Presentation Details
| Cognitive Vulnerability in Obstructive Sleep Apnea and Implications for Surgical Outcomes Yasmin Alhamdah1, 2, 3, Ellene Yan1, 2, 3, 4, Paras Kapoor1, 2, 3, Aparna Saripella1, Nina Butris1, 2, 3, Frances Chung1, 2, 3. 1Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.2Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.3Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.4Postgraduate PhD program, Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada |
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent upper airway collapse that is associated with various postoperative outcomes such as prolonged hospitalization and readmission. Beyond airway concerns, OSA has been associated with cognitive impairment (CI), a condition particularly concerning in older surgical patients. While the link between OSA and CI has been established, their implications on adverse outcomes are not well understood. Our study aims to clarify how coexisting OSA and CI influence postoperative outcomes in older surgical patients.
METHODS: This post-hoc analysis included 655 non-cardiac surgical participants aged ≥65 from the Postoperative Functional Disability in Unrecognized Cognitive Impairment (POF) and Detection of Cognitive Impairment (Detect-CI) studies. Preoperative diagnosed OSA was determined via electronic medical records, and risk was assessed with STOP or STOP-Bang questionnaires (high risk defined as STOP ≥2 or STOP-Bang ≥3). Participants were categorized as diagnosed/high-risk OSA (OSA/HR-OSA) or no diagnosis/low-risk (No-OSA/LR-OSA). CI was assessed with the in-person Montreal Cognitive Assessment (MOCA) or telephone MOCA (T-MoCA). Clinical outcomes were collected within 30 and 90 days postoperatively using chart review and interviews with participants/family members.
RESULTS: Of 655 participants, 377 (57.6%) had OSA/HR-OSA, 216 (33.0%) had CI and 137 (20.9%) had coexisting OSA/HR-OSA and CI (Table 1). More participants in the OSA/HR-OSA group had CI versus the No-OSA/LR-OSA group (36.3% vs. 28.4%, P = 0.041). Participants with coexisting OSA/HR-OSA and CI had 2-fold higher odds of 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 OSA/HR-OSA and No-CI participants, after adjustment for covariates (Table 2).
CONCLUSIONS: Coexisting OSA and CI was common at 21% and associated with 30-day adverse outcomes. Our findings highlight the importance of preoperative screening to identify and stratify high-risk patients for targeted interventions.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: This post-hoc analysis included 655 non-cardiac surgical participants aged ≥65 from the Postoperative Functional Disability in Unrecognized Cognitive Impairment (POF) and Detection of Cognitive Impairment (Detect-CI) studies. Preoperative diagnosed OSA was determined via electronic medical records, and risk was assessed with STOP or STOP-Bang questionnaires (high risk defined as STOP ≥2 or STOP-Bang ≥3). Participants were categorized as diagnosed/high-risk OSA (OSA/HR-OSA) or no diagnosis/low-risk (No-OSA/LR-OSA). CI was assessed with the in-person Montreal Cognitive Assessment (MOCA) or telephone MOCA (T-MoCA). Clinical outcomes were collected within 30 and 90 days postoperatively using chart review and interviews with participants/family members.
RESULTS: Of 655 participants, 377 (57.6%) had OSA/HR-OSA, 216 (33.0%) had CI and 137 (20.9%) had coexisting OSA/HR-OSA and CI (Table 1). More participants in the OSA/HR-OSA group had CI versus the No-OSA/LR-OSA group (36.3% vs. 28.4%, P = 0.041). Participants with coexisting OSA/HR-OSA and CI had 2-fold higher odds of 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 OSA/HR-OSA and No-CI participants, after adjustment for covariates (Table 2).
CONCLUSIONS: Coexisting OSA and CI was common at 21% and associated with 30-day adverse outcomes. Our findings highlight the importance of preoperative screening to identify and stratify high-risk patients for targeted interventions.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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