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doi: 10.1097/ALN.0b013e318297d89a
Perioperative Medicine

Perioperative Auto-titrated Continuous Positive Airway Pressure Treatment in Surgical Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial

Liao, Pu M.D.*; Luo, Quanwei M.D.; Elsaid, Hisham M.D.; Kang, Weimin M.D.; Shapiro, Colin M. F.R.C.P.C.§; Chung, Frances M.B.B.S.

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After publication of this article beginning on page 837 of the October 2013 issue, it was revealed that an interim analysis had been performed midway through this study, resulting in a change in primary outcome measure. The study was initiated in December 2009, with a primary outcome measure of nocturnal oxygen saturation index and secondary outcomes of peri- and postoperative adverse events. An interim analysis was performed in May 2010 after 49 patients had been randomized. Based on this analysis, the primary outcome measure was changed to apnea hypopnea index (AHI). This information was not available during peer review. Given the lack of statistical control for changing primary outcome measure based on an interim analysis, readers should interpret the results of the study with caution and consider them hypothesis generating rather than hypothesis testing.
Additionally, the authors note a mistake in table 2. In the second line of that table, the AHI values for the “All Randomized Patients” APAP (auto-titrated continuous positive airway pressure) group should be 30.1 (22.1, 42.5) and for the “All Randomized Patients” Control group should be 25.6 (18.8, 39.6). Text references to these groups in the Abstract and Results section should be corrected to these values.

Anesthesiology. 120(5):1302, May 2014.

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Background: Obstructive sleep apnea (OSA) may worsen postoperatively. The objective of this randomized open-label trial is to determine whether perioperative auto-titrated continuous positive airway pressure (APAP) treatment decreases postoperative apnea hypopnea index (AHI) and improves oxygenation in patients with moderate and severe OSA.
Methods: The consented patients with AHI of more than 15 events/h on preoperative polysomnography were randomized into the APAP or control group (receiving routine care). The APAP patients received APAP for 2 or 3 preoperative, and 5 postoperative nights. All patients were monitored with oximetry for 7 to 8 nights (N) and underwent polysomnography on postoperative N3. The primary outcome was AHI on the postoperative N3.
Results: One hundred seventy-seven OSA patients undergoing orthopedic and other surgeries were enrolled (APAP: 87 and control: 90). There was no difference between the two groups in baseline data. One hundred six patients (APAP: 40 and control: 66) did polysomnography on postoperative N3, and 100 patients (APAP: 39 and control: 61) completed the study. The compliance rate of APAP was 45%. The APAP usage was 2.4–4.6 h/night. In the APAP group, AHI decreased from preoperative baseline: 30.1 (22.1, 42.5) events/h (median [25th, 75th percentile]) to 3.0 (1.0, 12.5) events/h on postoperative N3 (P < 0.001), whereas, in the control group, AHI increased from 30.4 (23.2, 41.9) events/h to 31.9 (13.5, 50.2) events/h, P = 0.302. No significant change occurred in the central apnea index.
Conclusions: The trial showed the feasibility of perioperative APAP for OSA patients. Perioperative APAP treatment significantly reduced postoperative AHI and improved oxygen saturation in the patients with moderate and severe OSA.

© 2013 American Society of Anesthesiologists, Inc.

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