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Chambers T, Bamber H, Singh N. Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions. Curr Opin Pulm Med 2023; 29:557-566. [PMID: 37646529 DOI: 10.1097/mcp.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnoea (OSA) is an increasingly common pathology that all those involved in perioperative care will come across. Patients with the condition present a challenge at many stages along the perioperative journey, not least because many patients living with OSA are unaware of their diagnosis.Key interventions can be made pre, intra-, and postoperatively to improve outcomes. Knowledge of screening tools, diagnostic tests, and the raft of treatment options are important for anyone caring for these patients. RECENT FINDINGS Recent literature has highlighted the increasing complexity of surgical patients and significant underdiagnosis of OSA in this patient population. Work has demonstrated how and why patients with OSA are at a higher perioperative risk and that effective positive airways pressure (PAP) therapy can reduce these risks, alongside evidencing how best to optimise adherence to therapy, a key issue in OSA. SUMMARY OSA, and particularly undiagnosed OSA, presents a huge problem in the perioperative period. Perioperative PAP reduces the risk of postoperative complications but adherence remains an issue. Bespoke perioperative pathways should be developed to identify and optimise high risk patients, although at present evidence on how best to achieve this is lacking.
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Affiliation(s)
- Tom Chambers
- Core Anaesthetic Trainee, London School of Anaesthesia
- Honorary Clinical Fellow, St Bartholomew's Hospital, Bart's Health NHS Trust, London
| | - Harry Bamber
- Anaesthetic Trainee, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Wales, UK
| | - Nanak Singh
- Consultant Respiratory Physician, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Cho S, Lim DY, Kim S, Kim H, Kang W, Park WJ. Association between Occupational Noise Exposure and Insomnia among Night-Shift Production Workers: A 4-Year Follow-up Study. Noise Health 2023; 25:135-142. [PMID: 37815075 PMCID: PMC10747807 DOI: 10.4103/nah.nah_15_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 10/11/2023] Open
Abstract
Objectives This study aimed to investigate whether occupational noise exposure is a risk factor for insomnia among male night-shift production workers. Methods This study followed 623 male night-shift production workers at a tire manufacturing factory without insomnia for 4 years. Insomnia was evaluated based on the insomnia severity index at baseline and at 4-year follow-up. A score of ≥15 was defined as insomnia. The higher occupational noise exposure group was defined as those individuals exposed to 8-hour time-weighted-average noise above 80 dB (A). Results Participants' mean age was 46.3 ± 5.6 years. Of the 623 participants, 362 (58.1%) were in the higher occupational noise exposure group. At 4-year follow-up, insomnia occurred in 3.2% (n = 20) of the participants. In a multiple logistic regression analysis, the odds ratio of insomnia was 3.36 (95% confidence interval 1.083-10.405, P = 0.036) in the higher occupational noise exposure group when compared with the lower noise exposure group after adjusting for confounders. Conclusion Our findings suggested that occupational noise exposure affected insomnia in male night-shift production workers. To prevent insomnia, efforts are required to reduce workplace noise exposure levels. Alternatively, moving to a less noisy work environment should be considered for workers with severe insomnia.
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Affiliation(s)
- Seunghyeon Cho
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Dae-Young Lim
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Suwhan Kim
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hyeonjun Kim
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - WonYang Kang
- Institute of Occupation and Environment, Korea Workers’ Compensation & Welfare Service, Incheon, Republic of Korea
| | - Won-Ju Park
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
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Chambers T, Ruparelia P, Ellis G, Bishop T, Gooneratne M, Singh N. Obstructive sleep apnoea and perioperative medicine: a growing concern. Br J Hosp Med (Lond) 2022; 83:1-9. [DOI: 10.12968/hmed.2022.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Obstructive sleep apnoea represents a sizable public health and economic burden. Owing to rising obesity rates, the prevalence of obstructive sleep apnoea is increasing, and it is a condition that is significantly underdiagnosed. Exacerbated by the COVID-19 pandemic, the backlog of elective surgeries is also sizable and growing. A combination of these factors means that many patients due to have surgery will have obstructive sleep apnoea, either diagnosed or otherwise. Patients with obstructive sleep apnoea have a significantly increased risk of operative complications, but the evidence base for optimum perioperative management of these patients is limited. This article reviews sleep apnoea, its prevalence and its impact on operative management and perioperative outcomes for patients. The evidence base for screening and treating undiagnosed obstructive sleep apnoea is also comprehensively assessed. Finally, a pathway to manage patients with possible undiagnosed obstructive sleep apnoea is proposed, and areas for further research identified.
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Affiliation(s)
- Tom Chambers
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Prina Ruparelia
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Georgia Ellis
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Thomas Bishop
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Mevan Gooneratne
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Nanak Singh
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
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Mira Quirós MD, Maimó Bordoy A, El Haji K, Aguilar Sánchez JL, Tejada Gavela S. Cross-cultural adaptation and validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:393-401. [PMID: 35871142 DOI: 10.1016/j.redare.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/27/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Obstructive Sleep Apnea Syndrome (OSAS) or Apnea-Hypoapnea Syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests, such the STOPbang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations. OBJECTIVE The validation, translation, cross-cultural adaptation of the STBC to the Spanish population. MATERIAL AND METHODS The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version. RESULTS 44% of women and 56% of men were included, with a mean age of 53.58 ± 12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r = 0.777 (P < .001) and a Sperman correlation rho = 0.455 (P = .044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score >3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI) >5, >15, >30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%. CONCLUSIONS The STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS.
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Affiliation(s)
- M D Mira Quirós
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain.
| | - A Maimó Bordoy
- Servicio de Neumología, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain
| | - K El Haji
- Unidad de Investigación, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - J L Aguilar Sánchez
- Facultad de Medicina, Universidad de las Islas Baleares, Palma, Balearic Islands, Spain
| | - S Tejada Gavela
- Facultad de Medicina, Universidad de las Islas Baleares, Palma, Balearic Islands, Spain
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Kazubowska-Machnowska K, Jodkowska A, Michalek-Zrabkowska M, Wieckiewicz M, Poreba R, Dominiak M, Gac P, Mazur G, Kanclerska J, Martynowicz H. The Effect of Severity of Obstructive Sleep Apnea on Sleep Bruxism in Respiratory Polygraphy Study. Brain Sci 2022; 12:828. [PMID: 35884635 PMCID: PMC9313411 DOI: 10.3390/brainsci12070828] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) and sleep bruxism (SB) may appear concomitantly. Data on the relationship between OSA and SB are limited. It was shown that in a population with an increased risk of OSA, OSA was dependently correlated with SB on the degree of OSA severity only in mild and moderate cases of OSA. We aimed to confirm this relationship and affecting factors in a group of dental office patients in a prospective, observational study. Adult patients (n = 119) were evaluated using respiratory polygraphy. The risk of OSA was assessed using a STOP-Bang questionnaire (SBQ). The episodes of bruxism and respiratory events were scored according to the standards of the American Academy of Sleep Medicine. The prevalence of OSA and SB was found to be 63.02% and 41.17%, respectively. The bruxism episode index (BEI) was increased in the group with a higher risk of OSA (SBQ ≥ 3) compared to the group with a lower risk of OSA (3.49 ± 3.63 vs. 2.27 ± 2.50, p = 0.03). The sensitivity and specificity of the SBQ were not sufficient to predict SB. A positive linear correlation between AHI and BEI in the group with AHI < 23/h was found. The study confirmed that OSA was associated with SB in the group of patients with OSA and/or SB risk. The relationship between OSA and SB depended on the degree of severity of OSA and occurred in mild and moderate cases of OSA.
