Outcomes of coronary artery bypass grafting (CABG) in patients with OSA-COPD overlap syndrome versus COPD alone: an...

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are known risk factors for adverse outcomes after coronary artery bypass grafting (CABG).
• The co-occurrence of OSA and COPD (OSA-COPD overlap) may present unique challenges in the perioperative setting.
• Understanding the specific risks associated with OSA-COPD overlap post-CABG is crucial for optimizing patient care.

Purpose of the Study:

• To compare in-hospital outcomes between patients with OSA-COPD overlap and those with COPD alone following elective CABG.
• To identify specific postoperative complications and mortality risks associated with OSA-COPD overlap.

Main Methods:

• Retrospective analysis of adult patients (≥18 years) who underwent elective CABG between 2005 and 2018 from the US Nationwide Inpatient Sample (NIS).
• Patients were categorized into two groups: OSA-COPD overlap and COPD alone.
• Propensity score matching (PSM) was used to control for confounding variables, followed by logistic and linear regression analyses to assess outcomes.

Main Results:

• After PSM, 2,439 patients with OSA-COPD overlap and 9,756 with COPD alone were analyzed.
• OSA-COPD overlap was significantly associated with increased risks of overall postoperative complications (aOR=1.12), respiratory failure/prolonged mechanical ventilation (aOR=1.27), acute kidney injury (AKI) (aOR=1.14), and non-routine discharge (aOR=1.16).
• Conversely, OSA-COPD overlap was linked to a lower risk of in-hospital mortality (aOR=0.53). No significant difference in pneumonia or postoperative atrial fibrillation (AF) risk was observed.

Conclusions:

• In US adults undergoing CABG, OSA-COPD overlap is associated with elevated risks of non-routine discharge, AKI, and respiratory failure/prolonged mechanical ventilation compared to COPD alone.
• Despite increased complication risks, OSA-COPD overlap demonstrated a protective effect against in-hospital mortality post-CABG.
• The findings highlight the need for targeted perioperative management strategies for patients with OSA-COPD overlap undergoing CABG.