Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus

Aims

Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA.

Methods

Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing.

Results

Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity.

Conclusions

This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of “Neck grasp as a predictor of Sleep Apnea,” https://clinicaltrials.gov/ct2/show/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.

Sleep apnea and the impact on cardiovascular risk in patients with Marfan syndrome

Background

Marfan syndrome (MFS) is an inherited connective tissue disorder characterized by ectopia lentis, aortic root dilation and dissection and specific skeletal features. Obstructive sleep apnea (OSA) in MFS has been described earlier but the prevalence and its relation with the cardiovascular risk is still controversial. This study aimed to further investigate these aspects.

Methods

In this prospective longitudinal study, we performed an attended polysomnography in 40 MFS patients (60% women, 37 ± 12.8 years) and evaluated several cardiovascular parameters through echocardiography, resting electrocardiogram, 24 hr‐Holter monitoring and serum NT‐ProBNP measurements.

Results

We found that OSA was present in 42.5% of the patients and that higher body mass index was the most important factor associated with the presence of OSA. We observed that overweight was present in 27.5% of the patients in the whole cohort and in 55.6% if >40 years. Furthermore, when evaluating the impact of OSA on the cardiovascular system, we observed that patients with OSA tended to have higher systolic blood pressure, larger distal aortic diameters and a higher prevalence of ventricular arrhythmia. These differences were, however, not significant after adjusting for confounders.

Conclusions

Our study shows a high prevalence of OSA and a high prevalence of overweight in MFS patients. We found some trends between OSA and cardiovascular features but we could not establish a solid association. Our study, however might be underpowered, and a multicenter collaborative study could be very useful to answer some important open questions.

Subjective Hunger, Gastric Upset, and Sleepiness in Response to Altered Meal Timing during Simulated Shiftwork

Shiftworkers report eating during the night when the body is primed to sleep. This study investigated the impact of altering food timing on subjective responses. Healthy participants (n = 44, 26 male, age Mean ± SD = 25.0 ± 2.9 years, BMI = 23.82 ± 2.59kg/m2) participated in a 7-day simulated shiftwork protocol. Participants were randomly allocated to one of three eating conditions. At 00:30, participants consumed a meal comprising 30% of 24 h energy intake (Meal condition; n = 14, 8 males), a snack comprising 10% of 24 h energy intake (Snack condition; n = 14; 8 males) or did not eat during the night (No Eating condition; n = 16, 10 males). Total 24 h individual energy intake and macronutrient content was constant across conditions. During the night, participants reported hunger, gut reaction, and sleepiness levels at 21:00, 23:30, 2:30, and 5:00. Mixed model analyses revealed that the snack condition reported significantly more hunger than the meal group (p < 0.001) with the no eating at night group reporting the greatest hunger (p < 0.001). There was no difference in desire to eat between meal and snack groups. Participants reported less sleepiness after the snack compared to after the meal (p < 0.001) or when not eating during the night (p < 0.001). Gastric upset did not differ between conditions. A snack during the nightshift could alleviate hunger during the nightshift without causing fullness or increased sleepiness.

Preoperative Sleep Questionnaires Identify Medical Emergency Team Activation in Older Adults

Patients with obstructive sleep apnea (OSA) have increased postoperative complications that are important for patient safety and healthcare utilization. Questionnaires help identify patients at risk for OSA; however, among older adults who preoperatively self-administered OSA questionnaires, the frequency of postoperative Medical Emergency Team Activation (META), rapid response, code blue, code stroke, is unknown.

OBJECTIVES

Identify whether having OSA questionnaires completed by patients is feasible in the preoperative clinic. Determine the frequency of META among older patients at risk for OSA.

DESIGN AND INTERVENTION

Cohort of prospective patients independently completed 2 OSA questionnaires in a preoperative clinic, STOP-Bang (SB) and ISNORED (IS). Observers blinded to questionnaire responses recorded incidence of META.

SETTING AND PARTICIPANTS

Of the 898 consecutive patients approached in the preoperative assessment clinic and surgical navigation center, 575 (64%) consented and completed the questionnaires in <5 minutes and were included in the analysis.

MEASURES

Sleep questionnaire responses and frequency of inpatient postoperative META.

RESULTS

With an affirmative response to ≥3 questions on either questionnaire, 65% of patients enrolled were at risk for OSA. Of these, 3.1% sustained an META. In patients at risk for OSA, META occurred in 7.6% (SB+) and 7.2% (IS+) vs 2.5% (SB+) and 1.7% (IS+) for low risk. METAs were disproportionately higher among patients aged ≥65 years (6.3% vs 1.7%; P < .018), American Society of Anesthesiologists (ASA) physical status class ≥3, and IS+. All patients with META positively answered ≥3 of 15 components of the 2 questionnaires.

CONCLUSIONS/IMPLICATIONS

Preoperative, self-administration of SB and IS questionnaires is feasible. Overall, 65% of those with affirmative responses to ≥3 questions were at risk for OSA and associated with a disproportionate number of postoperative META in older patients. Additionally, risk of OSA identified by preoperative sleep questionnaires was associated with postoperative META among older adults. Use of clinical tools and OSA questionnaires may improve preoperative identification of META in this population.

Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment

PURPOSE OF REVIEW

This review aims to discuss the most recent data on sleep disorders and stroke, highlighting relevant findings for the practicing neurologist or health providers who encounter patients with sleep disorders and stroke.

RECENT FINDINGS

Sleep apnea and abnormal sleep duration have the strongest association with stroke risk. Possible mechanisms include non-dipping of blood pressure during sleep, hypoxemia or reoxygenation leading to sympathetic activation, hypertension, atrial fibrillation and impaired cerebral hemodynamics. Treatment studies suggest that continuous positive airway pressure (CPAP) for sleep apnea could improve primary prevention of stroke, but data is equivocal for secondary prevention. However, CPAP could improve functional outcomes after stroke.

SUMMARY

Sleep disorders present an opportunity to improve stroke risk and functional outcomes. However, new strategies are needed to determine the patients at high-risk who would most likely benefit from targeted care. Novel methods for phenotyping sleep disorders could provide personalized stroke care to improve clinical outcomes and public health strategies.

Snoring during Bronchoscopy with Moderate Sedation Is a Predictor of Obstructive Sleep Apnea

Background

Snoring is the cardinal symptom of obstructive sleep apnea (OSA). Snoring and upper airway obstruction associated with major oxygen desaturation may occur in populations undergoing flexible bronchoscopy.

