Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing

Alparslan Turan; Jing You; Cameron Egan; Alex Fu; Ashish Khanna; Yashar Eshraghi; Raktim Ghosh; Somnath Bose; Shahbaz Qavi; Lovkesh Arora; Daniel I Sessler; Anthony G Doufas

doi:10.1371/journal.pone.0127809

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Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing

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Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing

Alparslan Turan, Jing You, Cameron Egan, Alex Fu, Ashish Khanna, Yashar Eshraghi, Raktim Ghosh, Somnath Bose, Shahbaz Qavi, Lovkesh Arora, …

PloS one, Vol.10(5), pp.e0127809-e0127809

2015

DOI: 10.1371/journal.pone.0127809

PMCID: PMC4444020

PMID: 26010491

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Abstract

Evidence suggests that recurrent nocturnal hypoxemia may affect pain response and/or the sensitivity to opioid analgesia. We tested the hypothesis that nocturnal hypoxemia, quantified by sleep time spent at an arterial saturation (SaO2) < 90% and minimum nocturnal SaO2 on polysomnography, are associated with decreased pain and reduced opioid consumption during the initial 72 postoperative hours in patients having laparoscopic bariatric surgery. With Institutional Review Board approval, we examined the records of all patients who underwent laparoscopic bariatric surgery between 2004 and 2010 and had an available nocturnal polysomnography study. We assessed the relationships between the time-weighted average of pain score and total opioid consumption during the initial 72 postoperative hours, and: (a) the percentage of total sleep time spent at SaO2 < 90%, (b) the minimum nocturnal SaO2, and (c) the number of apnea/hypopnea episodes per hour of sleep. We used multivariable regression models to adjust for both clinical and sleep-related confounders. Two hundred eighteen patients were included in the analysis. Percentage of total sleep time spent at SaO2 < 90% was inversely associated with total postoperative opioid consumption; a 5-%- absolute increase in the former would relatively decrease median opioid consumption by 16% (98.75% CI: 2% to 28%, P = 0.006). However, the percentage of total sleep time spent at SaO2 < 90% was not associated with pain. The minimum nocturnal SaO2 was associated neither with total postoperative opioid consumption nor with pain. In addition, neither pain nor total opioid consumption was significantly associated with the number of apnea/hypopnea episodes per hour of sleep. Preoperative nocturnal intermittent hypoxia may enhance sensitivity to opioids.

Hypoxia - drug therapy

Sleep Apnea Syndromes - physiopathology

Pain, Postoperative - drug therapy

Sleep Apnea Syndromes - etiology

Humans

Hypoxia - etiology

Middle Aged

Male

Polysomnography

Analgesics, Opioid - administration & dosage

Sleep Apnea Syndromes - drug therapy

Adult

Female

Hypoxia - physiopathology

Bariatric Surgery - adverse effects

Pain, Postoperative - physiopathology

Details

Title: Subtitle: Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing
Creators: Alparslan Turan - Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America
Jing You - Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
Cameron Egan - Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America
Alex Fu - Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America
Ashish Khanna - Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
Yashar Eshraghi - Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America
Raktim Ghosh - Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America
Somnath Bose - Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
Shahbaz Qavi - Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
Lovkesh Arora - Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
Daniel I Sessler - Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America
Anthony G Doufas - Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America; Outcomes Research Consortium, Cleveland, Ohio, United States of America
Resource Type: Journal article
Publication Details: PloS one, Vol.10(5), pp.e0127809-e0127809
DOI: 10.1371/journal.pone.0127809
PMID: 26010491
PMCID: PMC4444020
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: Public Library of Science; United States
Language: English
Date published: 2015
Academic Unit: Anesthesia
Record Identifier: 9984006480302771

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