Effects of obstructive sleep apnea on postoperative outcomes following carpal tunnel release: A matched cohort analysis

Catherine Hand; Camden Bohn; Jared Sasaki; Henry Eilen; Brian Forsythe

doi:10.1016/j.jorep.2025.100696

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Research Article

2026

:5;

100696

doi:

10.1016/j.jorep.2025.100696

Effects of obstructive sleep apnea on postoperative outcomes following carpal tunnel release: A matched cohort analysis

Catherine Hand, Camden Bohn, Jared Sasaki, Henry Eilen, Brian Forsythe

Rush University Medical Center, Chicago, IL, USA

⁎Corresponding author: Brian Forsythe. forsythe.research@rushortho.com

Received: 2025-4-28, Accepted: 2025-5-25, Published: 2025-5-30

Disclaimer:
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Obstructive sleep apnea (OSA) has been linked to adverse perioperative outcomes in major orthopedic surgeries, yet its impact on minor ambulatory procedures such as carpal tunnel release (CTR) remains poorly understood. This study aimed to assess whether OSA is associated with increased postoperative complications following CTR.

A retrospective cohort analysis was conducted using the PearlDiver national insurance claims database to identify patients who underwent CTR between 2010 and 2021. Of 315,809 identified cases, 231,598 met inclusion criteria. Patients with a documented diagnosis of OSA prior to surgery (n = 42,040) were matched 1:1 to controls without OSA (n = 36,561 per group) based on age category (<55 vs. ≥55 years) and sex. Preoperative comorbidities were assessed using ICD codes, and postoperative complications within 90 days were identified using CPT and ICD codes. Multivariable logistic regression models were used to adjust for age, sex, Charlson Comorbidity Index, and relevant comorbidities.

A total of 73,122 patients were included (36,561 per cohort). The OSA group had higher rates of several comorbidities, including obesity, hypertension, COPD, CHF, and pulmonary hypertension (all p < 0.001). On adjusted analysis, OSA was associated with an increased risk of deep vein thrombosis (OR 0.56; 95 % CI, 0.37–0.84; p = 0.006) and a small but statistically significant increase in the risk of any postoperative complication (OR 0.93; 95 % CI, 0.86–0.99; p = 0.030). No significant differences were observed in surgical site infection, pulmonary embolism, wound disruption, readmission, or reoperation rates.

Although CTR is generally considered a low-risk procedure, patients with OSA experienced modestly elevated postoperative complication rates, particularly for thromboembolic events. These findings suggest that OSA may contribute to perioperative risk even in minor hand surgeries and support the need for individualized preoperative assessment and perioperative planning in this population.

Keywords

Obstructive sleep apnea

Carpal tunnel release

Postoperative complications

Hand surgery

Orthopedic surgery

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1 Introduction

Obstructive sleep apnea (OSA) is a chronic and underdiagnosed condition affecting an estimated 20–30 % of men and 10–15 % of women globally, with incidence rising in tandem with increasing rates of obesity and aging populations.¹ Characterized by recurrent episodes of upper airway collapse during sleep, OSA results in repeated arousals, intermittent hypoxia, hypercapnia, and sympathetic nervous system activation.¹^,² The consequences of these physiologic perturbations extend beyond sleep quality and daytime fatigue, as OSA is now recognized as a multisystem disorder linked to hypertension, pulmonary hypertension, insulin resistance, and systemic inflammation.^2–4

In surgical populations, OSA has emerged as an important perioperative risk factor, associated with increased rates of respiratory complications, prolonged hospital stays, difficult airway management, delayed recovery from anesthesia, and increased healthcare utilization.⁵ Particularly in the fields of cardiac surgery, studies have shown that OSA can increase the risk of postoperative pneumonia, venous thromboembolism (VTE), and cardiac events.⁶ Despite growing awareness of the implications of OSA in surgical care, its impact in the context of less invasive procedures, such as carpal tunnel release (CTR), has not been extensively explored.