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Affiliation(s)
| | - Anna Jodkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland;
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Marzena Dominiak
- Department of Oral Surgery, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland; (K.K.-M.); (M.D.)
| | - Pawel Gac
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, 7 Mikulicza-Radeckiego St., 50-345 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Justyna Kanclerska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
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BASH-GN: a new machine learning–derived questionnaire for screening obstructive sleep apnea. Sleep Breath 2022; 27:449-457. [DOI: 10.1007/s11325-022-02629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/31/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
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Pei C, Gui S. Effect of arterial blood bicarbonate (HCO 3-) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea. BMC Pulm Med 2021; 21:366. [PMID: 34774046 PMCID: PMC8590281 DOI: 10.1186/s12890-021-01720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01720-2.
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Affiliation(s)
- Chong Pei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, No. 81 of Mei Shan Road, Hefei, 230001, Anhui, People's Republic of China.,Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), No. 390 of Huai He Road, Hefei, 230001, Anhui, People's Republic of China
| | - Shuyu Gui
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, No. 81 of Mei Shan Road, Hefei, 230001, Anhui, People's Republic of China.
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Alkan M, Aytac I, Guven Aytac B, Unal H, Gursul B, Baskan S, Postaci A, Gogus N. Comparison of intraoral mask and classic face mask in terms of ventilation success and practitioners' workload assessments: A randomised crossover study. Int J Clin Pract 2021; 75:e14821. [PMID: 34499788 DOI: 10.1111/ijcp.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
AIM Providing effective ventilation of the unconscious patient is an essential skill in every specialty dealing with airway management. In this randomised crossover study aimed to compare intraoral and classic face mask in terms of ventilation success of patients, practitioners' workload and anxiety assessments. Also we analysed potential risk factors of difficult mask ventilation for both masks. METHODS In all, 24 anaesthesiology residents and 12 anaesthesiologists participated in the study. Each of the practitioners ventilated four patients with both masks at settled pressure and frequency. Practitioners rated their workload and anxiety related to masks with National Aeronautics and Space Administration Task Load Index score and State Trait Anxiety Inventory scale. Ventilation success was evaluated with Han scale, expiratory tidal volume and leak volume. We analysed potential risk factors of difficult mask ventilation with anthropometric characteristics and STOP-Bang score. RESULTS Ventilation success rate was superior with intraoral mask comparing to classic face mask in terms of successful ventilation (P = .000) and tidal volume (P = .000). Leak volume in in intraoral mask ventilation was significantly lower than classic face mask (P = .000). Difficult mask ventilation risk factors for classic face mask were high weight (P = .011), neck circumference (95% CI, OR = 1.180, P = .002), Mallampati score (P = .029) and high risk of OSAS (P = .001). Difficult mask ventilation risk factors for intraoral mask were high body mass index (95% CI, OR 1.162 P = .006) and Mallampati score (P = .043). The anxiety ratings of practitioners were similar between two masks. The workload rating is higher with intraoral mask comparing to classic face mask. CONCLUSION Intraoral mask may be an effective alternative device for bag-valve mask ventilation.
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Affiliation(s)
- Mikail Alkan
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Terme State Hospital, Samsun, Turkey
| | - Ismail Aytac
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Ankara City Hospital, Ankara, Turkey
| | - Betul Guven Aytac
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Ankara City Hospital, Ankara, Turkey
| | - Hidayet Unal
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Denizli State Hospital, Denizli, Turkey
| | - Bahattin Gursul
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Lokman Hekim Akay Hospital, Ankara, Turkey
| | - Semih Baskan
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Ankara City Hospital, Ankara, Turkey
| | - Aysun Postaci
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Ankara City Hospital, Ankara, Turkey
| | - Nermin Gogus
- Ankara Numune Education and Research Hospital, Ankara, Turkey
- Ankara City Hospital, Ankara, Turkey
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Wu H, Yang F, Zhang R, Xue H, Yang Y, Liao R, Li M, Wu X, Chen D, Chen G, Gong Y, Hou L. Study protocol for a randomised controlled clinical trial comparing desflurane-based versus propofol-based anaesthesia on postanaesthesia respiratory depression in patients with obstructive sleep apnoea after major abdominal surgery. BMJ Open 2021; 11:e051892. [PMID: 34667009 PMCID: PMC8527155 DOI: 10.1136/bmjopen-2021-051892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients with obstructive sleep apnoea (OSA) are more sensitive to postanaesthesia respiratory depression. Whether different anaesthetic regimens (intravenous-based or inhalational-based general anaesthesia) affect the postanaesthesia respiratory depression is controversial. Although desflurane has been reported that presents favourable rapid recovery profile in special patients including whom with OSA, the strong clinical evidence of the benefit on postanaesthesia respiratory depression is far from being revealed. This study aims to fill this knowledge gap by investigating the postanaesthesia respiratory depression in postanaesthesia care unit (PACU) in patients with OSA after major abdominal surgery, followed by desflurane-based anaesthesia compared with propofol-based anaesthesia. METHODS AND ANALYSIS Eight hundred and fifty-four patients with OSA scheduled for elective major abdominal surgery will be randomly 1:1 assigned to desflurane-based (n=427) or propofol-based anaesthesia (n=427) using a computer-generated randomisation scheme with permuted block size maintained by a centralised randomisation centre. Patients will be assessed before and a consecutive 3 days after their surgery according to the standardised tasks. Demographic data as well as surgical and anaesthesia information will be collected for the duration of the procedure. Incidence of postanaesthesia respiratory depression in PACU as well as anaesthesia recovery, emergence delirium, postoperative nausea and vomiting, rescue analgesia, duration of PACU and hospital stay, and any other adverse events will be assessed at the given study time point. Investigators performing postoperative follow-up are not involved in both anaesthesia implementation and postoperative care. ETHICS AND DISSEMINATION This study protocol has been approved by the ethics board at Xiang'an Hospital of Xiamen University (XAHLL2019003). The results of this study will be published in a peer-review journal and presented at national conferences as poster or oral presentations. Participants wishing to know the results of this study will be contacted directly on data publication. TRIAL REGISTRATION NUMBER ChiCTR2000031087.
