Abstract Background Obstructive sleep apnea (OSA) is associated with increased risk for several comorbidities, with the most prominent being obesity. Obesity is strongly linked to the development of macromastia, a primary indication for breast reduction. It is highly important to assess whether OSA serves as an independent risk factor for postoperative complications. Objectives To assess the rates of short- and long-complications following breast reduction, in obese patients (BMI 30) with and without documented OSA. Methods A retrospective cohort analysis was conducted using the TriNetX Global Collaborative-Network. Patients 18-years, with BMI 30, who underwent breast reduction were divided into two groups: those with documented OSA prior to surgery and those with no history of OSA. Propensity score matching (PSM) was applied to balance demographic and clinical variables. Primary outcomes included short-term postoperative complications at 30-, 60-, and 90-days. Secondary outcomes included long-term complications after 1- and 2-years. Results After 1:1 PSM, each cohort consisted of 3,414 patients. Within 30-days post-surgery, patients in the OSA cohort had a significantly increased risk of surgical site infection (RR: 1.444, p=0.02), readmission (RR: 1.512, p=0.03), inpatient hospitalization (RR: 1.326, p=0.04), and opioid use (RR: 1.122, p0.0001) compared to the control group. Results remained consistent at 60- and 90-days post-surgery. For long-term outcomes, OSA patients had reduced rates of breast deformity at 1-year and surgical revision rates at 2-years. Conclusions OSA is associated with increased risk for short-term postoperative complications following breast reduction surgery. However, OSA was paradoxically associated with lower rates of breast deformity and surgical revision.
Zontag et al. (Sun,) studied this question.