Letter to the Editor
Obstructive sleep apnea prevalence and adverse respiratory events in surgical patients
Prevalência de apneia obstrutiva do sono e eventos respiratórios adversos em pacientes submetidos a cirurgia
R. Reis
Corresponding author
Pneumonology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
A. Antunes
Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Reis" "autores" => array:1 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Reis" "email" => array:1 [ 0 => "ricardomcreis@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pneumonology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] 1 => array:3 [ "autoresLista" => "A. Antunes" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Antunes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Prevalência de apneia obstrutiva do sono e eventos respiratórios adversos em pacientes submetidos a cirurgia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the article “Patients with a high risk for obstructive sleep apnea syndrome: Postoperative respiratory complications” by Pereira et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the authors aim to evaluate the incidence of STOP-BANG score<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3, in surgical patients admitted to the Post-Anesthesia Care Unit. It is rather alarming that the reported prevalence of patients with characteristics suggestive of obstructive sleep apnea (OSA) as evaluated by the STOP-BANG questionnaire was 52% (177 from 340). This number suggests that the majority of patients in the surgical population have undiagnosed OSA; however, it is unfortunate that in this study there was no polysomnography analysis of the patients and so, there was no confirmation of this estimated prevalence. If, however, we report to the study done by Chung et al.,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> author of the STOP and STOP-BANG questionnaires,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which was also with a surgical population, we see that the reported percentage of patients with STOP-BANG<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3 is of 57.5% (429 from 746), which is close to the number from the study by Pereira et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, in the study by Chung et al.,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> these patients were analyzed with polysomnography and 75.3% of the group with SOTP-BANG score >3 were confirmed to have OSA (43.3% from the total of 746). If we accept that both of these surgical populations, from the study of Pereira et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the study of Chung et al.,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> are similar, we can infer that the prevalence of undiagnosed OSA in patients with STOP-BANG<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3 in the Pereira et al. study is 39% (177<span class="elsevierStyleHsp" style=""></span>*<span class="elsevierStyleHsp" style=""></span>0.75/340), somewhat lower than the reported estimated prevalence of 52%.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is interesting to note that the authors also conclude that these patients with High Risk OSA (HR-OSA) have a higher incidence of postoperative respiratory complications and that mild/moderate hypoxia was the most frequent adverse respiratory event (ARE) to occur in these patients. If we analyze the reported ARE it seems that, HR-OSA patients were not associated with overall statistically significant higher number of ARE (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.140). Also, out of the 6 defined types of ARE, only the previously mentioned mild/moderate hypoxia (the definition of which is included in the methods section) was statistically more frequent in this HR-OSA group. It is also noteworthy that the HR-OSA population had a statistically significant greater ASA score, more frequent neuromuscular residual blocking, high-risk surgery and major surgery and, as we can see in Table 3 of the article, out of the 8 analyzed “predictors of adverse respiratory events” only HR-OSA was not a statistically significant predictor, contrary to others, such as: gender, intra-abdominal surgery, high risk surgery, major surgery, use of neuromuscular blocking drugs and residual neuromuscular blockade (and the latter was the only independent risk factor for ARE).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion, this study exposes a high percentage of patients with probable undiagnosed OSA that would probably benefit from a polysomnography analysis. However, we feel this study has failed to show that surgical patients with a high risk of OSA, as determined by STOP-BANG score<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3, are associated with higher incidence of ARE in the postoperative period or, that HR-OSA is a predictor of these ARE. However, previous papers have shown that OSA itself is associated with a statistically significant higher incidence of respiratory complications,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> increased intensive care unit admissions,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and greater duration of hospital stay.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patients with a high risk for obstructive sleep apnea syndrome: postoperative respiratory complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 8 | 14 |