Carpal tunnel release (CTR) is one of the most commonly performed elective orthopedic procedures in the United States, with an estimated 600,000 cases conducted annually.⁷ It is typically performed under local or regional anesthesia and is generally considered low risk, with short operative times and high success rates.⁸^,⁹ However, patients undergoing CTR are not universally exempt from perioperative risk, particularly those with systemic conditions such as diabetes, obesity, and cardiovascular disease, which are known to increase the likelihood of postoperative complications.^10–12 OSA, which frequently coexists with these comorbidities, independently induces a pro-inflammatory, pro-thrombotic state through intermittent hypoxia, sympathetic overactivity, and endothelial dysfunction.^13–15 This pathophysiologic profile raises the possibility that even patients undergoing relatively minor procedures like CTR may be at elevated risk for adverse outcomes if they also carry a diagnosis of OSA.

Existing literature evaluating the role of OSA in orthopedic surgery has largely focused on major procedures, such as total joint arthroplasty and spinal fusion, where prolonged operative duration, substantial blood loss, and inpatient recovery introduce additional risk.¹⁶^,¹⁷ However, the extent to which OSA influences outcomes in low-acuity, outpatient orthopedic interventions like CTR remains poorly understood. This gap in evidence is clinically meaningful, as CTR patients with underlying OSA may be incorrectly triaged as low risk, potentially resulting in inadequate perioperative monitoring, anesthesia planning, or thromboprophylaxis.¹⁸

While the association between OSA and surgical risk is well established in major orthopedic and general surgeries, its relevance to minor ambulatory procedures such as CTR has not been well-characterized. Our study addresses this gap by demonstrating that the systemic effects of OSA may remain clinically relevant even in low-risk settings.

The objective of this study was to assess whether patients with OSA undergoing CTR experience higher postoperative complication rates compared to matched patients without OSA. Leveraging a large national administrative claims database, we hypothesized that patients with OSA would demonstrate higher rates of venous thromboembolism, wound-related complications, and overall postoperative morbidity, even after adjusting for age, sex, and major comorbidities.

2 Methods

2.1

2.1 Data source and study design

This retrospective cohort study utilized the PearlDiver national claims database to investigate the relationship between OSA and postoperative outcomes following CTR. PearlDiver aggregates de-identified patient-level data from Medicare, Medicaid, and private insurance claims across the United States. The database includes longitudinal data coded with ICD-9, ICD-10, and CPT classifications, enabling detailed tracking of procedures, diagnoses, and complications across care episodes.

Patients who underwent CTR between 2010 and 2021 were identified using CPT and ICD procedural codes. Demographic information, comorbidity profiles, and short-term outcomes were extracted to examine how OSA may influence the risk of perioperative morbidity following CTR.

2.2

2.2 Cohort selection and matching

Patients were divided into two cohorts: (1) an OSA group consisting of patients with a documented diagnosis of OSA before CTR, and (2) a control group composed of patients with no history of OSA. Matching was performed in a 1:1 ratio based on age category (<55 vs. ≥55 years), sex, Charlson Comorbidity Index (CCI), alcohol abuse, tobacco abuse, obesity, diabetes, coagulopathy, coronary artery disease, and osteoarthritis to minimize baseline demographic differences. This approach ensured that the two cohorts were comparable with respect to known demographic risk factors for surgical outcomes.

2.3

2.3 Baseline characteristics and comorbidity assessment

Preoperative comorbidities were identified using ICD-9 and ICD-10 codes documented prior to the index CTR procedure. Conditions selected for analysis included those previously associated with increased perioperative risk, such as asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), congestive heart failure (CHF), diabetes mellitus, hypertension (HTN), obesity, pulmonary hypertension (PHD), and others with potential influence on surgical outcomes.

A total of 315,809 patients who underwent CTR were initially identified. After applying continuous enrollment criteria and excluding duplicate procedures, 231,598 patients remained. Of these, 42,040 patients had a documented diagnosis of OSA prior to surgery, and 189,558 served as potential controls. After 1:1 matching based on age, sex, CCI, and key comorbidities, 73,122 patients were included in the final matched cohort (36,561 per group).

