Association of obstructive sleep apnea and postoperative cardiac complications: A systematic review and meta-analysis with trial sequential analysis

Abstract

The repetitive hypoxic and hypercapnia events of obstructive sleep apnea (OSA) are believed to adversely affect cardiopulmonary function, which make them vulnerable to a higher incidence of postoperative complications. The primary aim of this systematic review and meta-analysis was to examine the association of OSA and the composite endpoints of postoperative cardiac or cerebrovascular complications in adult undergoing non-cardiac surgery. MEDLINE, EMBASE and CENTRAL were systematically searched from its inception until May 2019. All observational studies were included. Twenty-two studies (n=3,033,814; 184,968 OSA vs 2,848,846 non-OSA) were included for quantitative meta-analysis. In non-cardiac surgery, OSA was significantly associated with a higher incidence of the composite endpoints of postoperative cardiac or cerebrovascular complications (odd ratio: 1.44, 95%CI: 1.17 to 1.78, ρ=0.007, trial sequential analysis=conclusive; certainty of evidence=very low). In comparison to non-OSA, OSA patients were reported to have nearly 2.5-fold risk of developing pulmonary complications (odd ratio: 2.52, 95%CI: 1.92 to 3.31, ρ<0.001, certainty of evidence=very low), postoperative delirium (odd ratio: 2.45, 95%CI: 1.50 to 4.01, ρ<0.001, certainty of evidence=low) and acute kidney injury (odd ratio: 2.41, 95%CI: 1.93 to 3.02, ρ<0.001, certainty of evidence=very low). This meta-analysis of 22 comparative studies demonstrated that OSA is a potential risk factor to postoperative adverse complications in adults undergoing non-cardiac surgery. However, the conclusions need to be interpreted with caution due to the nature of included observational studies with significant heterogeneity and low quality of evidence. CRD42019136564.