Introduction Obstructive sleep apnoea (OSA), the most common type of sleep-
disordered breathing, is associated with significant immediate and long-term
morbidity, including fragmented sleep and impaired daytime functioning, as
well as more severe consequences, such as hypertension, impaired cognitive
function and reduced quality of life. Perioperatively, OSA occurs frequently
as a consequence of pre-existing vulnerability, surgery and drug effects. The
impact of OSA on postoperative respiratory complications (PRCs) needs to be
better characterised. As OSA is associated with significant comorbidities,
such as obesity, pulmonary hypertension, myocardial infarction and stroke, it
is unclear whether OSA or its comorbidities are the mechanism of PRCs. This
project aims to (1) develop a novel prediction score identifying surgical
patients at high risk of OSA, (2) evaluate the association of OSA risk on PRCs
and (3) evaluate if pharmacological agents used during surgery modify this
association. Methods Retrospective cohort study using hospital-based
electronic patient data and perioperative data on medications administered and
vital signs. We will use data from Partners Healthcare clinical databases,
Boston, Massachusetts. First, a prediction model for OSA will be developed
using OSA diagnostic codes and polysomnography procedural codes as the
reference standard, and will be validated by medical record review. Results of
the prediction model will be used to classify patients in the database as
high, medium or low risk of OSA, and we will investigate the effect of OSA on
risk of PRCs. Finally, we will test whether the effect of OSA on PRCs is
modified by the use of intraoperative pharmacological agents known to increase
upper airway instability, including neuromuscular blockade, neostigmine,
opioids, anaesthetics and sedatives. Ethics and dissemination The Partners
Human Research Committee approved this study (protocol number: 2014P000218).
Study results will be made available in the form of manuscripts for
publication and presentations at national and international meetings
