Immediate Use of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Following Transsphenoidal Pituitary Surgery: A Case Series. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Rieley, William; Askari, Ayda; Akagami, Ryojo; Gooderham, Peter A.; Swart, Petrus A.; Flexman, Alana M.
• Is Part Of: Journal of neurosurgical anesthesiology. Volume 32:Issue 1(2020:Jan.)
• Publication Date: 2020-01
• Subjects: obstructive sleep apnea -- pituitary -- transsphenoidal -- acromegaly -- continuous positive airway pressure; Anesthesia in neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 617.96748
• DOI: 10.1097/ANA.0000000000000573
• Languages: English
• ISSNs: 0898-4921

Abstract

Abstract : Background: Patients who undergo transsphenoidal pituitary resection have an elevated risk of obstructive sleep apnea (OSA) yet their outcomes and the safety of continuous positive airway pressure (CPAP) remains unclear. Our study objective was to determine the incidence of complications related to the use of early positive airway pressure following pituitary resection. Methods: We retrospectively identified all patients who underwent endoscopic transsphenoidal pituitary tumor resection between January 1, 2005 and March 24, 2016 at our institution, including those with diagnosed or suspected OSA. We compared characteristics and postoperative complications of OSA patients who did and did not receive CPAP postoperatively. Results: In total, 427 patients underwent transsphenoidal pituitary resection. Of these, 64 (15%) had OSA. Acromegaly was more common in patients with OSA (42% vs. 10%; P <0.001) but not Cushing Disease (19% vs. 16%; P =0.54). Hypoxia was more common in patients with OSA as compared to those without (14% vs. 5%; P <0.001) and one patient with OSA was reintubated compared with none in the control group ( P =0.017). Eight patients had CPAP applied in the immediate postoperative period and the incidence of postoperative cerebrospinal fluid (CSF) leak, infection, and pneumocephalus was similar between OSA patients with and without CPAP. Discussion: Our case series of patients with OSA who received CPAP immediately following transsphenoidal pituitary resection resulted in similar rates of surgical complications. Our results support further investigation to establish the safety of CPAP in this population.