SLEEP apnea specific hypoxic burden predicted higher 30-day postoperative mortality and cardiac complications after major surgery.
Why Sleep Apnea Specific Hypoxic Burden Matters
Obstructive sleep apnea is a common, heterogeneous condition that can increase vulnerability to postoperative complications, particularly when anesthetics, sedatives, and postoperative analgesics contribute to upper airway collapse and impaired ventilatory responses. In perioperative risk assessment, traditional severity measures may not fully reflect the physiologic impact of obstructive events. Sleep apnea specific hypoxic burden was evaluated in this study as a metric designed to capture both the frequency of obstructive respiratory events and the depth and duration of associated oxygen desaturations.
Sleep Apnea Specific Hypoxic Burden and 30-Day Outcomes
Investigators linked a multicenter clinic-based cohort to a health administrative database, focusing on adults diagnosed with obstructive sleep apnea between 2007 and 2018 who subsequently underwent major noncardiothoracic surgery through December 2024. The final cohort included 2,286 patients, with a median age of 58 years and 64.4% men, undergoing surgery a median of 4.5 years after diagnosis.
The primary endpoint was a 30-day composite of stroke, atrial fibrillation, heart failure, myocardial infarction, venous thromboembolism, and all-cause mortality. Overall, 80 patients (3.5%) experienced the composite outcome within 30 days. Event rates rose across sleep apnea specific hypoxic burden categories at diagnosis, increasing from 1.6% in the low group to 5.8% in the high group.
Risk Stratification Signals and a Simplified Approach
After adjustment, higher sleep apnea specific hypoxic burden at diagnosis was associated with increased odds of the composite outcome, with the highest category showing an adjusted odds ratio of 2.79 versus the low category. A simple risk score incorporating age, emergency admission before surgery, and sleep apnea specific hypoxic burden demonstrated moderate discrimination for 30-day events. Similar patterns were reported using a simplified version of sleep apnea specific hypoxic burden derived automatically from a single oximetry signal extracted from diagnostic sleep studies. The authors noted that further research is needed to determine whether interventions guided by sleep apnea specific hypoxic burden scores can modify postoperative risk.
Reference: Bailly S et al. Sleep Apnea-Specific Hypoxic Burden and Postoperative Outcomes of Major Noncardiothoracic Surgery. JAMA Network Open. 2026;9(2):e260006. doi:10.1001/jamanetworkopen.2026.0006.