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Affiliation(s)
- Huanghui Wu
- Department of Anaesthesiology, Xiang'an Hospital of Xiamen University, Xiamen University, Xiamen, China
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
- Department of Anaesthesiology and Perioperative Medicine, Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Fei Yang
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
| | - Ran Zhang
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
| | - Haiyan Xue
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
| | - Yongyong Yang
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
| | - Ruizhe Liao
- Department of Anaesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Min Li
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
| | - Xiaozhi Wu
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
| | - Dongsheng Chen
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
| | - Guozhong Chen
- Department of Anaesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, China
- Department of Anaesthesiology and Perioperative Medicine, Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Anaesthesiology, Shanghai Fourth People's Hospital, Shanghai, China
| | - Yi Gong
- Department of Anaesthesiology, Xiang'an Hospital of Xiamen University, Xiamen University, Xiamen, China
- Department of Pain Medicine, The Third Hospital of Zhangzhou, Zhangzhou, China
| | - Lichao Hou
- Department of Anaesthesiology, Xiang'an Hospital of Xiamen University, Xiamen University, Xiamen, China
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10
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Moody OA, Zhang ER, Vincent KF, Kato R, Melonakos ED, Nehs CJ, Solt K. The Neural Circuits Underlying General Anesthesia and Sleep. Anesth Analg 2021; 132:1254-1264. [PMID: 33857967 DOI: 10.1213/ane.0000000000005361] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
General anesthesia is characterized by loss of consciousness, amnesia, analgesia, and immobility. Important molecular targets of general anesthetics have been identified, but the neural circuits underlying the discrete end points of general anesthesia remain incompletely understood. General anesthesia and natural sleep share the common feature of reversible unconsciousness, and recent developments in neuroscience have enabled elegant studies that investigate the brain nuclei and neural circuits underlying this important end point. A common approach to measure cortical activity across the brain is electroencephalogram (EEG), which can reflect local neuronal activity as well as connectivity among brain regions. The EEG oscillations observed during general anesthesia depend greatly on the anesthetic agent as well as dosing, and only some resemble those observed during sleep. For example, the EEG oscillations during dexmedetomidine sedation are similar to those of stage 2 nonrapid eye movement (NREM) sleep, but high doses of propofol and ether anesthetics produce burst suppression, a pattern that is never observed during natural sleep. Sleep is primarily driven by withdrawal of subcortical excitation to the cortex, but anesthetics can directly act at both subcortical and cortical targets. While some anesthetics appear to activate specific sleep-active regions to induce unconsciousness, not all sleep-active regions play a significant role in anesthesia. Anesthetics also inhibit cortical neurons, and it is likely that each class of anesthetic drugs produces a distinct combination of subcortical and cortical effects that lead to unconsciousness. Conversely, arousal circuits that promote wakefulness are involved in anesthetic emergence and activating them can induce emergence and accelerate recovery of consciousness. Modern neuroscience techniques that enable the manipulation of specific neural circuits have led to new insights into the neural circuitry underlying general anesthesia and sleep. In the coming years, we will continue to better understand the mechanisms that generate these distinct states of reversible unconsciousness.
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Affiliation(s)
- Olivia A Moody
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Edlyn R Zhang
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen F Vincent
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Risako Kato
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Eric D Melonakos
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Christa J Nehs
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Ken Solt
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
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11
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Paul M. The Impact of Obstructive Sleep Apnea on the Sleep of Critically Ill Patients. Crit Care Nurs Clin North Am 2021; 33:173-192. [PMID: 34023084 DOI: 10.1016/j.cnc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obstructive sleep apnea is becoming increasingly prevalent in society and thus critical care practitioners need to be prepared to care for these patients in the intensive care unit. Preparation begins with equipping the critical care nurse with the knowledge necessary to provide interventions which can enhance patient outcomes and mitigate complications.
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Affiliation(s)
- Michaelynn Paul
- Walla Walla University, School of Nursing, 10345 Southeast Market Street, Portland, OR 97216, USA.
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Savall A, Marcoux P, Charles R, Trombert B, Roche F, Berger M. Sleep quality and sleep disturbances among volunteer and professional French firefighters: FIRESLEEP study. Sleep Med 2021; 80:228-235. [PMID: 33610069 DOI: 10.1016/j.sleep.2021.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/22/2020] [Accepted: 01/26/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although insufficient sleep among firefighters reduces work efficiency and increases the risk of injury, little is known about the sleep quality of French firefighters in the Loire department. The aim of the FIRESLEEP study was to evaluate sleep quality and sleep disturbances among professional and voluntary French firefighters. METHODS A cross-sectional observational study was conducted between November 2018 and May 2019. Firefighters were invited to complete a questionnaire on a secure platform including clinical questions and validated questionnaires (Pittsburgh Sleep Quality Index [PSQI], Epworth sleepiness scale [ESS], Insomnia Severity Index [ISI] and the STOP-Bang score) during their periodic medical examination. RESULTS 193 firefighters were included in this study, of which 29% were of professional status and 71% were volunteer firefighters. Among them, 26.9% had poor sleep quality, 27.7% showed excessive daytime sleepiness (EDS), 18.8% reported moderate-to-severe symptoms of insomnia, and 1.6% had moderate-to-high risk of obstructive sleep apnea. Subgroup analysis revealed that professional firefighters had poorer sleep quality and higher sleep disturbances than volunteer firefighters. The independent risk factors associated with poor sleep quality were known sleep disorder, treated anxiety/depression, night calls, and insomnia symptoms. Moreover, the independent risk factors associated with EDS were short sleep duration, taking a nap, and insomnia symptoms; while older age was a protective factor for EDS. CONCLUSIONS Poor sleep quality and sleep disturbances are highly frequent in French firefighters and underdiagnosed. Prevention through education and systematic screening could limit the impact of sleep disturbances on firefighters' global health.
