Post‑operative sleep‑disordered breathing with different anesthesia techniques: an observational study

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Authors: L. Růžek ^1,2,3; L. Tušinovská ¹; V. Hándlová ³; M. Jelínek ¹; T. Tomáš ⁴; V. Šrámek ^1,3; O. Ludka ^2,3; L. J. Olson ⁵; I. Čundrle ml. ^1,2,3
Authors‘ workplace: Anesteziologicko resuscitační klinika, Fakultní nemocnice u sv. Anny v Brně ¹; Mezinárodní centrum klinického výzkumu, Fakultní nemocnice u sv. Anny v Brně ²; Lékařská fakulta Masarykovy Univerzity, Brno ³; 1. ortopedická klinika, Fakultní nemocnice u sv. Anny v Brně ⁴; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA ⁵
Published in: Anest. intenziv. Med., 32, 2021, č. 4-5, s. 204-210
Category: Původní článek

Overview

Objective: It has been suggested that regional anesthesia may prevent post‑operative exacerbation of obstructive sleep apnea. However, clinical evidence is lacking. We have hypothesized that post‑operative exacerbation of sleep‑disordered breathing is related to the anesthetic technique.
Design: Prospective observational study.
Setting: Orthopedic intensive care unit.
Material and methods: The inclusion criterion was orthopedic surgery requiring anesthesia. Multichannel polygraphy sleep studies were performed one night before and four consecutive nights after surgery. The Kruskal–Wallis test and Friedman’s ANOVA were used.
Results: Thirty‑five patients completed investigations and were compared according to anesthetic techniques which included 1) general anesthesia (n = 11); 2) subarachnoid anesthesia with intrathecal morphine (n = 11); and 3) subarachnoid anesthesia (without intrathecal morphine) with epidural catheter for opioid‑free post‑operative analgesia (n = 13). Obstructive sleep apnea was diagnosed pre‑operatively in 22 (63%) patients. In the general anesthesia group, hypopnea significantly increased on the third and fourth post‑operative nights (p < 0.05). In the subarachnoid anesthesia with intrathecal morphine group, hypopnea and oxygen desaturation index decreased significantly on the first post‑operative night and increased on the third and fourth post‑operative nights as did the apnea–hypopnea index (all p < 0.05). In the subarachnoid anesthesia with epidural catheter group, there were no significant changes in sleep‑disordered breathing parameters. In the subarachnoid anesthesia with epidural catheter group, the cumulative opioid dose was significantly lower compared to the other two groups.
Conclusion: Compared to pre‑operative findings, changes in sleep‑disordered breathing events were less pronounced in patients who received subarachnoid anesthesia (without intrathecal morphine) with epidural catheter for opioid‑free
post‑operative epidural analgesia.

Keywords:

surgery – esthesia – sleep‑disordered breathing – post-operative period

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