Alexandra M Hogan1,2,3, Sammra Ibrahim4, Melanie J Moylan5,6, David J Mccormack7, Ann-Marie Openshaw4, Francesca Cormack8, Alex Shipolini4. 1. Department of Anesthetics, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, UK - a.hogan@ucl.ac.uk. 2. Barts Heart Centre, Barts Health NHS Trust, London, UK - a.hogan@ucl.ac.uk. 3. Cognitive Neurosciences and Neuropsychiatry, UCL Great Ormond Street Institute of Child Health, London, UK - a.hogan@ucl.ac.uk. 4. Barts Heart Centre, Barts Health NHS Trust, London, UK. 5. Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand. 6. School of Psychology, University of Western Australia, Perth, Australia. 7. Waikato Cardiothoracic Unit, Waikato Hospital, Waikato Institute of Surgical Education and Research, University of Auckland, Auckland, New Zealand. 8. Cambridge Cognition, Department of Psychiatry, University of Cambridge, Cambridge, UK.
Abstract
BACKGROUND: We aimed to study prospectively the nature and effect of sleep apnea-hypopnea syndrome (SAHS) in patients undergoing coronary artery bypass graft (CABG) surgery over five years of follow-up. METHODS: Patients undergoing CABG surgery (N.=145) were assessed longitudinally (baseline, 1 year, and 5 years post-surgery) using the 'STOP-BANG' screen of sleep apnea risk. Additionally, all patients had a preoperative multiple-channel sleep-study, providing acceptable data for an obstructive and central apnea, and desaturation index in 97 patients. RESULTS: Preoperatively, over half (63%) of patients obtained an apnea-hypopnea index score (combining apnea types) in the moderate-severe range for SAHS, and STOP-BANG threshold score (>3/8) was reached by most (95%) patients. Despite some improvement in 'STOP symptoms' at 1-year follow-up, most patients (98%) remained at risk of SAHS at 5 years post-surgery. There was an underlying and chronic relationship between STOP-BANG score and cardiac symptoms at both baseline and 5-year follow-up. Additionally, SAHS variables were associated with greater incidence of acute postoperative events, and generally with increased length of stay on the intensive care unit. CONCLUSIONS: We confirm that SAHS is common in CABG-surgery patients, presenting additional clinical challenges and cost implications. The underlying pathophysiology is complex, including upper airway obstruction and cardiorespiratory changes of heart failure. In patients presenting for CABG-surgery, we show chronic susceptibility to SAHS, likely associated with traditional risk factors e.g. obesity but perhaps also with gradual decline in heart function itself. Superimposed on this, there is potential for exacerbated risk of morbidity at the time of CABG surgery itself.
BACKGROUND: We aimed to study prospectively the nature and effect of sleep apnea-hypopnea syndrome (SAHS) in patients undergoing coronary artery bypass graft (CABG) surgery over five years of follow-up. METHODS:Patients undergoing CABG surgery (N.=145) were assessed longitudinally (baseline, 1 year, and 5 years post-surgery) using the 'STOP-BANG' screen of sleep apnea risk. Additionally, all patients had a preoperative multiple-channel sleep-study, providing acceptable data for an obstructive and central apnea, and desaturation index in 97 patients. RESULTS: Preoperatively, over half (63%) of patients obtained an apnea-hypopnea index score (combining apnea types) in the moderate-severe range for SAHS, and STOP-BANG threshold score (>3/8) was reached by most (95%) patients. Despite some improvement in 'STOP symptoms' at 1-year follow-up, most patients (98%) remained at risk of SAHS at 5 years post-surgery. There was an underlying and chronic relationship between STOP-BANG score and cardiac symptoms at both baseline and 5-year follow-up. Additionally, SAHS variables were associated with greater incidence of acute postoperative events, and generally with increased length of stay on the intensive care unit. CONCLUSIONS: We confirm that SAHS is common in CABG-surgery patients, presenting additional clinical challenges and cost implications. The underlying pathophysiology is complex, including upper airway obstruction and cardiorespiratory changes of heart failure. In patients presenting for CABG-surgery, we show chronic susceptibility to SAHS, likely associated with traditional risk factors e.g. obesity but perhaps also with gradual decline in heart function itself. Superimposed on this, there is potential for exacerbated risk of morbidity at the time of CABG surgery itself.
Authors: Jordy Mehawej; Jane S Saczynski; Catarina I Kiefe; Hawa O Abu; Mayra Tisminetzky; Weijia Wang; Benita A Bamgbade; Eric Ding; Darleen Lessard; Edith Mensah Otabil; Connor Saleeba; Robert J Goldberg; David D McManus Journal: J Clin Sleep Med Date: 2022-02-01 Impact factor: 4.324