The correlation between obstructive sleep apnea-hypopnea syndrome and postoperative distal expansion of type A aortic dissection.

BACKGROUND

Distal expansion of type A aortic dissection is a severe complication following surgical intervention. Understanding the predictive factors of this condition can inform clinical practice and improve patient outcomes.

METHODS

This retrospective cohort study included 450 patients who underwent surgery for Stanford type A aortic dissection at our hospital between December 1, 2021, and December 31, 2023. Patients were divided into expansion (n = 152) and non-expansion (n = 298) groups based on the occurrence of postoperative distal aortic expansion, defined as a distal aortic diameter >40 mm or an annual growth rate >5 mm/year. Data collected included demographic information, comorbidities, preoperative sleep status, intraoperative parameters, and postoperative examination results. The normality of continuous variables was assessed using the Shapiro-Wilk test. Normally distributed continuous variables were compared using independent t-tests and presented as mean ± standard deviation, whereas non-normally distributed variables were analyzed with Mann-Whitney U tests and presented as median (interquartile range). Categorical variables were compared using χ2 tests. Spearman correlation and logistic regression analyses with Firth's correction were used to assess associations between variables and distal aortic expansion.

RESULTS

Significant differences between groups were noted in preoperative sleep status and intraoperative parameters. Patients in the expansion group had higher severity of snoring (6.57 ± 2.9 vs 3.63 ± 1.23; P < .001) and a higher prevalence of sleep apnea syndrome (80.26% vs 3.02%; P < .001). Intraoperative endoleak requiring proximal stent placement was more frequent in the expansion group (14.47% vs 7.38%; P = .026). Multifactor logistic regression with Firth's correction identified the presence of sleep apnea syndrome (coefficient = 2.392; P = .006; odds ratio [OR], 10.939; 95% confidence interval [CI], 2.897-41.325) as a significant predictor of postoperative distal expansion. When categorized by severity, both moderate to severe Apnea-Hypopnea Index (≥15 events/hour) (OR, 2.83; 95% CI, 1.46-5.49; P = .002) and severe Apnea Index (≥10 events/hour) (OR, 3.12; 95% CI, 1.58-6.17; P < .001) were significant independent predictors of distal expansion.

CONCLUSIONS

The presence and severity of sleep apnea syndrome, particularly indicated by the Apnea-Hypopnea Index, are significant predictors of postoperative distal type A aortic dissection expansion. These findings suggest that preoperative screening for sleep apnea may be essential in risk stratification and management of patients undergoing surgery for aortic dissection.