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A2430 - Patient with Obstructive Sleep Apnea Are Not at an Increased Risk of Complications When Undergoing Carotid Endarterectomy
Author Block: V. Kraskovsky1, P. Fay1, R. Metta2, M. J. Mador3; 1Department of Internal Medicine, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, United States, 2Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, United States, 3Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York, School of Medicine and Biomedical Sciences, Western New York Veterans Administration Healthcare System, Buffalo, NY, United States.
PURPOSE:Obstructive Sleep apnea (OSA) causes sleep fragmentation and results in poor sleep quality due primarily to recurrent hypoxic events and cortical arousals. OSA has also been shown to decrease cerebral vasoreactivity (CVR). Cerebral perfusion in different regions of the brain is also altered in patients with OSA. We hypothesized that in patients with OSA, the altered perfusion and CVR patterns might increase the risk of hyperperfusion injury as well as increase the risk of other neurologic sequelae in patients undergoing carotid revascularization.
METHODS:A retrospective chart review was conducted in patients from the Western New York VA Healthcare System between January 2000 and April 2015. Inclusion criteria included an ICD 9 or ICD 10 diagnosis of OSA, sleep study confirmation of OSA severity, and history of carotid revascularization (CEA). Exclusion criteria included patients with a 10% change in body weight between the time of the sleep study and the time of CEA, or had central sleep apnea. Endpoints evaluated for included mortality rate, hyperperfusion syndrome, neurologic complications, cardiovascular complications, and pulmonary complications.
RESULTS: 121 patients with OSA who underwent CEA were compared to age and BMI matched patients without OSA who underwent CEA. Mean age was 66.4 years. Mean BMI at time of CEA was 31.83. 98.3% of the patients were male. The overall rate of neurologic complications after CEA did not differ between patients with OSA and without OSA (19.83% vs 19.01%). Total cardiac and pulmonary complications did not differ between those with and without OSA (20.66% OSA vs 18.18% control and 4.96% OSA vs 2.38% control). The overall rate of neurologic complications after CEA did not differ between patients with mild, moderate, or severe OSA (22.45%,14.81%, 23.3%) and those without sleep apnea. Only 55% of patient with OSA who were prescribed CPAP prior to surgery were compliant with CPAP in the perioperative period. Rate of total complications did not differ based on compliance (23.81% compliant, 35.29% noncompliant, p=0.49) Comorbidities and medication usage were similar between the two groups except patients with OSA were more likely to use non benzodiazepine sedatives compared to controls (21.49% OSA vs 4.96%control p=0.002).
CONCLUSIONS: In a single center retrospective study, the rate of neurologic, cardiac, and pulmonary complications after CEA did not significantly differ between patients with OSA and those without. Furthermore, severity of sleep apnea was not associated with an increasing rate of complication after carotid revascularization.