Methods

To evaluate the prevalence of patients at a high risk of having OSA among patients undergoing bronchoscopy with sedation and to investigate whether snoring during the procedure predicts patients who are at risk of OSA, we prospectively enrolled 517 consecutive patients who underwent the procedure with moderate sedation. Patients exhibiting audible snoring for any duration during the procedure were considered snorers. The STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, Age, Neck circumference and Gender) questionnaire was used to identify patients at high (score ≥3 out of 8) or low risk (score <3) of OSA.

Results

Of the 517 patients, 165 (31.9%) snored during bronchoscopy under sedation. The prevalence of a STOP-Bang score ≥3 was 61.9% (320/517), whereas 200 of the 352 nonsnorers (56.8%) and 120 of the 165 snorers (72.7%) had a STOP-Bang score ≥3 (p=0.001). In multivariable analysis, snoring during bronchoscopy was significantly associated with a STOP-Bang score ≥3 after adjustment for the presence of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and stroke (adjusted odds ratio, 1.91; 95% confidence interval, 1.26–2.89; p=0.002).

Conclusion

Two-thirds of patients undergoing bronchoscopy with moderate sedation were at risk of OSA based on the screening questionnaire. Snoring during bronchoscopy was highly predictive of patients at high risk of OSA.

Health-related quality of life burden in severe asthma

It is largely unrecognised that the impacts of asthma are different in patients with severe disease compared with patients with mild to moderate disease. Severe asthma is associated with a significant health-related quality of life (HRQoL) burden due to excessive symptoms, frequent and life-threatening attacks, increased comorbidity burden, and high pharmacological treatment requirements. Interventions aimed at improving HRQoL need to be specifically tested in populations with severe asthma, including multicomponent interventions targeting the many clinical characteristics associated with the disease. It is necessary to have patient-reported outcome measures developed specifically for severe asthma. Public health messages recognising the significant burden of severe asthma on quality of life are needed.

Obstructive sleep apnoea in adults: peri-operative considerations: A narrative review

: Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients.The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids.The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome.

Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness

Sleep is an important determinant of collegiate athlete health, well-being and performance. However, collegiate athlete social and physical environments are often not conducive to obtaining restorative sleep. Traditionally, sleep has not been a primary focus of collegiate athletic training and is neglected due to competing academic, athletic and social demands. Collegiate athletics departments are well positioned to facilitate better sleep culture for their athletes. Recognising the lack of evidence-based or consensus-based guidelines for sleep management and restorative sleep for collegiate athletes, the National Collegiate Athletic Association hosted a sleep summit in 2017. Members of the Interassociation Task Force on Sleep and Wellness reviewed current data related to collegiate athlete sleep and aimed to develop consensus recommendations on sleep management and restorative sleep using the Delphi method. In this paper, we provide a narrative review of four topics central to collegiate athlete sleep: (1) sleep patterns and disorders among collegiate athletes; (2) sleep and optimal functioning among athletes; (3) screening, tracking and assessment of athlete sleep; and (4) interventions to improve sleep. We also present five consensus recommendations for colleges to improve their athletes’ sleep.

Pharmacological treatment for insomnia in patients with major depressive disorder

INTRODUCTION

Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice.

AREAS COVERED

Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD.

EXPERT OPINION

Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.

Nocturnal symptoms perceived as asthma are associated with obstructive sleep apnoea risk, but not bronchial hyper-reactivity

BACKGROUND AND OBJECTIVE

Obstructive sleep apnoea (OSA) and asthma are associated, and nocturnal breathing difficulty that is usually identified as asthma-like symptoms can be present in both conditions. We investigated how nocturnal asthma-like symptoms (NAS) and bronchial hyper-reactivity (BHR) contribute to the association between OSA risk and current asthma, which is currently unknown but a clinically important question.

METHODS

We used data from 794 middle-aged participants in a population-based cohort who provided information on OSA risk (defined by a STOP-Bang questionnaire score of at least 3), current asthma and NAS, and underwent methacholine bronchial challenge testing. Using regression models, we examined the association between OSA risk and current asthma-NAS subgroups and investigated any effect modification by BHR.

RESULTS

The participants were aged 50 years (49.8% male). OSA risk was associated with NAS with or without current asthma (odds ratio (OR): 2.6; 95% CI = 1.3-5.0; OR: 4.2; 95% CI = 1.1-16.1, respectively), but not with current asthma in the absence of NAS. BHR was associated with current asthma with or without NAS (OR: 2.9; 95% CI = 1.4-5.9; OR: 3.4; 95% CI = 2.0-7.0, respectively) but not with NAS in the absence of current asthma. The associations between OSA risk and current asthma were neither modified nor mediated by BHR.

CONCLUSION

Our findings suggest that some of the nocturnal symptoms perceived as asthma may be OSA symptoms. Patients with nocturnal asthma symptoms should be considered for possible OSA.

Estimating obstructive sleep apnea in Cyprus: a randomised, stratified epidemiological study using STOP-Bang sleep apnea questionnaire

INTRODUCTION

Several epidemiological studies have demonstrated that Obstructive Sleep Apnea (OSA) is a highly prevalent disorder in the general population and increases over time all over the world. The high prevalence is in part due to increasing rates of obesity. However, estimates of OSA prevalence in Southern Europe are generally lacking.

AIM

The aim of our study was to predict the risk of OSA in the general population of Cyprus, the southeast part of Europe, by using a dedicated questionnaire like STOP-Bang.

SUBJECTS AND METHOD

We screened 5736 sample housing units for eligible adults and a total population of 4118 eligible responders completed the STOP-Bang questionnaire. Participants were all adults, age 18 + residing in Cyprus. The sample was stratified according to the last demographic report (2016) by district, rural or urban area, gender and age and the estimated sample size needed was 2000. Our survey was conducted by Computer Aided Telephone Interviewing (CATI) method. The question about Neck Circumference was removed from the final evaluation due to the uncertainty of most of the participants and the risk of bias.

RESULTS

From a total of 4118 participants (2252 males - 54.7%, 1862 females - 45.3%), with 46.6% over 50 years old, 2641 (64.1%) were at low risk for OSA (0-2 positive answers), 1200 (29.1%) at intermediate risk (3-4 positive answers) and 277 (6.7%) at high risk (≥5 positive answers). In sum, 29.9% responded positively for snoring, 39.3% for feeling tired or sleepy during the day, 12.3% for observed apnea during sleep, and 24.6% for having or being treated for hypertension. Class II and III obesity with Body Mass Index (BMI) > 35 kgr/m² was observed in 192 subjects (4.7%). In the subpopulation of obese participants (BMI>30 kg/m²), intermediate to high risk of OSA was present in 45%, whereas in obesity class II and III the percentage reached almost 90%.

