Obstructive Sleep Apnea and Cognitive Impairment: Implications for Surgical Outcomes

The influence of coexisting obstructive sleep apnea (OSA) and cognitive impairment (CI) on perioperative outcomes is unclear, despite its potential clinical significance. We aimed to compare clinical outcomes between surgical patients with OSA or high risk OSA (OSA/HR-OSA) who have CI and those without CI. We assessed 655 surgical patients aged ≥ 65 years. All participants completed the STOP or STOP-Bang questionnaires to assess for risk of OSA and were classified as OSA/HR-OSA or No-OSA/LR-OSA. To assess for probable CI, participants completed the in-person or telephone Montreal Cognitive Assessment (MoCA) and were classified as CI or No-CI. Among 655 participants, 377 (57.6%) had OSA/HR-OSA and 216 (33.0%) had CI. Twenty-one percent (137/655) presented with coexisting OSA/HR-OSA and CI. More participants in the OSA/HR-OSA group had CI compared to the No-OSA/LR-OSA group (36.3% vs. 28.4%, p = 0.041). After adjustment, each additional year of education was associated with a 12% decrease in the odds of CI among participants with OSA/HR-OSA (p < 0.001). Participants with coexisting OSA/HR-OSA and CI had about 2-fold higher odds for all-cause complications (OR: 2.01, 95% CI: 1.29, 3.13, p = 0.002) and 80% higher adverse composite outcomes (OR: 1.79, 95% CI: 1.16, 2.79, p = 0.009) at 30 days postoperatively than those with OSA/HR-OSA and No-CI, after adjustment for covariates. In conclusion, coexisting OSA/HR-OSA and CI was common at 21% and associated with increased 30-day all-cause complications and composite outcomes. These findings emphasise the need for enhanced preoperative screening and multidisciplinary strategies to identify and manage such vulnerable patients.