Effects of obstructive sleep apnea on postoperative outcomes following total shoulder arthroplasty: A matched cohort analysis

Introduction Obstructive sleep apnea (OSA), marked by recurrent airway obstruction and disrupted sleep, is linked to increased perioperative risk in major surgeries. However, its impact on total shoulder arthroplasty (TSA) remains unclear. This study investigates the association between OSA and postoperative outcomes. Methods This retrospective cohort study used the PearlDiver Mariner Database to identify patients who underwent TSA from 2010 to 2021. Patients with OSA were compared to a matched control group without OSA, with matching based on demographics and comorbidities. Postoperative complications , including deep vein thrombosis (DVT), pulmonary embolism (PE), surgical site infection (SSI), transfusions, and revision TSA, were identified using ICD and CPT codes. Multivariate logistic regression was used to adjust for confounders. Results A total of 57,118 TSA patients were included, with 50 % (n = 28,559) having a documented diagnosis of OSA. Patients with OSA had a significantly higher prevalence of comorbidities, including hypertension (65.0 % vs. 62.1 %, p < 0.001), obesity (27.3 % vs. 18.8 %, p < 0.001), asthma (8.7 % vs. 4.9 %, p < 0.001), and COPD (17.8 % vs. 14.4 %, p < 0.001). The incidence of DVT, PE, SSI, and wound disruption was not significantly different between groups. However, OSA was associated with a significantly higher risk of revision TSA within two years (0.3 % vs. 0.2 %; OR: 1.43, 95 % CI: 1.04–2.00; p = 0.028). Additionally, OSA patients had a significantly lower rate of blood transfusion (0.6 % vs. 0.8 %; OR: 0.68, 95 % CI: 0.55–0.83; p < 0.001). Conclusion OSA does not significantly raise the risk of acute complications after TSA but is linked to a higher rate of revision surgeries, suggesting a role in long-term failure, possibly from poor wound healing , systemic inflammation, or obesity-related stress. Preoperative screening and postoperative optimization may help reduce these risks. Further research is needed to assess the effects of OSA severity and CPAP adherence on TSA outcomes.