CONCLUSIONS

Our survey yielded that the prevalence of intermediate to high risk for OSA was 50% in males and 18% in females, in the general population of Cyprus. These findings were similar to previously reported high OSA prevalence worldwide, considering the fact that a single questionnaire is only a screening tool and cannot alone diagnose sleep apnea.

Identifying Patients Experiencing Opioid-Induced Respiratory Depression During Recovery From Anesthesia: The Application of Electronic Monitoring Devices

BACKGROUND

Postsurgical patients experiencing opioid-related adverse drug events have 55% longer hospital stays, 47% higher costs associated with their care, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality compared to those with no opioid-related adverse drug events. Most of the adverse events are preventable.

GENERAL AIM

This study explored three types of electronic monitoring devices (pulse oximetry, capnography, and minute ventilation [MV]) to determine which were more effective at identifying the patient experiencing respiratory compromise and, further, to determine whether algorithms could be developed from the electronic monitoring data to aid in earlier detection of respiratory depression.

MATERIALS AND METHODS

A study was performed in the postanesthesia care unit (PACU) in an inner city. Sixty patients were recruited in the preoperative admissions department on the day of their surgery. Forty-eight of the 60 patients wore three types of electronic monitoring devices while they were recovering from back, neck, hip, or knee surgery. Machine learning models were used for the analysis.

RESULTS

Twenty-four of the 48 patients exhibited sustained signs of opioid-induced respiratory depression (OIRD). Although the SpO₂ values did not change, end-tidal CO₂ levels increased, and MV decreased, representing hypoventilation. A machine learning model was able to predict an OIRD event 10 min before the actual event occurred with 80% accuracy.

LINKING EVIDENCE TO ACTION

Electronic monitoring devices are currently used as a tool to assess respiratory status using thresholds to distinguish when respiratory depression has occurred. This study introduces a potential paradigm shift from a reactive approach to a proactive approach that would identify a patient at high risk for OIRD. Capnography and MV were found to be effective tools in detecting respiratory compromise in the PACU.

Sleep disturbances in HIV-infected patients associated with depression and high risk of obstructive sleep apnea

OBJECTIVE

To evaluate sleep disturbances in a diverse, contemporary HIV-positive patient cohort and to identify demographic, clinical, and immune correlates.

METHODS

A convenience sample of 176 patients from a racially and ethnically diverse HIV-positive patient cohort in an urban population. This was a cross-sectional, epidemiologic study. We surveyed participants using multiple standardized instruments to assess depression, sleep quality, and risk for sleep apnea. We analyzed demographic, behavioral, and clinical correlates.

RESULTS

A total of 56% of participants were female, 75% Black and 64% had heterosexual HIV risk. The median age was 49 years. Poor sleep quality (Pittsburgh Sleep Quality Index > 5) was reported by 73% of patients and 52% met insomnia diagnosis criteria. A single question about self-reported sleep problems predicted a Pittsburgh Sleep Quality Index > 5 with a sensitivity and specificity of 82% and 81%, respectively. Female sex was significantly associated with higher risk of poor sleep quality, depression, and insomnia, whereas higher risk of obstructive sleep apnea was significantly associated with older age, male sex, obesity (body mass index ⩾ 30 kg/m2), and metabolic comorbidities. High risk for obstructive sleep apnea, high rate of depression, and poor sleep hygiene represent treatment targets for sleep problems in HIV patients.

CONCLUSION

Sleep disturbances were common in this patient cohort, although largely undiagnosed and untreated. Sleep problems are linked to worse disease progression and increased cardiovascular mortality. Screening for sleep problems with a single question had high sensitivity and specificity. In those patients with self-reported sleep problems, screening for obstructive sleep apnea, depression, and sleep hygiene habits should be part of routine HIV care.

Real-world STOPBANG: how useful is STOPBANG for sleep clinics?

PURPOSE

The STOPBANG questionnaire has been widely used for screening obstructive sleep apnea (OSA) due to its time friendly, economic advantages over overnight polysomnography (PSG). The aim of this study was to analyze the usefulness of the items constituting the utility of STOPBANG in a sleep clinic and to establish the best assembly for OSA-screening methods in the Korean population.

METHODS

We retrospectively analyzed all patients who completed PSG as well as STOPBANG at a sleep center in a tertiary hospital from January 2016 to December 2017. The sensitivity and specificity of STOPBANG and its smaller counterparts (i.e., SOPBAG) were compared.

RESULTS

A total of 541 subjects completed PSG and STOPBANG. Two hundred thirty-five patients were diagnosed with OSA (OSA+) and were compared to those who were not (OSA-). The respective scores of STOPBANG in OSA+ versus OSA- were 4.29 ± 1.46 and 2.53 ± 1.48 (p < 0.001). There were significant differences in all factors except tiredness and age (SOPBNG). STOPBANG showed sensitivity of 89.1% and specificity of 57.4%. The AUC was 0.809. Excluding tiredness as well as neck circumference (SOPBAG), the AUC was 0.811. The sensitivity and specificity were 71.8% and 77.9%, respectively. The AUC of SOPBAG was neither superior nor inferior to that of STOPBANG.

CONCLUSION

The screening value of STOPBANG for OSA did not perform as expected when compared to PSG for accuracy in Koreans. STOPBANG can be simplified to SOPBAG while maintaining comparable screening performance. It may be practical to consider performing PSGs without the use of the STOPBANG in Korea.

A sleep apnoea questionnaire predicts organ damage in hypertensive patients

BACKGROUND

Arterial hypertension is associated with obstructive sleep apnoea, poor quality and duration of sleep, which might contribute to hypertension-mediated organ damage.

METHODS

We investigated the presence of insomnia, restless legs syndrome, and obstructive sleep apnoea using validated questionnaires (Insomnia Severity Index, Restless Legs Syndrome Rating Scale, and STOP-Bang), and their relationship with hypertension-mediated organ damage, in hypertensive patients.

RESULTS

In 159 consecutive consenting hypertensive patients [age 47(11) years, median and (interquartile range), body mass index 25.5(5.9) kg/m², office systolic and diastolic blood pressure 144(23)/92(12) mmHg], the STOP-Bang, but not the other scores, predicted cardiac remodelling: compared to patients with a STOP-Bang score < 3, those at high risk of obstructive sleep apnoea showed higher left ventricular mass index [49.8(11.9) vs. 43.3(11.9) g/m^2.7, p < 0.0001], left atrium volume [25.7(2.5) vs. 25.0(2.8) ml/m², p = 0.003], and aortic root diameter [33.6(3.0) vs. 33.0(3.7) mm, p < 0.0001]. They did not differ for microalbuminuria and estimated glomerular filtration rate. At multivariate analysis, after adjustment for office systolic blood pressure values, the STOP-Bang score remained a predictor of left ventricular mass index; while the Insomnia Severity Index and restless legs syndrome risk score had no predictive value. However, a significant interaction between STOP-Bang and Restless Legs Syndrome Rating Scale scores in determining left ventricular remodelling was found.

