respiratory complications, respective odds ratios (95% CI) were: 1.83 (1.62, 2.07), 1.44 (1.32, 1.58), and 1.85 (1.37, 2.49). Compared against age-, gender- and BMI-matched patients having Bariatric surgery, sMVAP was more strongly associated with postoperative complications in non-Bariatric surgical groups, including: (1) ELOS (Orthopedics [p < .0001], Gastrointestinal [p = .024], Neurosurgery [p = .016], Spine [p = .016]); (2) ICU-stay (Orthopedics [p = .0004], Gastrointestinal [p < .0001], and Otorhinolaryngology [p = .0102]); and (3) respiratory complications (Orthopedics [p =.037] and Otorhinolaryngology [p =.011]).
Conclusions:
OSA risk measured by sMVAP correlates with higher risk for select postoperative complications. Associations are stronger for non-Bariatric surgeries, where preoperative screening for OSA is not routinely performed. Thus, preoperative screening may reduce OSA-related risk for adverse postoperative outcomes.
Insights
The symptomless Multi-Variable Apnea Prediction index (sMVAP) effectively predicts Obstructive Sleep Apnea (OSA) and associated postoperative complications. Screening for OSA risk before non-Bariatric surgeries may improve patient outcomes.
Area of Science:
- Anesthesiology
- Sleep Medicine
- Surgical Outcomes Research
Background:
- Obstructive Sleep Apnea (OSA) is a common condition often undiagnosed before surgery.
- The symptomless Multi-Variable Apnea Prediction index (sMVAP) has emerged as a potential tool for assessing OSA risk.
- Preoperative OSA screening is mandatory for Bariatric surgery but not routinely performed for other elective procedures.
Purpose of the Study:
- To validate the association between sMVAP and OSA diagnosis.
- To assess the relationship between sMVAP and adverse postoperative outcomes in elective surgery patients.
- To compare the association of sMVAP with complications in Bariatric versus non-Bariatric surgical groups.
Main Methods:
- Analysis of data from 40,432 elective inpatient surgeries.
- Logistic regression was used to determine relationships between sMVAP and OSA, hypertension, and postoperative complications.
- Postoperative complications included extended length of stay (ELOS), intensive-care-unit-stay (ICU-stay), and respiratory complications.
Main Results:
- Higher sMVAP scores correlated with increased likelihood of prior OSA, hypertension, and all analyzed postoperative complications (p < .0001).
- The highest sMVAP quintile showed significantly increased odds of postoperative complications compared to the lowest quintile.
- Associations between sMVAP and complications were stronger in non-Bariatric surgeries compared to Bariatric surgeries.
Conclusions:
- sMVAP is a valid indicator of OSA risk and correlates with increased risk of specific postoperative complications.
- The stronger association in non-Bariatric surgeries suggests a potential benefit from routine preoperative OSA screening in these patient populations.
- Implementing preoperative OSA screening may mitigate the risk of adverse postoperative outcomes.