Clinical Edge

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Severe OSA increases cardiovascular risk after surgery

Key clinical point: Severe obstructive sleep apnea may increase cardiovascular risk after major surgery.

Major finding: Individuals with severe obstructive sleep apnea have a 2.23-fold increased risk of cardiovascular problems after major surgery.

Study details: A prospective observational cohort study of 1,218 patients undergoing major surgery.

Disclosures: The study was supported by the Health and Medical Research Fund (Hong Kong), National Healthcare Group–Khoo Teck Puat Hospital, University Health Network Foundation, University of Malaya, Malaysian Society of Anaesthesiologists, Auckland Medical Research Foundation, and ResMed. One author declared grants from private industry and a patent pending on an obstructive sleep apnea risk questionnaire used in the study. No other conflicts of interest were declared.


Chan M et al. JAMA 2019;321[18]:1788-98. doi: 10.1001/jama.2019.4783.


This study is large, prospective, and rigorous and adds important new information to the puzzle of the impact of sleep apnea on postoperative risk, Dennis Auckley, MD, and Stavros Memtsoudis, MD, wrote in an editorial accompanying this study. The study focused on predetermined clinically significant and measurable events, used standardized and objective sleep apnea testing, and attempted to control for many of the confounders that might have influenced outcomes.

The results suggest that obstructive sleep apnea should be recognized as a major perioperative risk factor, and it should receive the same attention and optimization efforts as comorbidities such as diabetes.

Dr. Auckley is from the division of pulmonary, critical care and sleep medicine at MetroHealth Medical Center, Case Western Reserve University, Cleveland, and Dr. Memtsoudis is clinical professor of anesthesiology at Cornell University, New York. These comments are adapted from an editorial (JAMA 2019;231[18]:1775-6). Both declared board and executive positions with the Society of Anesthesia and Sleep Medicine. Dr. Auckley declared research funding from Medtronic, and Dr. Memtsoudis declared personal fees from Teikoku and Sandoz.