CONCLUSIONS

In consecutive hypertensive stage I patients the STOP-Bang questionnaire allowed identification of a high-risk cohort featuring a more prominent cardiac damage. Hence, this inexpensive tool can be useful for risk stratification purposes in municipalities with limited access to health care resources.

Chronic Health Risks in Commercial Fishermen: A Cross-Sectional Analysis from a Small Rural Fishing Village in Alaska

OBJECTIVES

The purpose of this study is to evaluate chronic health risks before and during the fishing season in a sample of commercial fishermen, addressing the NIOSH priority of Total Worker Health^TM.

METHODS

Gillnet license holders in Cordova, Alaska (n = 607) were contacted to participate in a preseason survey (March 2015) assessing health behaviors. A mid-season survey (July 2015) was also conducted. Physical exams and additional assessments were performed on a subset of these fishermen.

RESULTS

Sixty-six fishermen participated in the preseason survey and 38 participated in the mid-season survey. The study population was overwhelmingly white males with an average age of 49. The average BMI was 27 with 70% of the participants overweight or obese. Nearly 80% of the sample considered their health good or better. Participants reported longer working hours, less sleep, and less aerobic exercise during the fishing season (P < .05). FitBit^TM monitoring (n = 8) confirmed less sleep and fewer steps during fishing season. In one exam (n = 20), 80% of participants showed measured hearing loss at 4 kz (conversation range), and 70% had one or more upper extremity disorders, including 40% with rotator cuff tendonitis.

CONCLUSIONS

The prevalence of hearing loss, upper extremity disorders, and sleep apnea risk factors were higher than in the general population both before and during the fishing season. Occupational factors including exposure to noise, the upper extremity demands of gillnetting, and long working hours while fishing exacerbate these chronic health conditions. Health promotion programs targeted toward these conditions may present opportunities for improving total worker health.

Implementation of an Obstructive Sleep Apnea Protocol in the Postanesthesia Care Unit for Patients Undergoing Spinal Fusion Surgery

PURPOSE

The purpose of this project was to implement and evaluate the effectiveness of a postanesthesia care unit (PACU) obstructive sleep apnea (OSA) protocol in patients undergoing spinal fusion surgery.

DESIGN

The structure of this project was a preimplementation and postimplementation design.

METHODS

A convenience sample of 63 patients admitted to the PACU after spinal fusion surgery, with diagnosed or high-risk OSA, was included in protocol implementation.

FINDINGS

The prevalence of diagnosed and high-risk OSA at the project implementation site totaled 74% in the spinal fusion population. The incidence of oxygen desaturations was 41% in the preimplementation group and 35% in the postimplementation group. The PACU to intensive care unit transfers were 10% in the preimplementation group and 3% in the postimplementation group.

CONCLUSIONS

Protocols for surgical patients with OSA require further examination but may function as a guide for postoperative nursing care.

Sleep questionnaires for the screening of obstructive sleep apnea in patients with type 2 diabetes mellitus compared with non-diabetic patients

BACKGROUND

Several tools have been used to screen for obstructive sleep apnea (OSA). Evaluation of the predictive performance of different questionnaires is essential in patients with type 2 diabetes mellitus (T2DM) because the prevalence of OSA in this population is high. The aim of this study was to evaluate different sleep questionnaires to identify T2DM patients with OSA, and to compare the predictive values of these questionnaires with a matched sample of non-diabetic patients.

METHODS

The study was a retrospective study of two patients groups (n = 350 with T2DM, n = 350 without T2DM) visiting a sleep clinic and matched by age, gender, body mass index, and the apnea-hypopnea index (AHI). Symptoms of OSA and Epworth Sleepiness Scale (ESS), STOP-Bang, Berlin questionnaire, and Athens insomnia scale (AIS) scores were compared, and sleep studies were performed.

RESULTS

Diabetic patients with OSA complained more frequently of nocturia (P = 0.025), morning headaches (P = 0.04), restless sleep (P = 0.002), and leg movements (P = 0.01) than non-diabetic patients with OSA. Most predictive values of the sleep questionnaires did not differ significantly between the two groups; however, the AIS was higher only in T2DM women (P = 0.01). In both groups, the Berlin and STOP-Bang questionnaires had the highest sensitivity. The ESS had the highest specificity in T2DM patients and the STOP and S-B questionnaires had the highest specificity in non-diabetics.

CONCLUSIONS

The predictive performance of the questionnaires was similar in both groups, especially in the case of moderate and severe OSA.

Actigraphy-based sleep analysis in sedentary and overweight/obese adults with primary hypertension: data from the EXERDIET-HTA study

PURPOSE

The aim of this study was to analyze actigraphy-based sleep quantity and quality in sedentary and overweight/obese adults with primary hypertension (HTN) divided by sex and cardiorespiratory fitness (CRF) and to assess the association of sleep parameters with body composition, blood pressure (BP), and CRF.

METHODS

This is a cross-sectional design utilizing data from the EXERDIET-HTA study conducted in 154 non-physically, obese adults with HTN (53.3 ± 7.8 years). Sleep parameters (total bedtime; total sleep time, TST; and sleep efficiency = (TST/total bedtime) × 100)) were calculated from raw accelerometer data (ActiGraph GT3X+). Peak oxygen uptake (V̇O_2peak) determined the CRF. Blood pressure was assessed with the 24-h ambulatory BP monitoring. The distributions of V̇O_2peak were divided into tertiles (low, medium, and high CRF) in each sex. Series of linear regression analyses were conducted between sleep, fitness, and health-related variables.

RESULTS

Short sleep duration (6.2 h) both on weekdays and weekends, poor sleep quality (< 85% of efficiency), and no significant differences in sleep variables between women and men, nor among CRF groups, were observed. The short sleeping pattern was negatively associated (P < 0.05) with mean and night systolic BP (mmHg, β = - 0.2), and sleep efficiency with waist circumference (cm, β = - 0.08, P = 0.05).

