To the Editor In their prospective cohort study, Dr Chan and colleagues1 found that among adults undergoing major noncardiac surgery, unrecognized severe obstructive sleep apnea (OSA) was significantly associated with increased postoperative cardiovascular complications, including cardiac death. These results are supported by observational research indicating a higher risk of postoperative cardiac complications in patients with sleep apnea.2 However, other data indicate lower postoperative mortality rates in patients with diagnosed sleep apnea compared with patients without sleep apnea.3 Some researchers have speculated that the intermittent chronic hypoxia seen in OSA may lead to cardioprotective effects after surgery through ischemic preconditioning.4
Santer P, Eikermann M. Unrecognized Obstructive Sleep Apnea in Patients Undergoing Surgery. JAMA. 2019;322(12):1211. doi:10.1001/jama.2019.10990
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