Correlation Between Risk-stratified Grade Of Obstructive Sleep Apnea And Perioperative Cardiopulmonary Complications Of Lung Cancer

Objective Obstructive sleep apnea(OSA)is a known risk factor for perioperative complications,and lobectomy combined with systematic lymph node dissection is the standard surgical treatment for early-middle stage lung cancer.However,there were few studies about the effect of OSA on the perioperative complications of lobectomy in patients with lung cancer.The STOP-Bang questionnaire has a high reliability and validity in predicting OSA and easy to operate,so it has been widely applied to clinical perioperative patients rapid screening and identification of management,this study through the STOP-Bang questionnaire screening the lung lobectomy patients with high-risk OSA,to explore the perioperative complications and the risk factor of OSA patients with high risk.Methods This study retrospectively collected clinical data of patients who underwent lobectomy for lung cancer in the department of thoracic surgery of Tianjin Chest Hospital from January 2014 to December 2018 and were confirmed to have lung cancer by final pathology.With the help of the Linkdoc database,screening the patients preliminarily according to the inclusion and exclusion criteria,and the incomplete patient data were supplemented by referring to the medical record database of our hospital.Final 731 patients were collected complete information and included in this study,the patients were divided into high-risk OSA group,medium-risk group and low-risk group according to the STOP-Bang questionnaire scores.Analysis the clinical characteristics and postoperative cardiopulmonary complications of three groups patients,then to explore the risk factors of cardiopulmonary complications of high-risk OSA group patients.Results 1.Among 731 patients(high-risk OSA 227/31.05%,medium-risk OSA256/35.02% and low-risk OSA 248/33.93%);high-risk group is given priority to with men,body mass index(BMI)(27.2±3.3)were significantly higher than medium-risk group(23.9±2.6)and low-risk group(22.5±2.2);and the hypertension,diabetes,coronary heart disease(CHD)ratio of high-risk group is higher than the other two groups;the FEV1 % Pre,PEF % Pre of high-risk group and medium-risk group is lower than low-risk group.2.The pulmonary complications(56/24.7%)and cardiaccomplications(51/22.5%)of high-risk group were significantly higher than the low-risk group(43/17.3%;30/12.1%).However,there was no significant difference in pulmonary complications(47/18.4%)and cardiac complications(35/13.7%)of medium-risk group with low-risk group.3.High-risk OSA patients were divided into two groups according to the presence or absence of cardiac complications.Univariate analysis showed there were significant differences in age,apnea symptoms,hypertension,coronary heart disease,pulmonary artery pressure,and FEV1%Pre between the two groups,and multivariate analysis showed that apnea symptoms,hypertension,coronary heart disease,and pulmonary artery pressure were independent risk factors.4.High-risk OSA patients were divided into two groups based on the presence or absence of pulmonary complications.Univariate analysis showed that gender,smoking index,FEV1%Pre,surgical method,duration of surgery and intraoperative blood loss were associated with pulmonary complications,and multivariate analysis showed that FEV1%Pre was an independent risk factor.Conclusion High-risk OSA patients were predominantly obese and smoking male,and the pulmonary ventilation function was worse in high-risk and medium-risk OSA group.The STOP-Bang questionnaire was effective in risk stratification of patients without preoperative diagnosis of OSA who underwent lobectomy.The postoperative pulmonary and cardiac complications of patients with high-risk OSA were significantly higher than low-risk group,and there was no significant difference between the medium-risk group and the low-risk group.Postoperative cardiac complications in high-risk OSA patients were associated with age,hypertension,coronary heart disease,apnea symptoms,pulmonary artery pressure,and fev1% Pre,among which apnea symptoms,hypertension,coronary heart disease,and pulmonary artery pressure were independent risk factors.The pulmonary complications of high-risk OSA patients were correlated with gender,smoking index,FEV1%Pre,surgical method,duration of surgery and intraoperative blood loss,among which FEV1%Pre was an independent risk factor.