| 2024 October | 36 | 38 | 74 |
| 2024 September | 39 | 45 | 84 |
| 2024 August | 53 | 49 | 102 |
| 2024 July | 52 | 31 | 83 |
| 2024 June | 25 | 23 | 48 |
| 2024 May | 31 | 32 | 63 |
| 2024 April | 40 | 37 | 77 |
| 2024 March | 42 | 20 | 62 |
| 2024 February | 34 | 19 | 53 |
| 2024 January | 25 | 24 | 49 |
| 2023 December | 16 | 24 | 40 |
| 2023 November | 28 | 26 | 54 |
| 2023 October | 22 | 42 | 64 |
| 2023 September | 24 | 34 | 58 |
| 2023 August | 21 | 17 | 38 |
| 2023 July | 19 | 29 | 48 |
| 2023 June | 20 | 17 | 37 |
| 2023 May | 30 | 23 | 53 |
| 2023 April | 21 | 21 | 42 |
| 2023 March | 42 | 19 | 61 |
| 2023 February | 23 | 28 | 51 |
| 2023 January | 17 | 17 | 34 |
| 2022 December | 50 | 13 | 63 |
| 2022 November | 56 | 36 | 92 |
| 2022 October | 46 | 30 | 76 |
| 2022 September | 18 | 25 | 43 |
| 2022 August | 23 | 37 | 60 |
| 2022 July | 30 | 46 | 76 |
| 2022 June | 16 | 21 | 37 |
| 2022 May | 31 | 39 | 70 |
| 2022 April | 23 | 30 | 53 |
| 2022 March | 25 | 49 | 74 |
| 2022 February | 22 | 40 | 62 |
| 2022 January | 25 | 41 | 66 |
| 2021 December | 25 | 35 | 60 |
| 2021 November | 17 | 40 | 57 |
| 2021 October | 32 | 46 | 78 |
| 2021 September | 29 | 39 | 68 |
| 2021 August | 30 | 28 | 58 |
| 2021 July | 28 | 39 | 67 |
| 2021 June | 15 | 32 | 47 |
| 2021 May | 29 | 39 | 68 |
| 2021 April | 69 | 51 | 120 |
| 2021 March | 56 | 23 | 79 |
| 2021 February | 64 | 18 | 82 |
| 2021 January | 35 | 24 | 59 |
| 2020 December | 25 | 21 | 46 |
| 2020 November | 37 | 30 | 67 |
| 2020 October | 24 | 22 | 46 |
| 2020 September | 67 | 20 | 87 |
| 2020 August | 70 | 25 | 95 |
| 2020 July | 94 | 19 | 113 |
| 2020 June | 91 | 15 | 106 |
| 2020 May | 86 | 29 | 115 |
| 2020 April | 66 | 16 | 82 |
| 2020 March | 68 | 11 | 79 |
| 2020 February | 65 | 28 | 93 |
| 2020 January | 83 | 15 | 98 |
| 2019 December | 70 | 19 | 89 |
| 2019 November | 79 | 13 | 92 |
| 2019 October | 107 | 11 | 118 |
| 2019 September | 81 | 18 | 99 |
| 2019 August | 83 | 14 | 97 |
| 2019 July | 88 | 14 | 102 |
| 2019 June | 82 | 18 | 100 |
| 2019 May | 99 | 11 | 110 |
| 2019 April | 61 | 28 | 89 |
| 2019 March | 110 | 8 | 118 |
| 2019 February | 106 | 8 | 114 |
| 2019 January | 111 | 21 | 132 |
| 2018 December | 53 | 10 | 63 |
| 2018 November | 30 | 5 | 35 |
| 2018 October | 27 | 9 | 36 |
| 2018 September | 24 | 3 | 27 |
| 2018 August | 42 | 26 | 68 |
| 2018 July | 42 | 16 | 58 |
| 2018 June | 51 | 20 | 71 |
| 2018 May | 56 | 22 | 78 |
| 2018 April | 85 | 19 | 104 |
| 2018 March | 69 | 15 | 84 |
| 2018 February | 53 | 13 | 66 |
| 2018 January | 48 | 17 | 65 |
| 2017 December | 73 | 19 | 92 |
| 2017 November | 45 | 9 | 54 |
| 2017 October | 25 | 12 | 37 |
| 2017 September | 30 | 15 | 45 |
| 2017 August | 30 | 19 | 49 |
| 2017 July | 28 | 14 | 42 |
| 2017 June | 38 | 42 | 80 |
| 2017 May | 39 | 17 | 56 |
| 2017 April | 18 | 6 | 24 |
| 2017 March | 24 | 5 | 29 |
| 2017 February | 12 | 4 | 16 |
| 2017 January | 16 | 4 | 20 |
| 2016 December | 22 | 11 | 33 |
| 2016 November | 25 | 9 | 34 |
| 2016 October | 6 | 6 | 12 |
| 2016 September | 7 | 4 | 11 |
| 2016 August | 11 | 5 | 16 |
| 2016 July | 3 | 7 | 10 |
| 2016 May | 0 | 13 | 13 |
| 2016 April | 11 | 2 | 13 |
| 2016 March | 26 | 14 | 40 |
| 2016 February | 38 | 25 | 63 |
| 2016 January | 27 | 18 | 45 |
| 2015 December | 32 | 16 | 48 |
| 2015 November | 20 | 15 | 35 |
| 2015 October | 16 | 13 | 29 |
| 2015 September | 24 | 17 | 41 |
| 2015 August | 27 | 11 | 38 |
| 2015 July | 29 | 9 | 38 |
| 2015 June | 10 | 3 | 13 |
| 2015 May | 28 | 5 | 33 |
| 2015 April | 26 | 14 | 40 |
| 2015 March | 24 | 15 | 39 |
| 2015 February | 21 | 5 | 26 |
| 2015 January | 20 | 9 | 29 |
| 2014 December | 29 | 14 | 43 |
| 2014 November | 32 | 15 | 47 |
| 2014 October | 28 | 15 | 43 |
| 2014 September | 22 | 25 | 47 |
| 2014 August | 18 | 14 | 32 |
| 2014 July | 35 | 10 | 45 |
| 2014 June | 34 | 12 | 46 |
| 2014 May | 35 | 13 | 48 |
| 2014 April | 46 | 24 | 70 |
| 2014 March | 73 | 34 | 107 |
| 2014 February | 58 | 40 | 98 |
| 2014 January | 74 | 32 | 106 |
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