Temporal link between cardiac arrhythmias and postoperative episodes of hypoxemia during nocturnal sleep in patients with obstructive sleep apnea syndrome

Objective

Obstructive Sleep Apnea (OSA) is known to impact morbidity in the perioperative period through a postoperative exacerbation of respiratory events after general anesthesia. Cardiac arrhythmias may be triggered by respiratory and/or hypoxic events, therefore we searched for a temporal link between cardiac arrhythmias and episodes of hypoxemia following surgery under general anesthesia during the nocturnal sleep phase.

Methods

We included patients with a preoperative STOP-BANG questionnaire score between 3 and 8, planned for an elective surgery with general anesthesia. Patients had a preoperative sleep study (N0) and two postoperative sleep studies on the first (N1) and third (N3) night after surgery. Patients with mild-to-moderate OSA (apnea/hypopnea index (AHI) between 15 and 30) were compared to patients with an AHI <15 (nil-mild OSA group). Analysis was conducted to detect concomitant hypoxic episodes and cardiac arrhythmias as defined by auricular or ventricular premature complexes, ventricular or supraventricular arrhythmias.

Main results

39 patients comprised the moderate-OSA group and 12 patients the nil-mild OSA group. In the whole cohort, the incidence of cardiac arrhythmias associated with hypoxic episodes was increased at N3 compared to N0 (median: 1 event per hour of recorded time [IQR: 0; 4] vs 0 [0; 2], p = 0.04). We observed this in the OSA group compared to the nil-mild OSA group (1 [0; 4] vs 1 [0; 2], respectively; p = 0.02).

Conclusion

This study indicates that more cardiac arrhythmias associated with hypoxemic episodes can be observed in the postoperative night, in patients with moderate OSA. This reinforces the importance of preoperative screening for OSA.

Clinical trial registry

NCT02833662.