The correlation between obstructive sleep apnea-hypopnea syndrome and postoperative distal expansion of Type A aortic dissection.

Abstract

Background: Distal expansion of Type A aortic dissection is a severe complication following surgical intervention. Understanding the predictive factors of this condition can inform clinical practice and improve patient outcomes.

Methods: This retrospective cohort study included 450 patients who underwent surgery for Stanford Type A aortic dissection at our hospital between 1 December 2021 and 31 December 2023. Patients were divided into expansion (n = 152) and non-expansion (n = 298) groups based on the occurrence of postoperative distal aortic expansion, defined as a distal aortic diameter >40 mm or an annual growth rate >5 mm/year. Data collected included demographic information, comorbidities, preoperative sleep status, intraoperative parameters, and postoperative examination results. The normality of continuous variables was assessed using the Shapiro-Wilk test. Normally distributed continuous variables were compared using independent t-tests and presented as mean ± standard deviation, while non-normally distributed variables were analyzed with Mann-Whitney U tests and presented as median (interquartile range). Categorical variables were compared using chi-square tests. Spearman correlation and logistic regression analyses with Firth's correction were used to assess associations between variables and distal aortic expansion.

Results: Significant differences between groups were noted in preoperative sleep status and intraoperative parameters. Patients in the expansion group had higher severity of snoring (6.57 ± 2.9 vs 3.63 ± 1.23, P < 0.001) and a higher prevalence of sleep apnea syndrome (80.26% vs 3.02%, P < 0.001). Intraoperative endoleak requiring proximal stent placement was more frequent in the expansion group (14.47% vs 7.38%, P = 0.026). Multifactor logistic regression with Firth's correction identified the presence of sleep apnea syndrome (coefficient = 2.392, P = 0.006, OR = 10.939, 95% CI: 2.897-41.325) as a significant predictor of postoperative distal expansion. When categorized by severity, both moderate-to-severe AHI (≥15 events/hour) (OR = 2.83, 95% CI: 1.46-5.49, P = 0.002) and severe AI (≥10 events/hour) (OR = 3.12, 95% CI: 1.58-6.17, P < 0.001) were significant independent predictors of distal expansion.

Conclusion: The presence and severity of sleep apnea syndrome, particularly indicated by the apnea-hypopnea index, are significant predictors of postoperative distal Type A aortic dissection expansion. These findings suggest that preoperative screening for sleep apnea may be essential in risk stratification and management of patients undergoing surgery for aortic dissection.