• Satya Krishna Ramachandran, Jaideep Pandit, Scott Devine, Aleda Thompson, and Amy Shanks.
• From the *Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School at Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts; †Nuffield Department of Anaesthesia, University of Oxford, Oxford, United Kingdom; and ‡Center for Observational & Real World Evidence, Merck, Sharpe and Dohme, Whitehouse Station, New Jersey.
• Anesth. Analg. 2017 Jul 1; 125 (1): 272-279.

BackgroundObstructive sleep apnea (OSA) is a prevalent condition that is associated with early postoperative respiratory complications (PRCs). As the majority of patients with OSA are undiagnosed, preoperative screening remains the most efficient method to identify suspected OSA.MethodsThis retrospective study was performed on patients undergoing anesthesia in a single academic medical center. We assigned OSA risk class retrospectively to all patients in the study by using the Perioperative Sleep Apnea Prediction (PSAP) score. We evaluated the relationship between PSAP categories and early postoperative invasive airway placement after adjusting for several preoperative and intraoperative factors (including surgical risk) previously associated with PRC occurrence.ResultsA total of 108,479 patients were included in the final analysis with an incidence of PRC was 0.3% (n = 280). High PSAP score was associated with postoperative intubation (adjusted odds ratio, 2.3; 95% confidence interval, 1.5-3.7). Several risk factors reflecting anesthetic agents, neuromuscular blocking agents, and opioids were also independently associated with early PRC.ConclusionsWe report that suspected OSA based on the PSAP score is independently associated with increased risk of early PRC. Specific anesthetic agents are independently associated with early PRC, pointing to the potential for examining risk modification through these exposures in future studies.

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