Each cohort included 36,561 patients. Despite equivalent demographic distributions, the OSA group demonstrated significantly greater medical complexity. Respiratory comorbidities were more common in the OSA cohort, including asthma (2784 [7.61 %] vs. 1591 [4.35 %]; p < 0.001), COPD (4644 [12.70 %] vs. 4004 [10.95 %]; p < 0.001), and pulmonary hypertension (768 [2.10 %] vs. 370 [1.01 %]; p < 0.001). Cardiovascular conditions were also more prevalent, including CHF (665 [1.82 %] vs. 564 [1.54 %]; p = 0.004), CAD (4396 [12.02 %] vs. 3973 [10.87 %]; p < 0.001), and HTN (19,138 [52.35 %] vs. 17,527 [47.94 %]; p < 0.001). In addition, the OSA group had higher rates of obesity (9958 [27.24 %] vs. 6509 [17.80 %]; p < 0.001), deficiency anemia (1452 [3.97 %] vs. 1297 [3.55 %]; p = 0.003), and tobacco use (5139 [14.06 %] vs. 4849 [13.26 %]; p = 0.002).

Conversely, OSA patients were significantly less likely to have certain comorbidities, including diabetes mellitus (10,820 [29.59 %] vs. 11,227 [30.71 %]; p = 0.001), CKD (1608 [4.40 %] vs. 1767 [4.83 %]; p = 0.005), osteoarthritis (6323 [17.30 %] vs. 6986 [19.10 %]; p < 0.001), rheumatoid arthritis (589 [1.61 %] vs. 682 [1.87 %]; p = 0.009), ischemic heart disease (IHD) (2142 [5.86 %] vs. 2522 [6.89 %]; p < 0.001), and cancer (3408 [9.32 %] vs. 3705 [10.13 %]; p < 0.001).

There were no statistically significant differences between groups in alcohol abuse (p = 0.131), liver disease (p = 0.673), or coagulopathy (p = 0.055) (Table 1).

Table 1 Matched cohort patient demographics.

Carpal Tunnel
Variable	Control	OSA	p-value
Age <55	10583	10583
Age >55	23676	23676
Male	16646	16646
Female	19915	19915
Asthma	1591	2784	<0.001
COPD	4004	4644	<0.001
CKD	1767	1608	0.005
CHF	564	665	0.004
CAD	3973	4396	<0.001
Diabetes Mellitus	11227	10820	0.001
HTN	17527	19138	<0.001
IHD (ischemic heart)	2522	2142	<0.001
Obesity	6509	9958	<0.001
Osteoarthritis	6986	6323	<0.001
PHD	370	768	<0.001
RheumArthritis	682	589	0.009
TobaccoUse	4849	5139	0.002
Alcohol Abuse	253	289	0.131
Liver Disease	1537	1561	0.673
Cancer	3705	3408	<0.001
Coagulopathy	373	428	0.055
Deficiency Anemia	1297	1452	0.003

2.4

2.4 Outcome measures and adverse events

The primary outcome was the incidence of postoperative complications occurring within 90 days of the index CTR. Complications were identified using standardized sets of ICD and CPT codes and included surgical site infection (SSI), deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, acute kidney injury (AKI), arrhythmia, wound disruption, hematoma, nerve injury, urinary tract infection (UTI), transfusion, readmission, and reoperation. A composite outcome of “any complication” was also analyzed to capture the overall burden of postoperative morbidity. All outcomes were limited to the 90-day postoperative period to ensure consistency with standard surveillance windows.

2.5

2.5 Statistical analysis

Descriptive statistics were used to summarize patient demographics, comorbidity prevalence, and outcome frequencies. Categorical variables were compared using chi-square tests, and continuous variables were compared using Student's t-tests where applicable. A two-tailed p-value of <0.05 was considered statistically significant.

Multivariable logistic regression models were constructed to evaluate the independent association between OSA and each postoperative complication. The models were adjusted for potential confounding variables, including age, sex, CCI, diabetes mellitus, osteoarthritis, obesity, tobacco use, alcohol abuse, coagulopathy, and coronary artery disease. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated for each outcome. All statistical analyses were conducted using R version 3.6.0 (R Foundation for Statistical Computing, Vienna, Austria) within the PearlDiver analytics platform.

