Influence of Different Anesthetic Procedures on Sleep Disorder Breathing

Study Overview
=================
Brief Summary
-----------------
Obstructive sleep apnea (OSA) is a common form of sleep disordered breathing characterized by partial or complete upper airway obstructions during sleep. OSA is associated with major comorbidities and perioperative complications. These complications are caused not only by the OSA itself, but also by exacerbations of this syndrome during the perioperative period (1). Benzodiazepines, volatile anesthetics and opioids may lead to lower hypoxia and hypercapnia sensitivity and may cause respiratory depression (2-5). Therefore, preference of neuraxial blockades and avoidance of opioids has been suggested for patients with OSA (6). However, there is still lack of evidence to evaluate the effects of various anesthesia procedures on OSA (6,7). We hypothesize different anesthetic procedures will have different effect on OSA exacerbations in the postoperative period. Accordingly, the aim of this study is to compare the number of sleep disordered breathing episodes in the postoperative period in patients with different anesthetic procedures.

Official Title
-----------------
Influence of Different Anesthetic Procedures on Sleep Disorder Breathing in Adult Patients Undergoing Elective Surgery

Conditions
-----------------
Obstructive Sleep Apnea

Intervention / Treatment
-----------------
* Procedure: anesthesia


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: elective orthopedic surgery Exclusion Criteria: already diagnosed sleep disorder breathing continuous positive airway pressure therapy tracheostomy American Society of Anesthesiologists class IV-V

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| General anesthesia (with opioids)<br>orthopedic surgery plus general anesthesia | Procedure: anesthesia<br>* Different anesthetic procedures<br>|
| Epidural anesthesia (without opioids)<br>orthopedic surgery plus epidural anesthesia (without opioids use) | Procedure: anesthesia<br>* Different anesthetic procedures<br>|
| Subarachnoid anesthesia (with opioids)<br>orthopedic surgery plus subarachnoid anesthesia (plus intrathecal opioid) | Procedure: anesthesia<br>* Different anesthetic procedures<br>|
| Regional anesthesia (without opioids)<br>orthopedic surgery plus regional anesthesia (peripheral nerve block, continous or single shot, without opioid use) | Procedure: anesthesia<br>* Different anesthetic procedures<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Apnea-hypopnea index change | Changes (post-pre) in apnea-hypopnea index 4 nights post surgery | 4 nights after surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
anesthesia, obstructive sleep apnea