Preoperative CPAP in OSA patients decrease opioid use and pain in the postoperative setting
Aljasmi M, Agarwal K, Uppalapati S, Mordis C, Bazan L, Roehrs T. Preoperative CPAP in OSA patients decrease opioid use and pain in the postoperative setting. Critical Care Medicine 2015; 43(12):184.
Critical Care Medicine
Learning Objectives: Over half of the patients with Obstructive Sleep Apnea (OSA) who present for surgery are undiagnosed and untreated. Patients with OSA are increased anesthesia risk with adverse events including airway challenges, respiratory complications, postoperative cardiac events and ICU transfer. Our aim was to determine whether identifying and treating patients with OSA reduces pain and opioid requirement during their post-operative stay. Methods: We performed a retrospective chart review of 103 patients that underwent inpatient elective surgery at Henry Ford Hospital, who had a STOPBANG score of 6 or greater (signifying higher risk for OSA). Patients with New York Heart Association III-IV heart failure, severe chronic obstructive pulmonary disease, neuromuscular disease, and drug or alcohol abuse were excluded. The primary endpoint of the study was morphine use and pain scores during the first two days post-operatively. Two tailed t test statistical analysis was performed. Results: Fifty patients were diagnosed with OSA and treated with Continuous Positive Airway Pressure (CPAP) and were included in the treatment group and 53 patients not on CPAP therapy were included in the non-treatment group. The two groups were similar in regards to race, ethnicity, co-morbid conditions, STOP-BANG score, age, ASA score, surgery risk category, and BMI. Combined postoperative days one and two revealed significantly lower pain scores (3.34, p-value=0.02) and morphine use (111.86 mg, p-value=0.02) in the treatment group compared to the non-treatment group (pain score 4.78; morphine use 360.08 mg), with the effect stronger on postoperative day 2 than postoperative day 1.Conclusions: Our findings suggest that patients with OSA that are treated with CPAP demonstrate a reduction in morphine use and pain. This stresses the importance of early diagnosis and treatment of OSA prior to scheduled elective surgery.