Association between pre-operative adherence to positive airway pressure therapy and postoperative opioid use after lower limb arthroplasty in patients with obstructive sleep apnoea.
Academic Article
Overview
abstract
Poor sleep is known to have a negative impact on pain perception, and obstructive sleep apnoea is the most prevalent sleep disorder in adults. Current evidence is conflicting with respect to the benefits of positive airway pressure treatment on pain in patients with obstructive sleep apnoea, which leaves the question of obstructive sleep apnoea as a modifiable factor in pain syndromes unanswered. We conducted a retrospective cohort study of United States of America veterans with obstructive sleep apnoea who underwent total knee or hip arthroplasty to compare positive airway pressure treatment adherence to postoperative opioid use. We reviewed the records for patients with a diagnosis of obstructive sleep apnoea who underwent elective total knee or hip arthroplasty at a single Veterans Affairs hospital. For patients who reported nocturnal positive airway pressure use, we reviewed data downloaded from positive airway pressure devices to determine adherence to therapy based on Medicare criteria. Patient characteristics, peri-operative opioid prescriptions and postoperative outcomes were collected from the electronic medical record. The cohort consisted of 401 patients between April 2014 and May 2019: 104 patients were adherent to positive airway pressure therapy at the time of surgery and 297 were non-adherent. Patients adherent to positive airway pressure therapy were significantly less likely to be prescribed an opioid prior to surgery compared to untreated patients (22% vs 39%, respectively, p = 0.010). Positive airway pressure adherence was not an independent predictor of postoperative opioid requirements in the first three postoperative days. Independent predictors of postoperative opioid requirements included pre-operative opioid prescription, age, history of cocaine abuse and congestive heart failure. In patients with obstructive sleep apnoea who undergo lower limb arthroplasty, adherence to positive airway pressure therapy was not associated with opioid consumption in the immediate postoperative period.
