The effects of opioids on perioperative outcomes in patients with obstructive sleep apnoea

Background: Previous use of opioids intraoperatively and during recovery was associated with increased hypoxic events. 1 Therefore, current guidelines, recommend a limitation of opioids use perioperatively in sleep apnoea patients. 2 Objectives: To determine the prevalence of sleep apnoea in a surgical population and evaluate the effects of opioids on perioperative outcomes in patients with OSA. Methods: A retrospective study was performed in a University Hospital between 1 st June 2013 and 1 st Dec 2015 and included 195 surgical patients investigated for OSA. Sleep apnoea was defined as dip rate u003e10 events/hour at a desaturation of 4% below the baseline. Results: From 195 patients screened for OSA, 83 had surgical interventions and were included, 36.1% females and median age 54. Prevalence of OSA was 40.9% with 9.6% severe OSA. Opioids were used during surgery in 78.4% of cases and included 69.8% fentanyl(F), 3.6% remifentanil, 2.4% alfentanil and 2.4% morphine+F. The use of opioids intraoperatively was higher in non-OSA patients 63% versus 36% in OSA group (p=0.07).Following multiple regression analysis, perioperative complications (intra and postoperative desaturations, prolonged recovery stay) were not related to opioid use. The only factor correlated with perioperative complications and opioid use was age(p=0.001). Conclusions: We have identified a high prevalence of sleep apnoea of 40.9% in surgical population. We found a limitation of opioid use in sleep apnoea population perioperatively, which was not related to perioperative complications, further studies being needed to confirm these results. References: 1. Vasu TS et al. J Clin Sleep Med 2012; 2. Gross JB et al. Anesthesiology 2014.