Short-Term Risk of Complications Related to Obstructive Sleep Apnea After Sinonasal Surgery

Surgical manipulation in the sinonasal cavity may transiently increase airflow resistance in patients with obstructive sleep apnea (OSA), predisposing them to inspiratory collapse of the oropharynx and/or hypopharynx. We hypothesized that patients with OSA undergoing sinonasal surgery would have higher rates of unplanned postoperative admission and respiratory complications than patients without OSA.

In this retrospective cohort study, patients ≥18 years undergoing sinonasal surgery were compared to patients having oropharyngeal, laryngeal, otologic, rotator cuff, and inguinal hernia surgery between January 2013 and December 2020. Cohorts were defined by the presence or absence of a preoperative diagnosis of OSA. All outcome variables were measured based on unique patient encounters for surgery; the total number of surgeries for the overall patient population (n=17,373) was greater than the total number of patients (n=11,951).

Study groups consisted of 4,575 sinonasal, 2,301 oropharyngeal, 1,231 laryngeal, 1,353 otologic, 434 rotator cuff, and 2,057 inguinal hernia surgical patients. Among patients undergoing sinonasal surgery, patients with OSA had more unplanned admissions than patients without OSA (risk ratio [RR] 3.12; 95% CI 2.07-4.70). In all surgery groups, postoperative supplemental oxygen therapy was required more often in patients with OSA. Patients with OSA had the greatest incidence of oxygen desaturation after oropharyngeal surgery (RR 1.95; 95% CI 1.34-2.85). Incidence of 30-day readmission did not differ between patients with and without OSA in any surgical group.

In this study, patients with OSA undergoing sinonasal surgery had a greater risk of unplanned hospital admission than patients without OSA, and patients with OSA undergoing oropharyngeal surgery had a greater risk of postoperative desaturation than patients without OSA. Patients with OSA undergoing any surgery had a greater incidence of supplemental oxygen requirement compared to patients without OSA.