阻塞性睡眠呼吸暂停患者心脏手术后的结局：比较研究的系统评价和Meta分析
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Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis of Comparative Studies
背景与目的
阻塞性睡眠呼吸暂停（OSA）是心脏手术患者常见的合并症，并可能使患者容易发生术后并发症。本meta分析的目的是明确接受心脏手术的
OSA患者发生术后并发症的证据。
方 法
检索Cochrane系统评价数据库、Medline、Medline在线、Web of Science、Scopus、EMBASE、Cochrane对照试验注册库和CINAHL建库至2016年10月的文献。检索接受心脏手术诊断或怀疑OSA的成年患者的研究。所有纳入研究必须报告至少1个术后并发症。主要结局是术后30天内主要不良心脑血管事（MACCEs），包括全因死亡、心肌梗死、心肌损伤、非致死性心脏骤停、血管重建、肺栓塞、深静脉血栓形成、新出现的术后房颤（POAF）、中风和充血性心力衰竭。次要结局是新出现的POAF。其他探索性结局包括：（1）术后气管插管和机械通气; （2）感染和/或败血症; （3）非计划重症监护病房（ICU）入院; 和（4）住院和ICU的住院时间。分别使用Cochrane评估管理器5.3（Cochrane，伦敦，英国）和OpenBUGS v3.0进行meta分析和Meta回归。
结 果
纳入了11项比较研究（n = 1801例，OSA与非OSA分别为688例和1113例）。MACCE在OSA患者中的发生率比非OSA高33.3％（OSA vs非OSA：31％：10.6％;比值比[OR]：2.4; 95％置信区间[CI]，1.38-4.2; P = .002）。与非OSA相比，OSA患者新出现的POAF发生率增高（OSA vs非OSA：31％vs 21％; OR，1.94; 95％CI，1.13-3.33; P = .02）。尽管OSA患者的术后气管插管和机械通气（OSA与非OSA：13％比5.4％; OR，2.67; 95％CI，1.03-6.89; P = .04）明显高于非OSA患者，但OSA患者的住院时间和住院时间与非OSA患者相比无明显差异。大多数OSA患者未经持续气道正压通气治疗。亚组的Meta回归和敏感性分析不影响OSA组和非OSA组术后并发症的OR值。
结 论
Meta分析显示，在心脏手术后，OSA患者MACCE和新出现的POAF比非OSA患者分别高出33.3％和18.1％
原始文献摘要
Nagappa M, Ho G, Patra J, et al. Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis of Comparative Studies[J]. Anesthesia & Analgesia, 2017:1.
BACKGROUND: Obstructive sleep apnea (OSA) is a common comorbidity in patients undergoing cardiac surgery and may predispose patients to postoperative complications. The purpose of this meta-analysis is to determine the evidence of postoperative complications associated with OSA patients undergoing cardiac surgery.
METHODS: A literature search of Cochrane Database of Systematic Reviews, Medline, Medline In-process, Web of Science, Scopus, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL until October 2016 was performed. The search was constrained to studies in adult cardiac surgical patients with diagnosed or suspected OSA. All included studies must report at least 1 postoperative complication. The primary outcome is major adverse cardiac or cerebrovascular events (MACCEs) up to 30 days after surgery, which includes death from all-cause mortality, myocardial infarction, myocardial injury, nonfatal cardiac arrest, revascularization process, pulmonary embolism, deep venous thrombosis, newly documented postoperative atrial fibrillation (POAF), stroke, and congestive heart failure. Secondary outcome is newly documented POAF. The other exploratory outcomes include the following: (1) postoperative tracheal intubation and mechanical ventilation; (2) infection and/or sepsis; (3) unplanned intensive care unit (ICU) admission; and (4) duration of stay in hospital and ICU. Meta-analysis and meta- regression were conducted using Cochrane Review Manager 5.3 (Cochrane, London, UK) and OpenBUGS v3.0, respectively.
RESULTS: Eleven comparative studies were included (n = 1801 patients; OSA versus non-OSA: 688 vs 1113, respectively). MACCEs were 33.3% higher odds in OSA versus non-OSA patients (OSA versus non-OSA: 31% vs 10.6%; odds ratio [OR], 2.4; 95% confidence interval [CI], 1.38–4.2; P = .002). The odds of newly documented POAF (OSA versus non-OSA: 31% vs 21%; OR, 1.94; 95% CI, 1.13–3.33; P = .02) was higher in OSA compared to non-OSA. Even though the postoperative tracheal intubation and mechanical ventilation (OSA versus non-OSA: 13% vs 5.4%; OR, 2.67; 95% CI, 1.03–6.89; P = .04) were significantly higher in OSA patients, the length of ICU stay and hospital stay were not significantly prolonged in patients with OSA compared to non-OSA. The majority of OSA patients were not treated with continuous positive airway pressure therapy. Meta-regression and sensitivity analysis of the subgroups did not impact the OR of postoperative complications for OSA versus non-OSA groups.
CONCLUSIONS: Our meta-analysis demonstrates that after cardiac surgery, MACCEs and newly documented POAF were 33.3% and 18.1% higher odds in OSA versus non-OSA patients, respectively.
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