CONCLUSIONS

Actigraphy-based sleep analysis reinforces that sleep disorders, such as short sleep duration and poor sleep quality, are associated with high BP and abdominal obesity in sedentary adults with overweight/obesity and HTN. Sleep pattern did not appear to be related with CRF level in this population.

Characterization of Patients in a Lifestyle Medicine Practice

Objective. Lifestyle medicine is a relatively new specialty within medicine. The aim of this report is to characterize patients who present to a lifestyle medicine clinical practice. Methods. LifeStyle Medical Centers is an independent, community-based practice; this report is based on over 3200 patients within this practice. Most of the data presented were obtained from an intake questionnaire developed by the practice to provide background and screening particularly relevant to lifestyle medicine, including areas such as stress, sleep, physical activity, health knowledge, motivation, weight loss history and goals, and smoking. Results. Patients who present for lifestyle care come with varied goals, past histories, and current lifestyle issues. Many express a very high level of motivation to lose an unrealistically large amount of weight. The prevalence of physical inactivity, inadequate sleep, high stress, and risk of depression are high, yet the importance of these to health and well-being are often not recognized by the patient. Over 90% of the cost of care was covered by insurance. Conclusions. Having a better understanding of the patients who come to a lifestyle medicine clinic will help practices better design their lifestyle programs and guide lifestyle medicine providers to better engagement and care of their patients.

Risk factors for possible REM sleep behavior disorder: A CLSA population-based cohort study

OBJECTIVE

To assess sociodemographic, socioeconomic, and clinical correlates of idiopathic REM sleep behavior disorder (RBD) in a 30,097-person national cohort.

METHODS

Participants 45 to 85 years of age in Canada were collected as part of the Canadian Longitudinal Study on Aging. Possible RBD (pRBD) was screened with the REM Sleep Behavior Disorder Single-Question Screen, a questionnaire with 94% specificity and 87% sensitivity. To improve diagnostic accuracy, those screening positive for apnea or non-REM parasomnia (young-onset pRBD) and those self-reporting dementia or Parkinson disease were excluded. A series of sociodemographic, lifestyle, and mental health variables were analyzed cross-sectionally. Potential correlates were assessed via multivariable logistic regression.

RESULTS

Of 30,097 participants, 958 (3.2%) were identified as having pRBD. Male sex (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.78-2.44) and lower education (OR 0.95, 95% CI 0.92-0.98) were associated with pRBD. Participants with pRBD had smoked more (pack-years OR 1.01, 95% CI 1.00-1.01) and were more likely to be moderate to heavy drinkers (OR 1.25, 95% CI 1.04-1.51). There was a strong association between pRBD and self-reported antidepressant treatment for depression (OR 2.77, 95% CI 2.23-3.45), psychological distress (OR 1.61, 95% CI 1.44-1.80), mental illness (OR 2.09, 95% CI 1.75-2.49), and posttraumatic stress disorder (OR 2.68, 95% CI 1.97-3.65).

CONCLUSIONS

Our study replicated previous reported associations between pRBD and smoking, low education, and male sex and found previously unreported links with alcohol use and psychological distress. Risk factors for pRBD differ from those previously defined for neurodegenerative synucleinopathies.

Obstructive Sleep Apnea Screening in Patients With Atrial Fibrillation: Missed Opportunities for Early Diagnosis

BACKGROUND

"There is a high prevalence of obstructive sleep apnea (OSA) among patients with atrial fibrillation (AF). There is also strong evidence that proper OSA management can reduce AF recurrence." Polysomnography is the gold standard for OSA diagnosis, but screening tests, such as STOP-BANG, have been successful in identifying patients at risk for OSA. Our study assesses screening rates for OSA in patients with persistent AF, and willingness of patients at increased risk for OSA towards further diagnostic evaluation.

METHODS

A total of 254 persistent AF patients were surveyed regarding prior screening for OSA, and if previously unscreened, assessed with STOP-BANG. Prior cardioversions and willingness to undergo further workup was also recorded. Patients at risk for OSA were given educational brochures. Subjects with diagnosis of OSA were asked about their compliance with positive airway pressure therapy.

RESULTS

Sixty-six percent of AF patients were never screened for OSA; 75% unscreened participants (95% CI: 68-81%) were at high risk for OSA. Patients with previous hospitalizations or electrical cardioversions were more frequently screened for OSA (P = 0.02, P = 0.03, respectively). Forty-three percent of high-risk individuals had a BMI < 30. Among patients at risk for OSA (score ≥ 3), the majority (n = 99, 79%) were interested in follow-up with a sleep study (n = 93, 74%).

CONCLUSIONS

Although there is a strong OSA-associated risk for AF, which is amenable to intervention, most patients with persistent AF are not assessed for OSA. Simple to use screening questionnaires are sensitive and can reliably identify patients at high risk for OSA, reserving costlier and somewhat inconvenient nocturnal polysomnography to only those at risk. We hope our study will help to push the AF and OSA connection into the spotlight in the primary care of patients with AF.

Screening extremely obese pregnant women for obstructive sleep apnea

BACKGROUND

Obesity is prevalent among pregnant women in the United States; obstructive sleep apnea is highly comorbid with obesity and is associated with adverse pregnancy outcomes. Screening for obstructive sleep apnea in pregnant women has remained a challenge because of a lack of validated screening tools.

OBJECTIVE

The purpose of this study was to evaluate established obstructive sleep apnea screening tools, a sleepiness scale, and individual component items in a cohort of pregnant women with extreme obesity in mid pregnancy with the use of objective testing to determine obstructive sleep apnea status and to describe the prevalence of obstructive sleep apnea among women with extreme obesity.

STUDY DESIGN

Adult pregnant subjects, between 24 and 35 weeks gestation, with a body mass index ≥40 kg/m² at the time of enrollment completed obstructive sleep apnea screening tools (Berlin Questionnaire, American Society of Anesthesiologists checklist, and STOP-BANG questionnaire) and the Epworth Sleepiness Scale; they also underwent physical examination of the neck, mouth, and airway. The published obstructive sleep apnea in pregnancy prediction score was calculated for each subject. Obstructive sleep apnea status for each subject was determined by the results of an overnight, unattended type III home sleep apnea test.

RESULTS

Twenty-four percent of pregnant women with extreme obesity had obstructive sleep apnea on home sleep apnea testing in mid pregnancy (Apnea-Hypopnea Index, ≥5 events per hour]. Established obstructive sleep apnea screening tools performed very poorly to screen for obstructive sleep apnea in this cohort. Age, body mass index, neck circumference, frequently witnessed apneas, and highly likely to fall asleep while driving were associated most strongly with obstructive sleep apnea status in this cohort.

