Post-operative sleep-disordered breathing with different anesthesia techniques: an observational study

Objective: It has been suggested that regional anesthesia may prevent post-operative exacerbation of obstructive sleep apnea. However, clinical evidence is lacking. We have hypothesized that post-operative exacerbation of sleep-disordered breathing is related to the anesthetic technique. Design: Prospective observational study. Setting: Orthopedic intensive care unit. Material and methods: The inclusion criterion was orthopedic surgery requiring anesthesia. Multichannel polygraphy sleep studies were performed one night before and four consecutive nights after surgery. The Kruskal-Wallis test and Friedman's ANOVA were used. Results:Thirty-five patients completed investigations and were compared according to anesthetic techniques which included 1) general anesthesia (n = 11); 2) subarachnoid anesthesia with intrathecal morphine (n = 11); and 3) subarachnoid anesthesia (without intrathecal morphine) with epidural catheter for opioid-free post-operative analgesia (n = 13). Obstructive sleep apnea was diagnosed pre-operatively in 22 (63%) patients. In the general anesthesia group, hypopnea significantly increased on the third and fourth post-operative nights (p < 0.05). In the subarachnoid anesthesia with intrathecal morphine group, hypopnea and oxygen desaturation index decreased significantly on the first post-operative night and increased on the third and fourth post-operative nights as did the apnea-hypopnea index (all p < 0.05). In the subarachnoid anesthesia with epidural catheter group, there were no significant changes in sleep-disordered breathing parameters. In the subarachnoid anesthesia with epidural catheter group, the cumulative opioid dose was significantly lower compared to the other two groups. Conclusion: Compared to pre-operative findings, changes in sleep-disordered breathing events were less pronounced in patients who received subarachnoid anesthesia (without intrathecal morphine) with epidural catheter for opioid-free post-operative epidural analgesia.