Breathe poorly, recover worse? The impact of obstructive sleep apnea on cardiac surgery outcomes - an updated systematic review and meta-analysis.

PURPOSE: We aimed to perform a systematic review and meta-analysis of postoperative outcomes and the influence of obstructive sleep apnea (OSA) in patients undergoing cardiac surgery.

METHODS

We systematically searched PubMed, Embase, Scopus, Cochrane Library and Web of Science for eligible studies from inception to May 2025. We included randomized or nonrandomized interventional studies comparing patients with versus without OSA undergoing cardiac surgery. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. Statistical analysis was performed using RStudio 4.5.1. Heterogeneity was assessed with I2 statistics.

RESULTS

A total of 2,642 studies were screened, and 33 were fully reviewed. We included seventeen studies involving 67,565 patients. Major adverse cardiac and cerebrovascular events (RR: 1.66; 95% CI: 1.358–2.035; I² = 0.0%) was significantly increased in patients with OSA. The rates of all-cause mortality, myocardial ischemia, postoperative atrial fibrillation, acute renal failure, dialysis, pulmonary thromboembolism, tracheostomy, reintubation and bleeding were similar in both groups.

CONCLUSION

The presence of OSA in patients undergoing cardiac surgery is associated with a significantly higher risk of major adverse cardiac and cerebrovascular events. However, definitive conclusions are hampered by significant heterogeneity across studies, which is likely due to the inclusion of nonrandomized studies, which underscores the need for further high-quality research.