Can the use of postoperative CPAP in patients at high risk of OSA reduce desaturation episodes after surgery?: a controlled, randomized, clinical trial

Abstract

Background: The prevalence of obstructive sleep apnea (OSA) in the general population ranges from 2 to 6% but the incidence is directly proportional to the age and weight. Few patients with confirmed diagnosis and only 5% receive treatment. The higher prevalence of OSA in the surgical population has been demonstrated in several studies as well as the increased surgical risk. A meta-analysis confirmed the increased complications (postoperative desaturation, acute respiratory failure, cardiac events and the need for transfer to ICU) in this population. When OSA is diagnosed preoperatively, the rate of postoperative pulmonary complications is low and not associated with OSA severity. The beneficial effect of CPAP on patients with OSA is known but its benefit is unknown in patients at high risk of OSA undergoing surgery to prevent these respiratory complications such as post-surgical desaturations. Objective: To evaluate the effectiveness of CPAP vs ventimask postoperative in patients with high risk of OSA to prevent postoperative desaturations. The secondary objectives are to examine the reduction of postoperative hospital stay of these patients and to evaluate the prevalence of high risk of OSA in surgical population. Methods: The design is a single-center, randomized, simple blind, and parallel-group trial will be performed between 2017 and 2019 in Dr. Josep Trueta University Hospital of Girona. 682 patients will be recluted during 2 years and randomized into two groups. 341 will receive CPAP therapy with an oxygen concentration of 50% and PEEP 8-10 cm H2O the first 24 hours after surgery and 341 patients will receive ventimask a 50% of oxygen concentration