2.6

2.6 Ethical considerations

The study was exempt from institutional review board (IRB) oversight due to the use of anonymized, de-identified data in accordance with HIPAA guidelines and federal research standards.

3 Results

3.1

3.1 Postoperative outcomes

Patients with OSA experienced significantly higher rates of certain postoperative complications within 90 days following CTR. The incidence of DVT was significantly greater in the OSA group compared to controls (193 [0.53 %] vs. 112 [0.31 %]; OR: 0.56, 95 % CI: 0.37–0.84; p = 0.006). While pneumonia occurred more frequently among OSA patients (973 [2.66 %] vs. 848 [2.32 %]; p = 0.003), this difference was not statistically significant after multivariable adjustment (adjusted p = 0.054). Similarly, although UTI was slightly less common in the OSA group (2051 [5.61 %] vs. 2214 [6.05 %]; p = 0.011), this did not remain significant after adjustment (adjusted p = 0.893).

There were no significant differences between groups in the rates of surgical site infection (p = 0.061), pulmonary embolism (p = 0.644), acute kidney injury (p = 0.373), arrhythmia (p = 0.656), wound disruption (p = 0.083), hematoma (p = 0.839), nerve injury (p = 0.366), transfusion (p = 0.292), reoperation (p = 0.514), or hospital readmission (p = 0.778) within 90 days of surgery (Table 2).

Table 2 Complications within 90 days following shoulder arthroplasty.

Carpal Tunnel
Adverse Events^a	Control	OSA	p-value	OR (95 % CI)	Adjusted p-value
Surgical Site Infection	304	351	0.071	0.78 (0.60–1.01)	0.061
DVT	112	193	<0.001	0.56 (0.37–0.84)	0.006
Pulmonary Embolism	91	92	1.000	1.11 (0.71–1.77)	0.644
Acute Kidney Injury	686	659	0.474	1.10 (0.89–1.36)	0.373
Arrhythmia	35	35	1.000	1.22 (0.51–3.03)	0.656
Wound Disruption	167	179	0.553	0.76 (0.55–1.04)	0.083
Hematoma	108	116	0.640	1.04 (0.69–1.57)	0.839
Nerve Injury	70	66	0.797	1.22 (0.79–1.93)	0.366
Pneumonia	848	973	0.003	0.83 (0.69–1.00)	0.054
Transfusion	119	95	0.115	1.39 (0.76–2.58)	0.292
UTI	2214	2051	0.011	0.99 (0.89–1.11)	0.893
Reoperation	41	52	0.300	0.75 (0.31–1.77)	0.514
Readmission	458	466	0.817	0.98 (0.86–1.12)	0.778
Any Complication	4315	4377	0.486	0.93 (0.86–0.99)	0.030

a Adjusted for: age, gender, diabetes, osteoarthritis, obesity, tobacco use, alcohol abuse, coagulopathy, coronary artery disease, CCI.

3.2

3.2 Complications and reoperations

The overall incidence of any postoperative complication was significantly higher in the OSA group compared to controls (4377 [11.97 %] vs. 4315 [11.80 %]; OR: 0.93, 95 % CI: 0.86–0.99; p = 0.030). This difference persisted after adjustment for age, sex, and comorbidities. However, there were no statistically significant differences between groups in the rates of reoperation within 90 days of surgery (Table 2).

4 Discussion

This study is an analysis of the association between OSA and postoperative outcomes in patients undergoing CTR. The principal findings of the present investigation are: (1) OSA in patients undergoing CTR is associated with a significantly increased risk of DVT and a modest but significant increase in overall postoperative complications; (2) while pneumonia and UTI showed statistical significance on unadjusted analysis, these associations were not sustained after multivariable adjustment; and (3) these findings highlight the need for tailored perioperative risk stratification and management in OSA patients, even for minor ambulatory orthopedic procedures.

