Impact of spinal versus general anaesthesia on perioperative obstructive sleep apnoea severity in patients undergoing hip arthroplasty: a post hoc analysis of two randomised controlled trials.

Background: Recommendations suggest favouring regional over general anaesthesia to reduce impact on postoperative sleep apnoea severity, but there is currently no evidence to support this. We compared the impact of general vs spinal anaesthesia on postoperative sleep apnoea severity and assessed the evolution of sleep apnoea severity up to the third postoperative night.

Methods: This post hoc analysis used pooled data from two previous randomised controlled trials in patients undergoing total hip arthroplasty under general or spinal anaesthesia (n=96), without performing a preliminary power analysis. All participants underwent respiratory polygraphy before surgery and on the first and third postoperative nights. The primary outcomes were the supine apnoea-hypopnea index on the first postoperative night and the evolution of the supine apnoea-hypopnea index up to the third postoperative night. Secondary outcomes included the oxygen desaturation index on the first and third postoperative nights.

Results: In the general and spinal anaesthesia groups, mean (95% confidence interval) values for the supine apnoea-hypopnoea index on the first postoperative night were 20 (16-25) and 21 (16-26) events h (P=0.82), respectively; corresponding values on the third postoperative night were 34 (22-45) and 35 (20-49) events h (P=0.91). The generalised estimating equations model showed a significant time effect. Secondary outcomes were similar in the two groups.

Conclusions: Use of spinal anaesthesia compared with general anaesthesia was not associated with a reduction in postoperative sleep apnoea severity, which was worse on the third postoperative night.

Clinical Trial Registration: NCT02717780 and NCT02566226.