Risk of OSA in Patients with One Ovary After Hysterectomy
There is no direct evidence that having one ovary remaining after hysterectomy specifically increases the risk of obstructive sleep apnea (OSA). The available evidence does not establish a causal relationship between partial oophorectomy with hysterectomy and OSA development.
Understanding OSA Risk Factors
OSA is characterized by periodic, partial, or complete obstruction of the upper airway during sleep, which can lead to:
- Repetitive arousals from sleep
- Daytime hypersomnolence
- Episodic oxygen desaturation
- Cardiovascular dysfunction
According to the American Society of Anesthesiologists (ASA), the general prevalence of OSA is:
- 2% in women and 4% in men for overt OSA
- 9% in women and 24% in men for sleep-disordered breathing 1
Primary Risk Factors for OSA
The primary risk factors for OSA include:
- Obesity (most significant risk factor)
- Advanced age
- Male sex
- Family history
- Menopause
- Craniofacial abnormalities
- Health behaviors (smoking, alcohol use) 2
Hysterectomy and OSA Connection
While hysterectomy itself has not been directly linked to OSA development, there are several considerations:
Hormonal Changes: If both ovaries are removed (bilateral oophorectomy), the resulting surgical menopause could potentially increase OSA risk, as menopause is a known risk factor. However, with one ovary remaining, hormone production typically continues.
Surgical Complications: Research shows that patients with pre-existing OSA undergoing hysterectomy have higher risks of:
- Respiratory complications (OR 3.25)
- Renal complications (OR 1.98)
- ICU admission (OR 2.28) 3
Perioperative Considerations: OSA is underdiagnosed in the preoperative gynecologic surgical population, which can impact surgical outcomes 4
Clinical Implications
For patients with one ovary remaining after hysterectomy:
- Screening: Consider OSA screening if other risk factors are present (obesity, snoring, observed apneas, daytime sleepiness)
- Perioperative Management: If OSA is diagnosed or suspected, follow ASA guidelines for perioperative management:
- Avoid continuous opioid infusions
- Ensure full reversal of neuromuscular blockade before extubation
- Position patient in semi-upright or lateral position
- Use multimodal pain management to minimize opioid use 5
Conclusion
Having one ovary remaining after hysterectomy does not appear to be an independent risk factor for OSA development. Standard OSA risk assessment should focus on established risk factors such as obesity, age, menopause status, and clinical symptoms rather than ovarian status post-hysterectomy.