Systematic review of the association between sleep apnea and postoperative complications after ENT surgery

Objective: This systematic review aims to determine whether patients with obstructive sleep apnea (OSA) undergoing Ear, Nose, and Throat (ENT) surgery have an increased risk of postoperative complications. Methods: The review followed the Preferred Reporting Items of Systematic Reviews guidelines. A comprehensive search was conducted in Medline, EMBASE, Cochrane CENTRAL, CINAHL, and Google Scholar. The search was performed and updated the on 27th of August 2024 and included all studies involving adults diagnosed with obstructive sleep apnea (OSA) undergoing ENT surgery. Studies focused on OSA-specific surgeries were excluded. The ROBINS-I tool was used to assess the risk of bias for the included studies. The primary outcome was all reported postoperative complications. Results: The search identified 18,487 articles, with 88 full-text articles reviewed. Three studies, encompassing 1,071 patients, were finally included. The complications reported were desaturation, postoperative hypertension, and infections. All three studies had a serious risk of bias. Conclusion: This review finds an increased risk of specific complications, including desaturation, hypertension, and infection, in OSA patients undergoing ENT surgery. However, the current body of evidence is significantly limited by the small sample sizes, heterogeneity in study design, variability in diagnostic methods, and inconsistent outcome reporting across the included studies. These limitations hinder the ability to draw definitive conclusions or establish clear recommendations regarding the perioperative management of OSA patients in ENT settings, including whether routine postoperative admission is warranted. The findings emphasize the urgent need for more rigorous, high-quality research to guide clinical decision-making.