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Affiliation(s)
- Angélique Savall
- Department of Education and Research in General Practice, Saint-Etienne Jean Monnet University, Pôle Santé Nord, 42270 Saint Priest en Jarez, France; Clinical and Exercise Physiology, EA 4607 SNA EPIS, University Hospital and Jean Monnet University, PRES Lyon, 42023 Saint-Etienne, France.
| | - Pierre Marcoux
- Department of Education and Research in General Practice, Saint-Etienne Jean Monnet University, Pôle Santé Nord, 42270 Saint Priest en Jarez, France
| | - Rodolphe Charles
- Department of Education and Research in General Practice, Saint-Etienne Jean Monnet University, Pôle Santé Nord, 42270 Saint Priest en Jarez, France; Loire Departmental Fire and Emergency Service (DFES 42), 42007 Saint Etienne, France
| | - Béatrice Trombert
- Public Health, University Hospital, 42277 Saint-Priest-en-Jarez Cedex, France; Clinical and Exercise Physiology, EA 4607 SNA EPIS, University Hospital and Jean Monnet University, PRES Lyon, 42023 Saint-Etienne, France
| | - Frédéric Roche
- Clinical and Exercise Physiology, EA 4607 SNA EPIS, University Hospital and Jean Monnet University, PRES Lyon, 42023 Saint-Etienne, France
| | - Mathieu Berger
- Clinical and Exercise Physiology, EA 4607 SNA EPIS, University Hospital and Jean Monnet University, PRES Lyon, 42023 Saint-Etienne, France.
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Borczynski E, Worobel-Luk P. Capnography monitoring of patients with obstructive sleep apnea in the post-anesthesia care unit: a best practice implementation project. ACTA ACUST UNITED AC 2020; 17:1532-1547. [PMID: 31305387 DOI: 10.11124/jbisrir-2017-003939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The prevalence of OSA is substantial in North America. Post-operative patients with OSA are at risk for respiratory complications, but about 60% of surgical patients with this condition go undiagnosed. If the presence of sleep apnea is known, non-invasive capnography monitoring can be applied post-operatively to help detect early respiratory compromise during the recovery phase. The STOP-Bang Questionnaire, a validated screening tool to evaluate the risk of OSA, can efficiently be used as part of the pre-surgical evaluation. OBJECTIVES The aim of this project was to improve safety by averting post-operative respiratory events in patients with obstructive sleep apnea (OSA) through early detection of compromise during recovery from anesthesia. Specific objectives focused on implementing nurse-initiated capnography monitoring of patients with OSA in two post-anesthesia care units and, when indicated, expediently communicating abnormal end-tidal carbon dioxide excursions. METHODS Strategies and audit data were organized and evaluated using the Joanna Briggs Institute's Getting Research into Practice (GRiP) and Practical Application of Clinical Evidence Systems (PACES) tools. Medical record review was used for the baseline audit and three follow-up compliance audits of evidence-based practice. Multiple teaching methodologies were employed to reach and engage post-anesthesia care unit nurses. Equipment was maintained at the point of care. Nurses' participation in the project was voluntary. RESULTS There was nearly full compliance with the new practice of initiating capnography, when indicated. Compliance with escalating abnormal capnography results with associated concerning assessment findings was 100%, but the escalation sample size was only two patients. CONCLUSIONS Patients with known OSA benefited from non-invasive capnography monitoring during recovery from anesthesia because post-anesthesia care unit nurses were empowered to initiate evidence-based technology. Expedient adoption of the new practice was due to comprehensive nurse education, familiarity with a similar capnography monitoring process and the value nurses placed on capnography as another assessment tool to safeguard patients. A larger sample of patients is needed to evaluate compliance with escalating concerning findings to providers. Sustainability will be impacted if the post-anesthesia care unit's standards of care include capnography for patients with OSA.
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Affiliation(s)
- Elizabeth Borczynski
- University of California San Francisco (UCSF) Medical Center, San Francisco, USA.,UCSF Centre for Evidence Synthesis & Implementation: a Joanna Briggs Institute Centre of Excellence
| | - Pamela Worobel-Luk
- UCSF Centre for Evidence Synthesis & Implementation: a Joanna Briggs Institute Centre of Excellence
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Mikhaeil JS, Pepper CG, Hayward GC. Mechanisms of opioid‐induced respiratory depression in sleep apnoea: new insights for anaesthesiology. J Physiol 2020; 598:3827-3828. [DOI: 10.1113/jp280214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Connor G. Pepper
- Schulich School of Medicine & Dentistry Western University London ON Canada
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Carr SN, Reinsvold RM, Heering TE, Muckler VC. Integrating the STOP-Bang Questionnaire Into the Preanesthetic Assessment at a Military Hospital. J Perianesth Nurs 2020; 35:368-373. [DOI: 10.1016/j.jopan.2020.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
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Cost-effectiveness Analysis of Preoperative Screening Strategies for Obstructive Sleep Apnea among Patients Undergoing Elective Inpatient Surgery. Anesthesiology 2020; 133:787-800. [DOI: 10.1097/aln.0000000000003429] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background
Obstructive sleep apnea is underdiagnosed in surgical patients. The cost-effectiveness of obstructive sleep apnea screening is unknown. This study’s objective was to evaluate the cost-effectiveness of preoperative obstructive sleep apnea screening (1) perioperatively and (2) including patients’ remaining lifespans.
Methods
An individual-level Markov model was constructed to simulate the perioperative period and lifespan of patients undergoing inpatient elective surgery. Costs (2016 Canadian dollars) were calculated from the hospital perspective in a single-payer health system. Remaining model parameters were derived from a structured literature search. Candidate strategies included: (1) no screening; (2) STOP-Bang questionnaire alone; (3) STOP-Bang followed by polysomnography (STOP-Bang + polysomnography); and (4) STOP-Bang followed by portable monitor (STOP-Bang + portable monitor). Screen-positive patients (based on STOP-Bang cutoff of at least 3) received postoperative treatment modifications and expedited definitive testing. Effectiveness was expressed as quality-adjusted life month in the perioperative analyses and quality-adjusted life years in the lifetime analyses. The primary outcome was the incremental cost-effectiveness ratio.
Results
In perioperative and lifetime analyses, no screening was least costly and least effective. STOP-Bang + polysomnography was the most effective strategy and was more cost-effective than both STOP-Bang + portable monitor and STOP-Bang alone in both analyses. In perioperative analyses, STOP-Bang + polysomnography was not cost-effective compared to no screening at the $4,167/quality-adjusted life month threshold (incremental cost-effectiveness ratio $52,888/quality-adjusted life month). No screening was favored in more than 90% of iterations in probabilistic sensitivity analyses. In contrast, in lifetime analyses, STOP-Bang + polysomnography was favored compared to no screening at the $50,000/quality-adjusted life year threshold (incremental cost-effectiveness ratio $2,044/quality-adjusted life year). STOP-Bang + polysomnography was favored in most iterations at thresholds above $2,000/quality-adjusted life year in probabilistic sensitivity analyses.
