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Updated: Jan 13, 2026

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
New-onset obstructive sleep apnea and insomnia after total knee replacement in patients with osteoarthritis:
Shuo-Yan Gau1,2,3,4, Hsiang-En Tsai5, Hui-Chin Chang3,6,7
1Department and Graduate Institute of Business Administration, National Taiwan University, Taipei, Taiwan.
Background:
Total knee replacement (TKR) is the primary treatment for advanced osteoarthritis, but its impact on postoperative sleep disorders remains unclear. This study investigates the association between TKR and new-onset obstructive sleep apnea (OSA) and insomnia.
Method:
A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Adults (⩾18 years) diagnosed with osteoarthritis who underwent TKR were propensity-matched 1:1 to non-TKR controls based on demographics, comorbidities, and medication use. The primary outcomes were new-onset OSA and insomnia, assessed using Cox proportional hazard models with hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity and stratification analyses were performed to validate findings.
Results:
TKR patients had a significantly higher risk of OSA (HR: 1.71, 95% CI: 1.50-1.95 at 1 year; HR: 1.36, 95% CI: 1.28-1.44 at 5 years) and insomnia (HR: 1.55, 95% CI: 1.32-1.82 at 1 year; HR: 1.22, 95% CI: 1.13-1.31 at 5 years). Sensitivity analyses confirmed robustness across different propensity-matching methods and washout periods. Stratification showed higher risks in older adults (⩾65 years: HR: 1.40 for OSA, 1.32 for insomnia) and females (HR: 1.49 for OSA, 1.27 for insomnia).
Conclusion:
TKR increases the long-term risk of OSA and insomnia, particularly in older and female patients. Clinicians were recommended to monitor postoperative sleep health to improve recovery outcomes.
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