BACKGROUND: Obstructive sleep apnea (OSA) has been associated with postoperative complications. We hypothesized that postoperative auto-titrating positive airway pressure (APAP) applied to patients at high-risk for OSA would shorten hospital stay and reduce postoperative complications. METHODS: Included were patients aged 18 to 100 years scheduled for elective total knee or hip arthroplasty, and able to give informed consent. Patients without contraindication to positive airway pressure therapy (PAP) were divided into a high-risk or low-risk group based on the Flemons sleep apnea clinical score. Low-risk patients received standard care. High-risk patients were randomized to receive standard care, or standard care plus postoperative APAP. All patients were administered a pre-dismissal, cardio-respiratory sleep study. The primary endpoint was length of stay, while secondary endpoints were a range of postoperative complications. RESULTS: One hundred thirty-eight patients were enrolled in the study. There were 52 in the low-risk and 86 in the high-risk group. Within the high-risk group, 43 were randomized to standard care and 43 to receive postoperative APAP plus standard care. There were no significant differences in the length of stay (p = 0.65) or any of the secondary endpoints between the randomized groups. On subgroup analysis of patients with an AHI of >= 15, patients randomized to APAP had a longer postoperative stay (median 5 days versus 4 days, p = 0.02). CONCLUSIONS: The role for empiric postoperative APAP requires further study, but our findings did not show benefit for APAP applied postoperatively to PAP naive patients at high-risk for sleep apnea.

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