Sleep apnea in patients undergoing coronary artery bypass grafting: Impact on perioperative outcomes

Abstract

SummarySleep‐disordered breathing is common in patients with coronary artery disease undergoing coronary artery bypass grafting. Sleep‐disordered breathing is associated with increased perioperative morbidity, arrhythmias (e.g. atrial fibrillation) and mortality. This study investigated the impact of sleep‐disordered breathing on the postoperative course after coronary artery bypass grafting, including development of atrial fibrillation. This prospective single‐centre cohort study included adults undergoing coronary artery bypass grafting. All were screened for sleep‐disordered breathing (polygraphy) and atrial fibrillation (electrocardiogram) preoperatively; those with known sleep‐disordered breathing or atrial fibrillation were excluded. Endpoints included new‐onset atrial fibrillation, duration of mechanical ventilation, time in the intensive care unit, and postoperative infection. Regression analysis was performed to identify associations between sleep‐disordered breathing and these outcomes. A total of 508 participants were included (80% male, median age 68 years). The prevalence of any (apnea–hypopnea index ≥ 5 per hr), moderate (apnea–hypopnea index = 15–30 per hr) and severe (apnea–hypopnea index > 30 per hr) sleep‐disordered breathing was 52.9%, 9.3% and 10.2%, respectively. All‐cause 30‐day mortality was 0.98%. After adjustment for age and sex, severe sleep‐disordered breathing was associated with longer respiratory ventilation support (crude odds ratio [95% confidence interval] 5.28 [2.18–12.77]; p < 0.001) and higher postoperative infection rates (crude odds ratio 3.32 [1.45–7.58]; p < 0.005), but not new‐onset atrial fibrillation or mortality. New‐onset atrial fibrillation was significantly associated with postoperative infection and prolonged hospital stay. The significant associations between sleep‐disordered breathing and several adverse outcomes after coronary artery bypass grafting support the need for preoperative sleep‐disordered breathing screening in individuals undergoing cardiac surgery.