4.1

4.1 OSA and perioperative complications in CTR

Our finding that OSA was independently associated with a higher risk of DVT following CTR supports the pathophysiologic link between OSA and hypercoagulability described in prior studies. Recurrent hypoxic episodes during sleep in OSA lead to sympathetic overactivation, systemic inflammation, and increased expression of prothrombotic mediators such as fibrinogen and plasminogen activator inhibitor-1.¹³^,¹⁹^,²⁰ These mechanisms have been associated with elevated VTE risk in orthopedic and general surgery cohorts and appear to extend to lower-risk procedures such as CTR.²¹^,²²

Importantly, DVT prophylaxis is not routinely implemented for CTR patients, and yet our results suggest that OSA may independently increase thromboembolic risk. This has potential clinical implications, especially in patients with additional risk factors like obesity, immobility, or prior history of VTE.²³^,²⁴

The overall higher complication rate observed in OSA patients likely reflects the cumulative effects of systemic comorbidity and physiologic dysregulation. In our cohort, patients with OSA had significantly higher rates of obesity, hypertension, coronary artery disease, congestive heart failure, asthma, COPD, pulmonary hypertension, tobacco use, and anemia, all of which may amplify the risk of postoperative complications, even in a procedure as minimally invasive as CTR.²⁵^,²⁶

This extends prior research by illustrating that even brief, outpatient procedures are not exempt from the physiologic consequences of untreated OSA.

4.2

4.2 The apparent associations with pneumonia and UTI

Our analysis also revealed a higher unadjusted rate of pneumonia and a lower unadjusted rate of UTI in OSA patients. However, neither association remained statistically significant after adjustment for demographic and comorbidity variables. The elevated pneumonia risk may be attributable to coexisting pulmonary disease, such as asthma and COPD, which were more prevalent in the OSA group and are themselves known to increase the risk of lower respiratory tract infections.²⁷^,²⁸

Similarly, the lower observed rate of UTI in OSA patients may be spurious or reflective of unmeasured confounding, such as differences in bladder catheterization practices, health-seeking behavior, or coding variability.²⁹ It is also possible that patients with OSA are more likely to receive preoperative counseling and perioperative support, which could reduce exposure to modifiable risks for UTI. These findings should be interpreted cautiously.

4.3

4.3 Overall morbidity and the ambulatory surgery context

Perhaps the most notable finding is that OSA was associated with a modest but statistically significant increase in the overall risk of “any complication” within 90 days of CTR (adjusted OR: 0.93, p = 0.030). While the absolute difference in rates was small (11.97 % vs. 11.80 %), this result underscores that OSA-related vulnerability extends beyond major procedures. Given that CTR is often performed in ambulatory settings, under local or regional anesthesia, and with early discharge, these findings challenge the assumption that OSA does not meaningfully impact low-acuity orthopedic care.⁷^,¹²^,¹⁶ Prior research on ambulatory hand surgery has often focused on its low overall complication rates, yet our data suggest that certain systemic comorbidities, such as OSA, may elevate risks even in this setting.²⁶

Although the absolute increase in overall complications was modest (0.17 %), when extrapolated to hundreds of thousands of CTR procedures annually in the U.S., even small relative increases may impact a significant number of patients. Furthermore, in the context of ambulatory surgery, where postoperative monitoring is limited, this marginal increase may carry disproportionate weight for select high-risk individuals.

4.4

4.4 Clinical implications

Our results highlight the importance of early identification and proactive perioperative planning for patients with OSA, even in minor surgical settings. For patients undergoing CTR, preoperative screening tools like the STOP-Bang questionnaire can help flag those at elevated risk.¹⁴^,¹⁵ When OSA is identified, care teams may consider implementing individualized care plans that include CPAP optimization, reduced sedative use, and vigilant monitoring for VTE and pulmonary complications.¹^,²^,²¹

While we do not advocate for routine thromboprophylaxis in CTR, our findings suggest that selected OSA patients with additive risk factors (e.g., obesity, prior VTE) may benefit from individualized VTE risk assessment. These results are best interpreted as hypothesis-generating and underscore the importance of tailored perioperative planning rather than protocol-wide changes.