CONCLUSION

We found that 24% of pregnant women with body mass index ≥40 kg/m² between 24 and 35 weeks gestation have obstructive sleep apnea, defined as Apnea-Hypopnea Index ≥5 events per hour on an overnight type III home sleep apnea test. We found the Berlin Questionnaire, American Society of Anesthesiologists checklist, STOP-BANG, obstructive sleep apnea in pregnancy score by Facco et al, and the Epworth Sleepiness Scale were not useful screening tools for obstructive sleep apnea in a cohort of obese pregnant women. However, age, body mass index, neck circumference, frequently witnessed apneas, and likely to fall asleep while driving were associated with obstructive sleep apnea in this cohort. Further studies are needed to adjust the criteria and thresholds within the available screening tools to better predict obstructive sleep apnea in pregnant women with obesity.

Waist, neck circumferences, waist-to-hip ratio: Which is the best cardiometabolic risk marker in women with severe obesity? The SOON cohort

A centralized deposit of adiposity increases the risk of cardiometabolic diseases. Several anthropometric markers can be used to characterize fat distribution. In the case of severe obesity, several markers, such as hip and waist circumference, are prone to measurement error. Conversely, neck circumference is easy to obtain. The aim was to determine the best surrogate marker of obesity-related cardiometabolic diseases from: body mass index (BMI), waist, hip and neck circumferences and waist-to-hip ratio.

Prevalence of sleep disorders and sleep problems in an elite super rugby union team

The aim of this study was to determine the prevalence of sleep disorders in an elite rugby union team using in-laboratory polysomnography (PSG) and sleep questionnaires. Twenty-five elite rugby union players underwent a night of PSG during the "off-season" of the Super Rugby competition to assess their sleep. Of interest were measurements that detected the presence of obstructive sleep apnea (OSA; apnea-hypopnea index ≥5 events/hr) and the presence of moderate-severe periodic leg movements during sleep (PLMs; ≥15 events/hr). Players completed sleep-related questionnaires to assess daytime sleepiness, perception of insomnia, risk of OSA, and the presence of restless legs syndrome (RLS) and underwent basic anthropometric assessments including body mass index and neck circumference. OSA was present in 24% (n=6) of players and PLMs ≥15 events/hr in 12% (n=3). Questionnaire responses showed that all players had insomnia defined subthreshold insomnia and excessive daytime sleepiness, two players were identified as being at risk for OSA and none were classified as having RLS. In conclusion, sleep disorders and excessive sleepiness are common in elite rugby union players. A process to identify and manage sleep disorders should be considered by teams to optimise their physical recovery, athletic performance and to safeguard their health.

Predictors of CPAP adherence following stroke and transient ischemic attack

OBJECTIVE

Continuous positive airway pressure (CPAP) has been shown to improve functional, motor and cognitive outcomes in post-stroke obstructive sleep apnea (OSA). However, rates of CPAP adherence are often low and factors impacting CPAP adherence remain under-explored. Our objective was to determine predictors of CPAP adherence in patients who had a stroke or transient ischemic attack (TIA).

METHODS

We screened 313 stroke/TIA patients for OSA using in-hospital polysomnography or the ApneaLink home sleep apnea test. Potential predictors were recorded at baseline and adherence to CPAP was recorded during a six-month follow-up visit. Selected variables from our univariate analyses were included in multivariate regression models to determine predictors of CPAP adherence. For our logistic regression analyses, CPAP adherence (CPAP use of ≥4 h per night) was the dependent outcome variable. In our linear regression analyses, total CPAP use per week (recorded in hours) was the dependent outcome variable.

RESULTS

Eighty-eight patients (mean age 67.81 ± 13.09 years, 69.32% male, mean body mass index 27.93 ± 5.23 kg/m²) were diagnosed with OSA, prescribed CPAP, and assessed for adherence at a six-month follow-up visit. In these 88 patients, 46 (52.27%) were adherent with CPAP therapy. From our regression models, two significant predictors of CPAP adherence were identified: greater functional status (p = 0.04) and not endorsing daytime tiredness (p = 0.047) post-stroke/TIA.

CONCLUSION

Patients with greater functional capacity and those with less daytime fatigue demonstrated stronger adherence to CPAP therapy. Our findings may facilitate future treatment strategies for enhancing CPAP adherence in the vulnerable stroke/TIA population.

Effects of continuous positive airway pressure in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia

In patients with obstructive sleep apnea, short-term use of a continuous positive airway pressure mask improves oxygenation, decreases the apnea-hypopnea index, and reduces hemodynamic instability. In this study, we investigated the effects of use of a continuous positive airway pressure mask in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia. Forty patients who underwent propofol sedation after spinal anesthesia for transurethral bladder or prostate resection with a STOP-Bang score of 3 or more were enrolled in this study. Patients were randomly divided into two groups: a simple oxygen mask group (n = 20) and a continuous positive airway pressure mask group (n = 20). After spinal anesthesia, propofol was injected at a target concentration of 1.3 mcg/ml via a target concentration control injector. ApneaLink™ was applied to all patients. Patients in the simple oxygen mask group were administered oxygen at a rate of 6 L/min through a simple facial mask. Patients in the CPAP mask group were connected to a pressurizer, and oxygen (6 L/min, 5-15 cm H₂O) was administered. Blood pressure, heart rate, respiratory rate, and oxygen saturation were recorded preoperatively, after spinal anesthesia, and every 5 min after the injection of propofol to observe hemodynamic changes. Apnea-hypopnea index was estimated using ApneaLink™. There were no significant differences in hemodynamic changes between the two groups. Apnea-hypopnea index was significantly reduced in the continuous positive airway pressure mask group compared to the simple facial mask group. Application of a continuous positive airway pressure mask in a patient at high risk of obstructive sleep apnea can lower the incidence of obstructive sleep apnea during sedation without a significant effect on hemodynamic stability.

A Population-Based Study of the Bidirectional Association Between Obstructive Sleep Apnea and Type 2 Diabetes in Three Prospective U.S. Cohorts

OBJECTIVE

Multiple lines of evidence support a complex relationship between obstructive sleep apnea (OSA) and diabetes. However, no population-based study has evaluated the potential bidirectional association between these two highly prevalent disorders.

