Thorac Cardiovasc Surg 2015; 63 - OP96
DOI: 10.1055/s-0035-1544348

Impact of Sleep Disordered Breathing on Morbidity and Mortality after Elective Coronary Bypass Graft Surgery -A Bicentric Prospective Controlled Observational Study

S. Rupprecht 1, A. Nachtmann 2, T. Doenst 3, T. Schultze 1, O. Witte 1, H. Hoyer 1, R. Sven 1, J. Rastan 4
  • 1Klinik für Neurologie, Friedrich-Schiller-Universität zu Jena, Jena, Germany
  • 2Klinik für Neurologie, Rotenburg, Germany
  • 3Klinik für Herzchirurgie, Friedrich-Schiller-Universität zu Jena, Jena, Germany
  • 4Klinik für Herz- und Gefäßchirurgie, Rotenburg, Germany

Objectives: Concomitant sleep disordered breathing (SDB) is common in patients undergoing coronary artery bypass graft surgery (CABG). However, SDB is significantly underdiagnosed in these patients although its impact on postoperative recovery is considerable. Aim of this prospective study was to evaluate SDB as a risk factor for postoperative morbidity and to identify SDB related postoperative CABG complications.

Methods: A total of 219 patients with stable coronary artery disease who underwent elective CABG were included in the study. All participants were polygraphically screened for SDB two days prior surgery and continuously monitored for major postoperative complications. Telephonic follow up was performed 30 days after surgery to assess survival, hospital readmission, sternal instability, wound healing problems and reappearance of angina symptoms. The primary end point was a composite of all-cause-death within 30 days and major postoperative complications (cardiac, respiratory, surgical, infectious, acute renal failure requiring dialysis and stroke) within 7 days after surgery.

Results: SDB (apnea/hypopnea index 3 10/h) was present in 69% and moderate/severe SDB (apnea/hyponea index 3 20/h) in 43% of the CABG patients. There was no difference in the primary composite-end-point between patients with and without SDB (OR 0.97, p < 0.094) and between patients with moderate/severe SDB and none[AR1] /mild SDB (OR 1.07, p ≤ 0.85). However, moderate/severe SDB was associated with higher hospital mortality (OR 8.45, p < 0.005), 30d mortality (OR 10.1, p < 0.03), a higher rate of sepsis (OR 3.29, p < 0.01), septic shock (OR 3.02, p < 0.035) and respiratory composite complications (OR 2.85 p ≤ 0.002) mainly due to higher rate of pneumonia (11.7% vs. 3.2%).

Conclusion: Moderate/severe SDB is highly prevalent in patients with coronary disease and increases morbidity and mortality after elective coronary bypass graft surgery. The increase in postoperative risk can be explained by a higher rate of septic and infectious complications. Because SDB is well treatable, SDB screening had to be routinely included in preoperative risk evaluation.