Outcomes following total shoulder arthroplasty in patients with obstructive sleep apnea

Obstructive sleep apnea (OSA) is a known risk factor for various medical complications including cardiovascular disease, cognitive dysfunction, and respiratory failure. With global prevalence of OSA on the rise, understanding its impact on common orthopedic procedures has become increasingly important. Although the impact of OSA has been studied in patients undergoing total hip arthroplasty and cervicothoracic spinal surgery, its relationship with total shoulder arthroplasty (TSA) is still unclear. Therefore, the purpose of this study was to evaluate the relationship of complications following TSA in patients with OSA.

A retrospective cohort analysis using the TriNetX research platform was conducted on all patients with OSA undergoing an anatomic or reverse TSA. Patients were excluded if they had a history of revision TSA, hemiarthroplasty, chronic respiratory diseases, upper humerus fracture, a body mass index of less than 30, or were aged <18 years. Medical complications were assessed at 7, 30, and 90 days, whereas orthopedic complications were assessed at 2 and 5 years. Mortality was evaluated over a 5-year period using Kaplan-Meier analysis. Outcomes were compared using odds ratios, and a P value < .05 was considered significant.

Final analysis included 5636 patients in both the OSA and non-OSA in each cohort with 1:1 propensity score-based matching. Patients undergoing TSA with OSA were at higher risk of acute kidney injury (1.69% vs. 1.10%), pulmonary embolism (0.62% vs. 0.34%), pneumonia (0.89% vs. 0.46%), ischemic stroke (0.73% vs. 0.39%), respiratory failure (0.43% vs. 0.18%), emergency department visits (2.45% vs. 1.86%), and readmission rates (6.62% vs. 4.19%) at 7, 30, and 90 days postoperatively. Patients with OSA experienced higher rates of wound dehiscence (0.64% vs. 0.32%) and urinary tract infections (1.70% vs. 1.21%) at 30 and 90 days postoperatively. Finally, rates of deep vein thrombosis in the OSA cohort were only elevated at 90 days postoperatively (1.99% vs. 1.15%). All orthopedic outcomes and mortality rates were comparable between both cohorts throughout the 5 years.

The findings of this study suggest that patients with OSA may experience higher rates of medical complications in the short term, but no difference in orthopedic or mortality outcomes in the long term. Further research is warranted to explore how the severity of OSA influences complication rates after TSA and to identify preventative strategies that surgeons can implement to mitigate the adverse effects of OSA on postoperative outcomes.