RESEARCH DESIGN AND METHODS

We followed 146,519 participants from the Nurses' Health Study (NHS; 2002-2012), Nurses' Health Study II (NHSII; 1995-2013), and Health Professionals Follow-up Study (HPFS; 1996-2012) who were free of diabetes, cardiovascular disease, and cancer at baseline. Cox proportional hazards models were used to estimate hazard ratios (HRs) for developing diabetes according to OSA status. In parallel, we used similar approaches to estimate risk of developing OSA according to diabetes status among 151,194 participants free of OSA, cardiovascular disease, and cancer at baseline. In all three cohorts, diagnoses of diabetes and OSA were identified by validated self-reports.

RESULTS

Similar results were observed across the three cohorts. In the pooled analysis, 9,029 incident diabetes cases were identified during follow-up. After accounting for potential confounders, the HR (95% CI) for diabetes was 2.06 (1.86, 2.28) comparing those with versus without OSA. The association was attenuated but remained statistically significant after further adjusting for waist circumference and BMI (HR 1.37 [95% CI 1.24, 1.53]), with the highest diabetes risk observed for OSA concomitant with sleepiness (1.78 [1.13, 2.82]). In the second analysis, we documented 9,364 incident OSA cases during follow-up. Compared with those without diabetes, the multivariable HR (95% CI) for OSA was 1.53 (1.32, 1.77) in individuals with diabetes. Adjustment for BMI and waist circumference attenuated the association (1.08 [1.00, 1.16]); however, an increased risk was observed among those with diabetes who used insulin compared with those without diabetes (1.43 [1.11, 1.83]), particularly among women (1.60 [1.34, 1.89]).

CONCLUSIONS

OSA is independently associated with an increased risk of diabetes, whereas insulin-treated diabetes is independently associated with a higher risk of OSA, particularly in women. Clinical awareness of this bidirectional association may improve prevention and treatment of both diseases. Future research aimed at elucidating the mechanisms that underlie each association may identify novel intervention targets.

Managing nocturia: The multidisciplinary approach

Nocturia, defined as waking at night to pass urine, is a common condition which increases with age. Whilst nocturia is known to have an important effect on quality of life, more recent evidence has linked the symptom with significant morbidity and mortality due to the effects of sleep deprivation on glucose metabolism and the immune system. The causes of nocturia are multifactorial and may be related to urine overproduction, storage disorders and primary sleep disorders. The commonest underlying pathology, however, is nocturnal polyuria, which may be associated with a number of medical conditions. This review explores the underlying causes of nocturia and nocturnal polyuria and, by doing so, describes a multidisciplinary approach to managing patients effectively.

High rates of respiratory symptoms and airway disease in mental health inpatients in a tertiary centre

BACKGROUND

People with severe mental illness (SMI) have a lower life expectancy due in part to a higher prevalence of cardiac and metabolic disease. Less is known of the prevalence of respiratory disease in this group.

AIMS

This cross-sectional, observational study aimed to assess the prevalence of symptoms associated with respiratory disease in patients admitted to an inpatient mental health unit.

METHODS

A convenience sample of 82 inpatients had a structured interview and questionnaire completed. The questionnaire included self-reported diagnoses of common diseases and screening questions designed to detect respiratory disease and sleep disordered breathing. Targeted spirometry was performed on the basis of symptoms and smoking status.

RESULTS

Patients reported high rates of respiratory symptoms, including wheezing (38%) and dyspnoea (44%); 52% of patients reported daily tobacco use. Productive cough was significantly associated with tobacco use (P < 0.005). Ten patients (18%) had spirometry consistent with chronic obstructive pulmonary disease (COPD) of whom six did not have a formal diagnosis of COPD previously.

CONCLUSIONS

People with SMI have high rates of respiratory symptoms with a high prevalence of COPD on spirometry. Half of the COPD cases were not previously diagnosed, suggesting a hidden burden of respiratory disease in patients with SMI.

Preventing Opioid-Induced Respiratory Depression in the Hospitalized Patient With Obstructive Sleep Apnea

PURPOSE

To enhance the role of nursing interventions in the management of perioperative opioid-induced respiratory depression (OIRD) in patients with obstructive sleep apnea (OSA).

DESIGN

Narrative review of the literature.

METHODS

Literature reviewed with emphasis on recommendations by professional and accrediting organizations.

FINDINGS

Postsurgical OIRD increases hospital stay (55%), cost of care (47%), 30-day readmission (36%), and inpatient mortality (3.4 fold). OSA increases the risk of OIRD and may result in legal claims averaging $2.5 million per legal claim.

CONCLUSIONS

Nursing interventions are essential to improving outcome and reduce cost in the management of postsurgical OIRD in OSA patients.

Phenotypic and genetic analysis of an adult cohort with extreme obesity

CONTEXT

Adult extreme obesity (EO) is a growing health concern. The prevalence of known obesity associated co-morbidities namely cardio-metabolic and neuro-psychiatric disease in EO is not fully established. The contribution of pathogenic genetic variants, previously implicated in early childhood onset obesity, to adult EO is also not established.

OBJECTIVE

We undertook phenotypic and genetic analysis of adult patients with extreme obesity (EO, BMI > 50). Specifically, we assessed the prevalence of eating disorders, cardio-metabolic, and neuro-psychiatric disease and the presence of pathogenic variants in known monogenic obesity genes.

DESIGN

A total of 55 patients with EO from a single site bariatric surgery referral program were assessed for the presence of eating disorders, cardio-metabolic, and neuro-psychiatric disease. The 54 obese (O) patients with a BMI < 50 from the same program were identified for phenotypic comparison. The 45 EO patients underwent whole exome sequencing to identify deleterious variants in known monogenic obesity genes.

OUTCOMES

(1) Presence of eating disorders, cardio-metabolic, and neuro-psychiatric disease in EO compared to O. (2) Onset of obesity in the EO group. (3) Presence of deleterious variants in genes previously implicated in monogenic obesity in the EO group.

RESULTS

The EO group had higher prevalence of lifetime neuro-psychiatric disease (67.3% vs. 37%, p = 0.001) and sleep apnea (74.6% vs. 51.9%, p = 0.01) but lower prevalence of type 2 diabetes (30.1% vs. 50%, p = 0.045) compared to O. There were no significant differences in binge eating, dyslipidemia, hypertension, and cardiac disease. In the EO group, we found previously unreported singleton variants in NTRK2 (pS667W, bio-informatically predicted to be deleterious) and BDNF (pE23K). No previously confirmed loss of function variants in monogenic obesity genes were found.

CONCLUSIONS

Adults with EO have significantly increased prevalence of neuro-psychiatric disease and a possibly lower burden of type 2 diabetes compared to less obese patients. Known monogenic causes of obesity were not highly prevalent in this cohort. Further studies are warranted to confirm these preliminary findings.

