Summary

Despite controlling for age and BMI, patients with obstructive sleep apnea report worse physical health and shoulder function post-rotator cuff repair compared to healthy patients, despite no pre-operative differences.

Abstract

Introduction

Obstructive sleep apnea (OSA) prevalence in the general adult population is estimated to be 6-17%, and as high as 49% in older adults. These patients are at 45-59% greater risk of postoperative complications, such as hypoxemia, acute hypercapnia, as well as hyperalgesia, due to higher levels of inflammatory markers compared to patients without OSA. While older adults are at higher risk of OSA, they are also at a higher risk of having a rotator cuff tear (RCT). Previous research has shown 30% of adults >60 years and 62% of adults >80 years have a RCT. Given the prevalence of OSA and RCT in older adults, OSA may negatively affect parameters of mental, physical health, and shoulder function in patients recovering from rotator cuff repair (RCR). The purpose of this study was to compare patient reported outcomes (PROs) between OSA patients and controls that underwent RCR.

Methods

A retrospective review of patients who underwent RCR by 5 fellowship-trained orthopedic surgeons between 2014 and 2019 was performed. Patient medical history was screened for a diagnosis of OSA or deemed at high risk by STOP BANG questionnaire. All patients were asked to complete PROs pre-operatively, at 3, and 6 months post-operatively. A mixed-model ANOVA was performed with age and BMI as covariates due to higher age and BMI increasing OSA risk as well as being associated with worse outcomes following RCR.

Results

Data from 91 (44 female) control and 89 (24 female) OSA patients were available for analysis. As expected as OSA risk increases with male sex, higher BMI, and age; mean BMI (25.1 ± 4.0 kg/m2 vs. 30.4 ± 5.1 kg/m2), age (57.7 ± 11.8 years vs. 61.7 ± 8.7 years), were significantly higher in the OSA group (p<0.05). In addition, there were also significantly less females in the OSA group compared to control (p<0.05). There was no significant effect of OSA for VAS, VR-12 mental scores, and SANE (p>0.05). However, OSA patients had a significantly lower ASES score compared to control (66.79 ± 21.03 vs. 60.95 ± 21.70, respectively, p<0.05) when adjusted for age and BMI, but no interaction effect with time (p>0.05). In contrast, VR-12 physical scores showed a significant interaction effect of time and OSA condition, when adjusted for age and BMI. More specifically, control patients at both 3 months (41.0 ± 1.0 vs. 37.1 ± 1.0, p<0.05) and 6 months (49.2 ± 1.2 vs. 42.3 ± 1.3, p<0.05) reported better physical health post-RCR compared to OSA patients. Lastly, the difference in 6-month VR-12 physical scores between groups met minimal clinical important difference (MCID) criteria.

Conclusion

The findings of our study suggest PROs related to shoulder pain and mental health among OSA patients that underwent RCR are not significantly different from healthy patients. However, our results show despite controlling for age and BMI, patients with OSA report significantly worse physical health post-operatively and shoulder function compared to healthy patients.