The clinical effectiveness of preoperative screening and post-screening interventions for obstructive sleep apnea: A systematic review and meta-analysis.

OBJECTIVES

The objective of this systematic review and meta-analysis is to evaluate the clinical utility of preoperative screening for obstructive sleep apnea (OSA) and determine the impact of targeted interventions on reducing postoperative adverse outcomes in surgical patients identified as high risk of OSA (HR-OSA).

METHODS

A comprehensive literature search was conducted across multiple databases for studies evaluating the utilization of validated OSA screening tools and OSA interventions within the surgical setting. Primary outcomes included postoperative adverse respiratory and cardiac events, delirium, length of stay (LOS), intensive care unit (ICU) admissions, 30-day readmissions, and mortality. Interventions included continuous positive airway pressure (CPAP) or auto-titration positive airway pressure (APAP) use, sleep consultation, OSA safety protocols, wrist bands, and patient education. Certain studies used a combination of these interventions for HR-OSA patients.

RESULTS

Fifty-four studies (324,935 patients) were included. The odds of adverse postoperative respiratory complications (OR 3.59, 95 % CI: 1.73-7.43) and cardiac complications (OR 2.82, 95 % CI: 1.62-4.92) events were significantly higher, and hospital LOS was significantly longer (mean difference: 0.79 days, 95 % CI: 0.42-1.15) for HR-OSA patients than those at low risk of OSA (LR-OSA). The odds of delirium, ICU admission, and 30-day readmission were not significantly increased for HR-OSA patients. In contrast, for HR-OSA patients who received post-screening interventions such as safety protocols, education and other targeted interventions, no significant differences in respiratory complications (OR 0.86, 95 % CI: 0.56-1.31), delirium (OR 0.69, 95 % CI: 0.12-4.06), escalation of care (OR 0.86, 95 % CI: 0.62-1.18), or composite adverse events (OR 0.81, 95 % CI: 0.61-1.08) were found compared to OSA patients who received no intervention.

CONCLUSIONS

Our findings confirm HR-OSA as a risk factor for postoperative adverse events. Preoperative screening for OSA and subsequent targeted perioperative interventions and management strategies may contribute to a reduction in postoperative adverse outcomes. The current evidence regarding the efficacy of targeted interventions is limited by significant heterogeneity and sparsity of high-quality data and should be interpreted as exploratory.