Obstructive Sleep Apnea in Elective Spine Surgery: National Prevalence and Inpatient Outcomes

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

Epidemiologic studies suggest that the prevalence of moderate to severe obstructive sleep apnea (OSA) is increasing. OSA has been linked to increased rates of postoperative complications following surgery. Large studies, however, regarding surgical outcomes in this patient population, particularly in the spine literature, are limited. Consequently, the purpose of this study was to assess the prevalence of and postoperative risks conferred by OSA in the elective spine population.

METHODS

Using data from the National Inpatient Sample from 2008 to 2012, an estimated 56 372 (5.1%) patients with OSA undergoing elective cervical and thoracolumbar spine surgery were selected and compared to 1 052 837 patients without OSA undergoing the same procedures. Our primary outcome measures included postoperative complication rates, inpatient mortality, length of stay, and total hospital charges.

RESULTS

Patients with OSA were, on average 2.6 years older than those without OSA (P < .001) and had a higher comorbidity burden. The prevalence of OSA increased between 2008 and 2012 from 3.5% to 6.8%; P < .001. OSA was associated with a 3-fold increase in major complications (P < .001) and was confirmed as an independent risk factor for major complications based on multivariate analysis (odds ratio [OR] = 2.82; 95% CI = 2.59-2.79; P < .001). Rates of deep venous thrombosis were doubled in patients with OSA. OSA was determined to be an independent predictor of pulmonary complications (OR = 2.69; 95% CI = 2.59-2.79; P < .001). OSA did not increase the risk of postoperative mortality.

CONCLUSIONS

Patients with OSA often have multiple concomitant comorbidities and consequently are at increased risk of experiencing a more difficult postoperative course following elective spine surgery. Specifically, increased risks of pulmonary complications and deep venous thrombosis should be anticipated.

Comparison of Predictor of Desaturation Disorders and Daytime Sleepiness Based On Epworth Sleepiness Scale and STOP-BANG Questionnaires in Mild to Moderate Obstructive Sleep Apnea Patients

BACKGROUND

Obstructive sleep apnea (OSA) is characterised by recurrence in upper airway obstruction during sleep.

AIM

This study aimed to compare the predictive values of the Epworth Sleepiness Scale (ESS) and STOP-BANG in the desaturation of patients with mild to moderate obstructive apnea based on the apnea-hypopnea index (AHI) scale.

METHODS

A group of 79 patients (43 male and 36 female) were selected. The suspected patients were introduced to the sleep clinic, and the ESS and STOP-BANG questionnaires were filled up, then subjected to polysomnography test, and the scores of the disease were also determined based on an apnoea-hypopnoea index (AHI). Finally, the desaturation rate (SO₂ < 3% based on the baseline) and desaturation index were determined in patients. Consequently, the finding was compared with the results of the questionnaires.

RESULTS

Patients with STOP-BANG score above 3 had significantly higher weight, oxygen desaturation index (ODI) index and average desatu, while peripheral capillary oxygen saturation (SpO₂) base and average SpO₂ were lower than those with scores below 3 (P < 0.05). However, there was no significant difference between the patients with the ESS questionnaire score above 10 and below 10 (P > 0.05).

CONCLUSION

The results of these two questionnaires reflect the unsaturated oxygen index in the blood, and can be considered for the evaluation of the severity of the disease.

An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine

Purpose of review

The present review aims to provide an update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine.

Recent findings

The STOP-Bang questionnaire was originally validated as a screening tool to identify surgical patients who are at high-risk of obstructive sleep apnea (OSA). A recent meta-analysis confirmed that STOP-Bang is validated for use in the sleep clinic, surgical, and general population. Patients with a STOP-Bang score of 0--2 can be classified as low-risk for moderate-to-severe OSA. Those with a score of 5--8 can be classified as high-risk for moderate-to-severe OSA. In patients with a score of 3 or 4, a specific combination of a STOP score at least 2 + BMI more than 35 kg/m² or STOP score at least 2 + male or STOP score at least 2 + neck circumference more than 40 cm indicates higher risk for moderate-to-severe OSA. Further, patients with a STOP-Bang score at least 3 can be classified as high risk for moderate-to-severe OSA if the serum HCO₃^- at least 28 mmol/l. STOP-Bang can be used as a novel tool for perioperative risk stratification because it easily identifies patients who are at increased risk of perioperative complications.

Summary

STOP-Bang at least 3 was recommended previously to identify the suspected or undiagnosed OSA. To reduce the false positive cases and to improve its specificity, a stepwise stratification is recommended to identify the patients at high risk of moderate-to-severe OSA. Because of its practical application, STOP-Bang is a useful screening tool for patients with suspected or undiagnosed OSA.

Catestatin serum levels are increased in male patients with obstructive sleep apnea

PURPOSE

Obstructive sleep apnea (OSA) is a complex sleep disorder associated with autonomic and sympathetic dysregulation. To the contrary, catestatin, an endogenous pleiotropic peptide cleaved from chromogranin A, is known for its inhibitory effects on catecholamine release and sympathetic activity. The aims of the study were to determine catestatin serum levels among male OSA patients compared to healthy control subjects and to explore associations of catestatin with anthropometric, polysomnographic, and lipid profile parameters.

METHODS

Seventy-eight male OSA patients aged 50.3 ± 8.8 years and 51 age/sex/BMI-matched control subjects aged 50.4 ± 7.8 years were enrolled in the study. Catestatin serum levels were determined by an enzyme-linked immunosorbent assay (ELISA).

RESULTS

Catestatin serum levels were significantly higher among OSA patients compared to control subjects (2.9 ± 1.2 vs. 1.5 ± 1.1 ng/mL, p < 0.001). Serum catestatin levels significantly correlated with apnea-hypopnea index (AHI) among non-obese OSA subjects (r = 0.466, p = 0.016; β = 0.448, p = 0.026), while in whole OSA population, catestatin levels significantly correlated with neck circumference (r = 0.318, p < 0.001; β = 0.384, p < 0.001) and high-density lipoprotein (HDL) cholesterol (r = - 0.320, p < 0.001; β = - 0.344, p < 0.001). In multivariate-adjusted regression model, serum catestatin was significant and independent predictor of OSA status (OR 4.98, 95% CI 2.17-11.47, p < 0.001).

CONCLUSIONS

Catestatin serum levels are significantly increased in male OSA population and positively correlate with disease severity in non-obese patients. OSA status is independently predicted by catestatin levels; however, this finding is restricted to patients with moderate-to-severe disease. Further studies are necessary to elucidate the mechanistic role of catestatin in the complex pathophysiology of OSA.