Given that OSA patients in this study demonstrated a significantly elevated burden of cardiopulmonary comorbidities, surgical decision-making should incorporate comprehensive risk stratification, even for low-risk procedures.³^,⁵^,²⁵Although not centered on surgical technique, this study provides valuable insight for orthopedic surgeons tasked with preoperative assessment, anesthesia planning, and discharge decisions in medically complex patients.¹⁷^,¹⁸

4.5

4.5 Future directions

This study offers preliminary insight into the potential impact of OSA on CTR outcomes, but several unanswered questions remain. Future prospective studies should explore the role of OSA severity, treatment adherence (particularly continuous positive airway pressure [CPAP] compliance), and intraoperative ventilation techniques on surgical recovery and complication profiles.³⁰^,³¹ Additionally, research into patient-reported outcomes, functional recovery, and resource utilization could clarify the broader healthcare implications of sleep-disordered breathing in outpatient orthopedic surgery.³²^,³³

Finally, as healthcare moves toward precision-based care, developing validated perioperative risk calculators that incorporate OSA status may improve surgical planning and patient counseling across procedural risk levels.³⁴

7 Limitations

Although this study benefits from a large, nationally representative sample and robust matching methodology, several limitations must be acknowledged when interpreting the association between OSA and postoperative outcomes following CTR. The retrospective nature of this study, relying on administrative claims data from the PearlDiver database, inherently limits the ability to establish causality. Outcomes and exposures were identified through ICD-9, ICD-10, and CPT codes, which are subject to potential coding errors, misclassification, or underreporting. For example, complications that were not coded or occurred outside of the reimbursed clinical episode may have been missed, particularly those managed conservatively in outpatient settings and not captured in billing records.

Although patients were matched by age and sex, and multivariate models adjusted for key comorbidities and the Charlson Comorbidity Index, residual confounding remains possible. Important clinical variables, such as functional status, surgical technique, operative duration, anesthesia type, and postoperative care protocols, were not available and could not be controlled for in the analysis. The dataset lacks granularity on OSA-specific factors that may significantly influence outcomes. Information on the severity of OSA (e.g., apnea-hypopnea index), diagnostic modality (polysomnography vs. clinical diagnosis), and adherence to CPAP therapy is not available and therefore limit the ability to draw causal inferences from our findings. These variables likely influence perioperative risk but could not be incorporated into our models. As a result, this analysis may underestimate or fail to detect outcome differences stratified by OSA severity or treatment compliance.

Additionally, PearlDiver does not provide direct clinical outcome measures such as grip strength, nerve conduction recovery, or patient-reported symptom resolution following CTR. Therefore, the impact of OSA on functional recovery and subjective improvement cannot be assessed in this study. However, our focus was to examine perioperative medical risks that may impact clinical decision-making and patient safety in the ambulatory surgical setting.

As this analysis is limited to patients with documented procedural and diagnostic codes, there is potential for selection bias. Patients without coded diagnoses of OSA may include individuals with undiagnosed or untreated disease, which could attenuate observed differences between cohorts. Moreover, undiagnosed OSA cases may be present in the control group, which would bias results toward the null and likely underestimate the true magnitude of association. Despite these limitations, this study provides insights into the perioperative risks associated with OSA in the context of a common ambulatory orthopedic procedure.

8 Conclusion

In this large, matched cohort study of patients undergoing carpal tunnel release, OSA was independently associated with a significantly increased risk of deep vein thrombosis and a modest but statistically significant elevation in overall postoperative complication rates within 90 days of surgery. Although other adverse outcomes such as pneumonia and urinary tract infection demonstrated significance on unadjusted analysis, these associations did not persist after multivariable adjustment. These findings underscore that even for minor, ambulatory orthopedic procedures, OSA may confer a measurable increase in perioperative risk.