Conclusions
The cost-effectiveness of preoperative obstructive sleep apnea screening differs depending on time horizon. Preoperative screening with STOP-Bang followed by immediate confirmatory testing with polysomnography is cost-effective on the lifetime horizon but not the perioperative horizon. The integration of preoperative screening based on STOP-Bang and polysomnography is a cost-effective means of mitigating the long-term disease burden of obstructive sleep apnea.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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De Cosmo G, Levantesi L, Del Vicario M. Sedation in digestive endoscopy: innovations for an old technique. Minerva Anestesiol 2020; 86:565-570. [DOI: 10.23736/s0375-9393.19.13949-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Sea level nocturnal minimal oxygen saturation can accurately detect the presence of obstructive sleep apnea in a population with high pretest probability. Sleep Breath 2020; 25:171-179. [PMID: 32306175 DOI: 10.1007/s11325-020-02014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate whether a predictive model based on nocturnal minimal oxygen saturation (SpO2) alone can accurately detect the presence of obstructive sleep apnea (OSA) in a population with suspected OSA. METHODS A total of 4297 participants with suspected OSA were enrolled in this study, and laboratory-based polysomnography (PSG) tests were performed at sea level in all subjects. Nocturnal minimal SpO2 was obtained automatically as part of the PSG test. Stratified sampling was used to divide the participants' data into the training set (75%) and the test set (25%). An OSA detection model based on minimal SpO2 alone was created using the training set data and its performance was evaluated using the independent test set data ("hold-out" evaluation). Gender-specific models, and models based on minimal SpO2 in combination with other predictive factors (age, body mass index, waist-to-hip ratio, snoring grade, Epworth Sleepiness Scale score, and comorbidities), were also created and compared in terms of OSA detection performance. RESULTS The prevalence of OSA was 85.6% in our study population. The models including multiple predictors, and the gender-specific models, failed to outperform the model based solely on minimal SpO2, which showed good predictive performance (C statistic, 0.922) having an overall accuracy rate of 0.86, sensitivity of 0.87, specificity of 0.84, positive predictive value of 0.97, and positive likelihood ratio of 5.34. In addition, the model based on minimal SpO2 alone could also accurately predict the presence of moderate-to-severe OSA and severe OSA, with C statistics of 0.914 and 0.900, respectively. CONCLUSIONS A predictive model based on nocturnal minimal SpO2 alone may be an alternative option to detect the presence of OSA in a high-risk population when standard diagnostic tests are unavailable.
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Perioperative implications and prevalence of Obstructive Sleep Apnea risk in a surgical population using the updated STOP-Bang questionnaire. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Strutz PK, Kronzer V, Tzeng W, Arrington B, McKinnon SL, Ben Abdallah A, Haroutounian S, Avidan MS. The relationship between obstructive sleep apnoea and postoperative delirium and pain: an observational study of a surgical cohort. Anaesthesia 2019; 74:1542-1550. [PMID: 31531850 DOI: 10.1111/anae.14855] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 01/03/2023]
Abstract
Patients with obstructive sleep apnoea are at increased risk of adverse postoperative outcomes, such as cardiac and respiratory complications. It has been hypothesised that obstructive sleep apnoea also increases the risk for postoperative delirium and acute postoperative pain. We conducted a retrospective, observational study investigating the relationship of obstructive sleep apnoea with postoperative delirium and acute postoperative pain severity. Patients were classified as being at high risk for obstructive sleep apnoea if they had been diagnosed with this condition, or if they were positive for more than four factors using the 'STOP-BANG' screening tool. Adjusted logistic regression was used to investigate the association between obstructive sleep apnoea and postoperative delirium, and multivariable linear regression to study the relationship between obstructive sleep apnoea and postoperative pain severity. The incidence of postoperative delirium was 307 in 1441 patients (21.3%; 95%CI 19.2-23.5%). In unadjusted analysis, high risk for obstructive sleep apnoea was associated with delirium, with an odds ratio (95%CI) of 1.77 (1.22-2.57; p = 0.003). After adjustment for pre-specified variables, the association was not statistically significant with odds ratio 1.34 (0.80-2.23; p = 0.27). The mean (SD) maximum pain (resting or provoked) reported for the entire cohort was 63.8 (27.9) mm on a 0-100 mm visual analogue scale. High risk for obstructive sleep apnoea was not associated with postoperative pain severity (β-coefficient 2.82; 95%CI, -2.34-7.97; p = 0.28). These findings suggest that obstructive sleep apnoea is unlikely to be a strong risk factor for postoperative delirium or acute postoperative pain severity.
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Affiliation(s)
- P K Strutz
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA.,University of Illinois at Chicago College of Medicine Chicago, Illinois, USA
| | - V Kronzer
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Tzeng
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
| | | | - S L McKinnon
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
| | - A Ben Abdallah
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
| | - S Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA.,Washington University Pain Center, St. Louis, MO, USA
| | - M S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA
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Qassamali SR, Lagoo-Deenadayalan S, McDonald S, Morgan B, Goode V. The importance of the STOP- BANG questionnaire as a preoperative assessment tool for the elderly population. Geriatr Nurs 2019; 40:536-539. [PMID: 31481260 DOI: 10.1016/j.gerinurse.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Undiagnosed obstructive sleep apnea (OSA) may adversely impact surgical patients and can lead to increased morbidity and mortality during the perioperative period, especially among the geriatric patient population (Chung et al. 2008, 2012, 2014; McDonald et al., 2018; Zietlow et al., 2018; Singh et al., 2012). The setting of this quality improvement project was a preoperative anesthesia and geriatric evaluation clinic housed within a 957-bed tertiary academic affiliated hospital. The sample included 45 patients who met the criteria established for surgery and OSA screening preoperatively. Nine patients (20.0%) were assessed as low risk (Stop-bang [SB] score </=2) for OSA, and 36 patients (80.0%) had a prior diagnosis from an ICD-9/10 code or a SB score >/= 3 indicative of high-risk for OSA. The retrospective utilization of a modified SB screening on charts that did not receive a clinical OSA evaluation (n = 52) detected 23 (44.2%) patients who were considered high-risk for OSA but were not identified prior to surgery. The SB questionnaire is underutilized, and patients' OSA is often unidentified prior to surgery.
