Obstructive Sleep Apnea and Cognitive Impairment: Implications for Surgical Outcomes

Area of Science:

• Geriatric Medicine
• Sleep Medicine
• Neurology

Background:

• Obstructive sleep apnea (OSA) and cognitive impairment (CI) are prevalent in older adults.
• The combined impact of OSA and CI on perioperative outcomes remains understudied.
• Identifying patients with both conditions is critical for optimizing surgical care.

Purpose of the Study:

• To investigate the prevalence of coexisting OSA/high-risk OSA (HR-OSA) and CI in surgical patients aged 65 years and older.
• To compare perioperative outcomes between patients with and without CI within the OSA/HR-OSA group.
• To determine the association between coexisting OSA/HR-OSA and CI with 30-day postoperative complications.

Main Methods:

• A cohort of 655 surgical patients aged ≥65 years was assessed.
• OSA/HR-OSA risk was determined using the STOP or STOP-Bang questionnaires.
• Cognitive impairment (CI) was evaluated using the Montreal Cognitive Assessment (MoCA).

Main Results:

• 33.0% of patients had CI, and 57.6% had OSA/HR-OSA.
• 21% of patients had both OSA/HR-OSA and CI.
• Coexisting OSA/HR-OSA and CI were associated with a 2-fold increase in all-cause complications and an 80% increase in adverse composite outcomes at 30 days postoperatively.

Conclusions:

• Coexisting OSA/HR-OSA and CI is common in older surgical patients and significantly elevates the risk of adverse postoperative outcomes.
• Enhanced preoperative screening and multidisciplinary management strategies are essential for identifying and supporting vulnerable patients with both conditions.
• Further research is warranted to elucidate the mechanisms underlying these associations and to develop targeted interventions.