The potential impact of positive airway pressure treatment for obstructive sleep apnea on postoperative complications: Analysis of a large cohort study in a health care delivery system

Objective To assess the impact of treating Obstructive Sleep Apnea (OSA) with positive airway pressure (PAP) on the risk of postoperative complications. Methods This is a retrospective cohort study of Kaiser Permanente Northern California patients aged 18-89 diagnosed with OSA who had surgery, for whom PAP adherence data are available, and whose postoperative course has been included in the National Surgical Quality Improvement Program (NSQIP) database. They were divided into PAP-adherent and PAP-non-adherent groups based on their PAP use as recorded by the machine. The patients who used PAP more than 4 h per night for 21 nights or more out of 30 consecutive nights following initiation of PAP therapy, measured up to 2 years before surgery, were considered PAP-adherent. The outcome is any complication reviewed and recorded in the NSQIP database, including death, return to OR, cardiopulmonary complications, and infections within 30 days of surgery. Unadjusted and adjusted analyses were performed to assess the association between PAP adherence and the complications. Results Data from a total of 2210 patients who underwent an NSQIP-reviewed surgery and for whom PAP adherence is available (39.4% adherent) met the criteria for inclusion. Postoperative complications occurred in 39 (4.5%) of the PAP-adherent and 97 (7.2%) of the non-adherent patients. PAP adherence was associated with a decreased risk of postoperative complications (unadjusted OR 0.63, 95% CI 0.47-0.86, p < 0.01; adjusted OR 0.61, 95% CI 0.44-0.84, p < 0.01). Conclusion In this retrospective analysis, PAP adherence among patients with OSA is associated with a reduced risk of postoperative complications.