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Affiliation(s)
- Sonia R Qassamali
- Duke University School of Nursing, Nurse Anesthesia Program 307 Trent Dr, Durham, NC 27710
| | | | - Shelley McDonald
- Duke University Medical Center, 2301 Erwin Road Durham, NC 27710
| | - Brett Morgan
- Duke University School of Nursing, Nurse Anesthesia Program 307 Trent Dr, Durham, NC 27710
| | - Victoria Goode
- Duke University School of Nursing, Nurse Anesthesia Program 307 Trent Dr, Durham, NC 27710.
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Grimaldi D, Papalambros NA, Reid KJ, Abbott SM, Malkani RG, Gendy M, Iwanaszko M, Braun RI, Sanchez DJ, Paller KA, Zee PC. Strengthening sleep-autonomic interaction via acoustic enhancement of slow oscillations. Sleep 2019; 42:zsz036. [PMID: 30753650 PMCID: PMC7729207 DOI: 10.1093/sleep/zsz036] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/25/2019] [Indexed: 11/14/2022] Open
Abstract
Slow-wave sleep (SWS) is important for overall health since it affects many physiological processes including cardio-metabolic function. Sleep and autonomic nervous system (ANS) activity are closely coupled at anatomical and physiological levels. Sleep-related changes in autonomic function are likely the main pathway through which SWS affects many systems within the body. There are characteristic changes in ANS activity across sleep stages. Notably, in non-rapid eye-movement sleep, the progression into SWS is characterized by increased parasympathetic activity, an important measure of cardiovascular health. Experimental manipulations that enhance slow-wave activity (SWA, 0.5-4 Hz) can improve sleep-mediated memory and immune function. However, effects of SWA enhancement on autonomic regulation have not been investigated. Here, we employed an adaptive algorithm to deliver 50 ms sounds phase-locked to slow-waves, with regular pauses in stimulation (~5 s ON/~5 s OFF), in healthy young adults. We sought to determine whether acoustic enhancement of SWA altered parasympathetic activity during SWS assessed with heart rate variability (HRV), and evening-to-morning changes in HRV, plasma cortisol, and blood pressure. Stimulation, compared with a sham condition, increased SWA during ON versus OFF intervals. This ON/OFF SWA enhancement was associated with a reduction in evening-to-morning change of cortisol levels and indices of sympathetic activity. Furthermore, the enhancement of SWA in ON intervals during sleep cycles 2-3 was accompanied by an increase in parasympathetic activity (high-frequency, HRV). Together these findings suggest that acoustic enhancement of SWA has a positive effect on autonomic function in sleep. Approaches to strengthen brain-heart interaction during sleep could have important implications for cardiovascular health.
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Affiliation(s)
- Daniela Grimaldi
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nelly A Papalambros
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kathryn J Reid
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roneil G Malkani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maged Gendy
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marta Iwanaszko
- Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rosemary I Braun
- Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL
| | | | - Ken A Paller
- Department of Psychology, Northwestern University, Evanston, IL
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Öztürk NAA, Dilektaşlı AG, Çetinoğlu ED, Ursavaş A, Karadağ M. Diagnostic Accuracy of a Modified STOP-BANG Questionnaire with National Anthropometric Obesity Indexes. Turk Thorac J 2019; 20:103-107. [PMID: 30958981 DOI: 10.5152/turkthoracj.2018.18074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a very common sleep-related disorder and has many medical complications. Although the STOP-BANG questionnaire is an attractive screening tool because of high sensitivity, it lacks power in specificity. The aim of the present study was to evaluate and compare the diagnostic accuracy of standard STOP-BANG and a modified STOP-BANG questionnaire, using national cut-off values for neck circumference that determined OSA, in a sleep center population. MATERIALS AND METHODS One hundred eighty-five participants who were referred to the sleep-disordered breathing clinic were consecutively enrolled. We used 40 cm and 36 cm as the cut-off values for neck circumference, thus scoring patients accordingly and creating a modified STOP-BANG score with national anthropometric obesity indexes. RESULTS The median neck circumferences were 41 (39-44) cm, 40 (37-42) cm, and 43 (40-45) cm for total population, female gender, and male gender, respectively. The mean STOP-BANG score was 4.5±1.5, and the mean modified STOP-BANG score was 4.9±1.5. Discrimination of OSA measured by area under the curve for both questionnaires is comparable (p>0.05). Sensitivity to define OSA (apnea-hypopnea index (AHI)≥5) was 92.2% and 93.8% for original and modified STOP-BANG questionnaire, respectively. Sensitivity for moderate (AHI≥15) and severe OSA (AHI≥30) was identical for both questionnaires. CONCLUSION The STOP-BANG questionnaire has an excellent sensitivity, but modest specificity and adding national obesity indexes for neck circumference achieved similar results in terms of sensitivity and specificity with the original questionnaire.
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Affiliation(s)
| | - Aslı Görek Dilektaşlı
- Department of Pulmonary Medicine, Uludağ University School of Medicine, Bursa, Turkey
| | | | - Ahmet Ursavaş
- Department of Pulmonary Medicine, Uludağ University School of Medicine, Bursa, Turkey
| | - Mehmet Karadağ
- Department of Pulmonary Medicine, Uludağ University School of Medicine, Bursa, Turkey
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Sankar A, Beattie W, Tait G, Wijeysundera D. Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery. Br J Anaesth 2019; 122:255-262. [DOI: 10.1016/j.bja.2018.10.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/23/2018] [Accepted: 10/10/2018] [Indexed: 11/15/2022] Open
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Subramani Y, Nagappa M, Wong J, Mubashir T, Chung F. Preoperative Evaluation: Estimation of Pulmonary Risk Including Obstructive Sleep Apnea Impact. Anesthesiol Clin 2018; 36:523-538. [PMID: 30390776 DOI: 10.1016/j.anclin.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
One in 4 deaths occurring within a week of surgery are related to pulmonary complications, making it the second most common serious morbidity after cardiovascular events. The most significant predictors of the postoperative pulmonary complications (PPCs) are American Society of Anesthesiologists physical status, advanced age, dependent functional status, surgical site, and duration of surgery. The overall risk of PPCs can be predicted using scores that incorporate readily available clinical data.
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Affiliation(s)
- Yamini Subramani
- Department of Anesthesia and Perioperative Medicine, London Health Science Centre, St. Joseph Health Care, Western University, Centre, Victoria Hospital, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Science Centre, St. Joseph Health Care, Western University, University Hospital, 339 Windermere Road, London, Ontario N6A 5A5, Canada
| | - Jean Wong
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst street, Toronto, Ontario M5T2S8, Canada
| | - Talha Mubashir
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst street, Toronto, Ontario M5T2S8, Canada
| | - Frances Chung
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst street, Toronto, Ontario M5T2S8, Canada.
