Preoperative Use of Continuous Positive Airway Pressure is related to Postoperative Respiratory Complications in Patients with Obstructive Sleep Apnea Undergoing Endoscopic Sinus Surgery Arata Endo, Yuki Kuwabara, Kentaro Yamakawa * , Daisuke Sakamaki, Akihiro Suzuki, Ichiro Kondo, Yasushi Mio, and Shoichi Uezono Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan * Corresponding author: Kentaro Yamakawa, Department of Anesthesiology, The Jikei University School of Medicine, 3 25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan, Tel: +81-3-3433-1111; Fax: +81-3-5401-0454; E-mail: KYamakawa@jikei.ac.jp Received date: December 10, 2018; Accepted date: December 24, 2018 ; Published date: December 31, 2018 Copyright: © 2018 Endo A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Backgrounds: Patients with obstructive sleep apnea (OSA) undergoing endoscopic sinus surgery (ESS) are considered at risk of postoperative respiratory complications because postoperative nasal packing often delays resumption of preoperative continuous positive airway pressure (CPAP) therapy. Our hospital implemented a policy in 2011 that all patients with OSA undergoing ESS be admitted to the intensive care unit (ICU) for at least 1 night for postoperative respiratory monitoring. We conducted the present study to evaluate the policy by examining the incidence of postoperative respiratory complications and to identify risk factors for postoperative respiratory complications in these patients. Methods: All patients with OSA scheduled for ESS from 2011 to 2015 were included in this retrospective chart review. Postoperative respiratory complication was defined as decrease of the percutaneous arterial oxygen saturation (SpO 2 ) greater than 3% from each baseline or apnea for more than 20 seconds. We examined the incidence of respiratory complications and conducted multiple logistic regression analysis to determine risk factors for those of complications. Results: A total of 152 patients were analyzed. Postoperative respiratory complications were observed in 27 patients (17.8%) and the minimum value of SpO 2 was 84%. None of these patients experienced severe sequelae. Multiple logistic regression analysis showed that preoperative CPAP use was an independent risk factor for postoperative respiratory complications (odds ratio=4.1; 95% CI=1.1–14.7). Conclusion: This retrospective study revealed a relatively high incidence of postoperative respiratory complications after ESS in patients with OSA. Our hospital policy of continuous respiratory monitoring in the ICU for at least 1 night postoperatively appears to be valid for these patients. Keywords: Endoscopic sinus surgery; Obstructive sleep apnea; Postoperative respiratory complications Introduction Obstructive sleep apnea (OSA) is a common comorbidity in surgical patients [1]. It can lead to hypertension, cardiovascular disease, heart failure, and stroke [2,3]. Patients with OSA undergoing surgery are known to have a greater incidence of perioperative pulmonary complications such as requiring intubation or developing aspiration pneumonia, acute respiratory distress syndrome, or pulmonary embolism compared to those without [4]. Moreover, OSA can be a predisposing factor itself for perioperative death or anoxic brain injury due to respiratory arrest [5]. Continuous positive airway pressure (CPAP) is a major therapy for patients with moderate to severe OSA. It has been recommended that patients using preoperative CPAP resume it postoperatively because upper airway obstruction can be easily caused by remaining anesthetics and narcotics [6]. However, patients undergoing endoscopic sinus surgery (ESS) tend to delay resumption of CPAP therapy, owing to postoperative nasal packing. Afer a patient with OSA who had undergone ESS experienced postoperative respiratory arrest on the ward in our institution, we implemented a hospital-wide policy in 2011, stating that all patients with documented or suspected OSA who undergo ESS are to be admitted to the intensive care unit (ICU) for at least 1 night for postoperative respiratory monitoring. In the present study, we sought to validate our hospital policy by examining the incidence of postoperative respiratory complications in the ICU for patients with OSA undergoing ESS. In addition, we assessed possible risk factors for postoperative respiratory complications in these patients. Patients and Methods Te Jikei University Institutional Review Board approval was obtained, with waiver of informed patient consent because of the retrospective nature of the study. All consecutive patients with OSA J o u r n a l o f A n e s th es i a & C l i n i c a l R e s e a r c h ISSN: 2155-6148 Journal of Anesthesia & Clinical Research Endo A et al., J Anesth Clin Res 2018, 9:12 DOI: 10.4172/2155-6148.1000871 Research Open Access J Anesth Clin Res, an open access journal ISSN:2155-6148 Volume 9 • Issue 12 • 1000871