Given the high prevalence of OSA in the surgical population and its strong association with cardiopulmonary and metabolic comorbidities, our results support the consideration of heightened perioperative awareness, particularly in outpatient settings where formal monitoring may be limited. While routine thromboprophylaxis is not currently recommended for CTR, individualized risk assessment may be warranted in select OSA patients. Future prospective studies incorporating OSA severity, treatment adherence, and functional recovery metrics are essential to refine perioperative risk stratification and inform tailored surgical care pathways in this growing patient population.

CRediT authorship contribution statement

Catherine Hand: Writing – review & editing. Camden Bohn: Writing – review & editing. Jared Sasaki: Conceptualization, Methodology. Henry Eilen: Software, Validation. Brian Forsythe: Supervision, Project administration.

Ethical Statement for Solid State Ionics

Hereby, I Brian Forsythe consciously assure that for the manuscript “Effects of Obstructive Sleep Apnea on Postoperative Outcomes Following Carpal Tunnel Release: A Matched Cohort Analysis.” the following is fulfilled.1)This material is the authors' own original work, which has not been previously published elsewhere.2)The paper is not currently being considered for publication elsewhere.3)The paper reflects the authors' own research and analysis in a truthful and complete manner.4)The paper properly credits the meaningful contributions of co-authors and co-researchers.5)The results are appropriately placed in the context of prior and existing research.6)All sources used are properly disclosed (correct citation). Literally copying of text must be indicated as such by using quotation marks and giving proper reference.7)All authors have been personally and actively involved in substantial work leading to the paper, and will take public responsibility for its content.

The violation of the Ethical Statement rules may result in severe consequences.

To verify originality, your article may be checked by the originality detection software iThenticate. See also http://www.elsevier.com/editors/plagdetect.

I agree with the above statements and declare that this submission follows the policies of Solid State Ionics as outlined in the Guide for Authors and in the Ethical Statement.

Funding source declaration

This research was supported by internal department funds. No external funding was received for this project.

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[Google Scholar]

[26] Karl J.W., Gancarczyk S.M., Strauch R.J., . Complications of carpal tunnel release. Orthop Clin N Am. 2016;47(2):425-433.
[Google Scholar]

[27] Xiang B., Jiao S., Si Y., Yao Y., Yuan F., Chen R., . Risk factors for postoperative pneumonia: a case-control study. Front Public Health. 2022 Jul 8;10
[Google Scholar]

[28] Su V.Y., Liu C.J., Wang H.K., et al . Sleep apnea and risk of pneumonia: a nationwide population-based study. CMAJ (Can Med Assoc J). 2014 Apr 1;186(6):415-421.
[Google Scholar]

[29] Fernández-Pello S., Gil R., Escaf S., et al . Lower urinary tract symptoms and obstructive sleep apnea syndrome: Urodynamic evolution before and after one year of treatment with continuous positive airway pressure. Síntomas de tramo urinario inferior y síndrome de apnea obstructiva del sueño: evolución urodinámica antes y después de un año de tratamiento con presión continua positiva de la vía aérea. Actas Urol Esp. 2019;43(7):371-377.
[Google Scholar]

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[Google Scholar]

[31] Hai F., Porhomayon J., Vermont L., Frydrych L., Jaoude P., El-Solh A.A., . Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth. 2014;26(8):591-600.
[Google Scholar]

[32] Dempsey J.A., Veasey S.C., Morgan B.J., O'Donnell C.P., . Pathophysiology of sleep apnea [published correction appears in Physiol Rev.2010 Apr;90(2):797-8] Physiol Rev. 2010;90(1):47-112.
[Google Scholar]

[33] Wu W.Q., Zheng W.B., Wang H.B., Han J.H., Huang Y., Wang C.Y., . Influence of obstructive sleep apnea on postoperative cognitive dysfunction in elderly patients undergoing joint replacement. Am J Transl Res. 2022 Jun 15;14(6):4050-4057.
[Google Scholar]

[34] Vasu T.S., Grewal R., Doghramji K., . Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med. 2012;8(2):199-207.
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Effects of obstructive sleep apnea on postoperative outcomes following carpal tunnel release: A matched cohort analysis

Abstract