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Best perioperative practice in management of ambulatory patients with obstructive sleep apnea. Curr Opin Anaesthesiol 2018; 31:700-706. [DOI: 10.1097/aco.0000000000000661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Nurse Practitioner-Driven Optimization of Presurgical Testing. J Perianesth Nurs 2018; 33:887-894. [PMID: 30449437 DOI: 10.1016/j.jopan.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/24/2017] [Accepted: 08/27/2017] [Indexed: 12/19/2022]
Abstract
Nurse practitioners play a pivotal role as members of the perioperative team. This article outlines the evolution of presurgical testing from the vantage of generic testing to one that is tailored to the patient's clinical presentation and the type of surgery to be performed, whether it is high, intermediate, or low risk. Emphasis is placed on indicated testing, screening tools to identify patients at risk for perioperative complications, the optimization of patients before undergoing major cancer surgery, and enhanced recovery after surgery. The goal was to bring awareness to our colleagues that evidence-based practice defines the present role of the nurse practitioner in this setting and evidence will shape its future direction.
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Chang KW, Steward DL, Tabangin ME, Altaye M, Malhotra V, Patil RD. Clinical use of the STOP-BANG questionnaire to determine postoperative risk in veterans. Laryngoscope 2018; 129:259-264. [PMID: 30194731 DOI: 10.1002/lary.27295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine whether STOP-BANG (snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, gender) scores are associated with immediate postoperative adverse events in veterans undergoing surgery. METHODS In this prospective cohort study, veterans presenting to the presurgical clinic at a Veterans Affairs hospital answered the STOP-BANG questionnaire, which was scored as high risk (5-8), intermediate risk (3-4), and low risk (0-2) for obstructive sleep apnea (OSA), during a 6-month study period. Immediate postoperative respiratory and cardiovascular adverse events were recorded. RESULTS The patient population included 1,080 veterans. Ninety-five patients (8.8%) experienced adverse events, of which 74 (6.9%) were respiratory and 21 (1.9%) were cardiovascular in nature. Patients with high-risk STOP-BANG scores (5-8) had significantly greater odds of having an adverse event odds ratio (OR) 2.1 (95% confidence interval [CI]: 1.4, 3.3) and hypoxia OR 2.8 (95% CI: 1.7, 4.6) compared to those with low- to intermediate-risk scores (0-4). Among patients with OSA, those with high-risk scores (5-8) had greater odds of an adverse event OR 3.9 (95% CI: 1.1, 13.9) and hypoxia OR 3.7 (95% CI: 1.1, 13.0) compared to those with low- to intermediate-risk scores (0-4). Patients without a history of OSA with high-risk scores (5-8) did not have significantly greater odds of an adverse event OR 1.5 (95% CI: 0.82, 2.6) or a hypoxic event OR 1.7 (95% CI: 0.87, 3.4) compared to those with low- to intermediate-risk scores (0-4). CONCLUSION The STOP-BANG questionnaire was useful in the veteran population because high-risk scores were predictive of adverse events, in particular, hypoxia for patients with a previous diagnosis of OSA. In the future, this may direct studies and clinical activities aimed at optimizing safe and effective perioperative practices. LEVEL OF EVIDENCE 2b Laryngoscope, 129:259-264, 2019.
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Affiliation(s)
- Katherine W Chang
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - David L Steward
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Meredith E Tabangin
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Mekibib Altaye
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Vidhata Malhotra
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.,Department of Anesthesia, Cincinnati VA Medical Center, Cincinnati, Ohio, U.S.A
| | - Reena Dhanda Patil
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Kahramfar Z, Rahimi B. 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. Open Access Maced J Med Sci 2018; 6:1617-1621. [PMID: 30337975 PMCID: PMC6182531 DOI: 10.3889/oamjms.2018.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Zohreh Kahramfar
- Department of Pulmonary and Critical Care Medicine, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Besharat Rahimi
- Department of Pulmonary and Critical Care Medicine, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.
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Affiliation(s)
- Neil N Shah
- Department of Medicine, Dell Medical School, The University of Texas at Austin, Health Discovery Building, 1701 Trinity Street, Austin, TX 78712-1875, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
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Abstract
PURPOSE OF REVIEW Recent advances in diagnostic testing for obstructive sleep apnea in children have refined the standard tests while identifying several new tools that hold promise to radically change how we diagnose sleep apnea. RECENT FINDINGS Studies have demonstrated that the polysomnogram may be modified to permit home assessment of sleep disturbed breathing in children to ensure more widespread access to the test. Alternately, questionnaires, nocturnal oximetry, and diagnostic urinary biomarkers have shown great promise as both sensitive and specific tools to diagnose sleep apnea in children as well as track the severity of the disease. SUMMARY The gold standard polysomnogram has been refined to permit its application in a modified form at home and for brief examinations in children. This standard has been challenged on several fronts, including questionnaires, nocturnal oximetry, drug-induced sleep endoscopy, and noninvasive urinary biomarkers that may ultimately supplant polysomnography as the gold standard to diagnose obstructive sleep apnea syndrome in children.
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Amra B, Javani M, Soltaninejad F, Penzel T, Fietze I, Schoebel C, Farajzadegan Z. Comparison of Berlin Questionnaire, STOP-Bang, and Epworth Sleepiness Scale for Diagnosing Obstructive Sleep Apnea in Persian Patients. Int J Prev Med 2018; 9:28. [PMID: 29619152 PMCID: PMC5869953 DOI: 10.4103/ijpvm.ijpvm_131_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/10/2017] [Indexed: 12/24/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive and not available everywhere. To identify the best OSA questionnaire for screening in Persian population, we compared Berlin, STOP-BANG, and Epworth Sleepiness Scale (ESS). Methods: In a cross-sectional study conducted on 400 adult patients suspected of OSA in Bamdad Respiratory Research Center, patients completed three questionnaires. For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. According to PSG, patients categorized into without OSA (apnea-hypopnea index [AHI] <5), mild OSA (15> AHI ≥5), moderate OSA (30> AHI ≥15), and severe OSA (AHI ≥30). Based on questionnaires and PSG results, predictive parameters for screening tests were calculated. Results: There were 234 (58.5%) males and 166 (41.5%) females in study population. Mean age of patients was 49.29 ± 9.75 standard deviation years. There was significant association between age with OSA (P = 0.005) and between body mass index (BMI) and neck circumference, with moderate and severe OSA (P < 0.001). Sensitivities of Berlin, STOP-BANG, and ESS were 86.42%, 81.46%, and 59%, respectively. Specificities of Berlin, STOP-BANG, and ESS were 52.94%, 82.35%, and 76.47%, respectively. Conclusions: This study suggested that Berlin and STOP-BANG are more sensitive and accurate than ESS for OSA screening in Iran.
