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Evidence-based Practice and Quality Improvement

Quality of recovery after surgery in patients with obstructive sleep apnea


Silva, A.; Xara, D.; Mendonça, J.; Santos, A.; Abelha, F.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 17-18
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Background and Goal of Study: Obstructive sleep apnea (OSA) is an important clinical condition associated with perioperative complications and may affect quality of recovery after surgery. The aim of this study was to evaluate the quality of recovery in patients with high risk of OSA patients.

Materials and Methods: Observational prospective study approved by the Centro Hospitalar São João Ethics Committee and written informed consent was obtained. All consecutive adult Portuguese-speaking patients submitted to elective non-cardiac and non-neurological surgery were eligible to the study, during a 6-week period of time. A total of 221 patients were enrolled to the study. Demographic data, perioperative variables and length of recovery room stay were recorded. Patients were classified as being at high risk for OSA (HR-OSA) if their STOP-BANG score was 3 or more and were classified as being at low risk (LR-OSA) if their score was less than 3. The Quality of recovery 40 Portuguese version (QoR) was used to measure health status before surgery (T0) and 3 months after surgery (T3). Descriptive analyses of variables were used to summarize data and non-parametric tests were performed for comparisons (Wilcox signed rank test and the Mann Whitney U -test).

Results and Discussion: One hundred ninety eight patients completed the evaluation at T0 (47% were HR-OSA patients) and 190 at T3 (45% were HROSA patients). HR-OSA patients had overall significantly lower global QoR scores at T3 compared to LR-OSA patients (median 189 vs. 194 p=0.043). At T0 there were no differences between patients in all QoR40 dimensions and in global score. In patients with LR-OSA regarding evolution in QoR40 total and each QoR40 dimensions between T0 and T3 the median results were similar for psychological comfort (p=0.117), physical independence (p=0.578), and pain (p=0.491) but were higher for emotional state (p=0.035) and for global score (189 vs.179, p=0.008) while the same evolution in patients with HR-OSA showed similar median global score (p=0.245) and in all QoR dimensions except physical comfort (p=0.015).

Conclusion(s): Three months after surgery HR-OSA patients had a worse outcome according to QoR while LR-OSA patients showed improvements in QoR global scores.


1. Chung F, Subramanyam R, Liao P, et al. High STOP-BANG score indicates a high probability of obstructive sleep apnoea. British Journal of Anaesthesia 2012; 108 (5): 768-75.
© 2013 European Society of Anaesthesiology