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Affiliation(s)
- Babak Amra
- Department of Medicine, Pulmonary Unit, Isfahan University of Medical Sciences, Bamdad Respiratory Research Center, Isfahan, Iran
| | - Maedeh Javani
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Department of Medicine, Pulmonary Unit, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Thomas Penzel
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Department of Cardiology and Pulmonology, Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schoebel
- Department of Cardiology and Angiology, Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ziba Farajzadegan
- Department of Community and Preventive Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea. Curr Opin Anaesthesiol 2018; 31:89-95. [DOI: 10.1097/aco.0000000000000539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Burchakov DI, Mayorov AY. [Intermittent hypoxia due to sleep apnea syndrome in patients with type 2 diabetes mellitus]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:16-21. [PMID: 29171483 DOI: 10.17116/jnevro201711710116-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the possible association between intermittent hypoxia (IH) and HbA1c in patients with insufficient control type of 2 diabetes mellitus (T2DM). MATERIAL AND METHODS In this cross-sectional study 183 patients with HbAc1≥7% underwent three-channel overnight monitoring (ApneaLink) and completed Berlin Questionnaire, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Patients were divided in two groups, based on the cut-off value of oxygen desaturation index≥15. RESULTS AND CONCLUSION There were 79 (43%) patients with intermittent hypoxia, which was associated with poorer glycaemic control, defined as HbA1c>8.7% (sample median) in the univariate analysis and after adjustment for body mass index OR 2,40 (CI 1.21-4.95, p=0.021). Neither of three questionnaires yielded satisfactory results as a screening method in patients with T2DM. There is a need to implement instrumental screening of sleep-disordered breathing in this population and to study the effects of CPAP-therapy on glycaemic control and carbohydrate metabolism.
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Affiliation(s)
- D I Burchakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A Yu Mayorov
- Sechenov First Moscow State Medical University, Moscow, Russia; Endocrinological Research Centre, Moscow, Russia
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Nagappa M, Patra J, Wong J, Subramani Y, Singh M, Ho G, Wong DT, Chung F. Association of STOP-Bang Questionnaire as a Screening Tool for Sleep Apnea and Postoperative Complications: A Systematic Review and Bayesian Meta-analysis of Prospective and Retrospective Cohort Studies. Anesth Analg 2017; 125:1301-1308. [PMID: 28817421 DOI: 10.1213/ane.0000000000002344] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk of postoperative complications increases with undiagnosed obstructive sleep apnea (OSA). The high-risk OSA (HR-OSA) patients can be easily identified using the STOP-Bang screening tool. The aim of this systematic review and meta-analysis is to determine the association of postoperative complications in patients screened as HR-OSA versus low-risk OSA (LR-OSA). METHODS The following data bases were searched from January 1, 2008, to October 31, 2016, to identify the eligible articles: Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Cochrane Databases of Systematic Reviews, Medline-in-Process & other nonindexed citations, Google Scholar, Embase, Web of Sciences and Scopus. The search included studies with adult surgical patients screened for OSA with STOP-Bang questionnaire that reported at least 1 cardiopulmonary or any other complication requiring intensive care unit admission as diagnosis of outcome. We used a Bayesian random-effects analysis to evaluate the existing evidence of STOP-Bang in relation to OSA and to assess the association of postoperative complications with the identified HR-OSA patients by study design and methodologies. RESULTS This systematic review and meta-analysis was conducted using 10 cohort studies: 23,609 patients (HR-OSA, 7877; LR-OSA, 15,732). The pooled odds of perioperative complications were higher in the HR-OSA versus LR-OSA patients (odds ratio 3.93, 95% credible interval, 1.85-7.77, P= .003; 6.86% vs 4.62%). The length of hospital stay was longer in HR-OSA by 2 days when compared with LR-OSA (5.0 ± 4.2 vs 3.4 ± 2.8 days; mean difference 2.01; 95% credible interval, 0.77-3.24; P= .005). Meta-regression to adjust for baseline confounding factors and subgroup analysis did not materially change the results. CONCLUSIONS This systematic review and meta-analysis suggests that HR-OSA is related with higher risk of postoperative adverse events and longer length of hospital stay when compared with LR-OSA patients. Our findings support the implementation of the STOP-Bang screening tool for perioperative risk stratification.
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Affiliation(s)
- Mahesh Nagappa
- From the *Department of Anesthesia & Perioperative Medicine, University Hospital, Victoria Hospital and St. Joseph Hospital, London Health Sciences Centre and St. Joseph Health Care, Western University, London, Ontario, Canada; and †Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Panchasara B, Poots AJ, Davies G. Are the Epworth Sleepiness Scale and Stop-Bang model effective at predicting the severity of obstructive sleep apnoea (OSA); in particular OSA requiring treatment? Eur Arch Otorhinolaryngol 2017; 274:4233-4239. [PMID: 28856422 DOI: 10.1007/s00405-017-4725-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/19/2017] [Indexed: 01/10/2023]
Abstract
Obstructive sleep apnoea (OSA) is a condition characterised by repetitive upper airway collapse during sleep. The condition carries a range of health sequelae that can prove fatal in cases with co-existing risk factors for the condition, such as obesity and hypertension. Utilisation of a high-performance screening tool for OSA is thus important. A retrospective audit using the ESS and Stop-Bang scores, alongside Apnoea-Hypopnea Index values, for patients who underwent polysomnography over 1 year. Multinomial logistic regression was used to compare the predictive abilities of ESS, SBM, and body mass index (BMI) for the patient outcome groups, "None" (No OSA), "Notreat" (OSA not requiring treatment) and "treat" (OSA requiring treatment). The influences of age, gender and BMI on outcome group were also assessed. 126 bariatric and 66 non-bariatric patients were included. Multinomial logistic regression failed to demonstrate predictive ability of ESS. A higher Stop-Bang score significantly increases the risk being in the "treat" group. In addition, male gender, greater age and a higher BMI each individually increase the risk of OSA requiring treatment. Stop-Bang failed to demonstrate predictive significance when age and gender were controlled for. ESS is not an appropriate screening tool for OSA. Stop-Bang, however, remains a useful screening tool, with the ability to detect patient with OSA in need of treatment. Further study may benefit the development and implementation of a concise and more specific screening tool that considers high evidence-based risk factors for OSA, including male gender, greater age and raised BMI.
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Affiliation(s)
- Binita Panchasara
- Acute Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK. .,Department of Medicine, Imperial College London, London, UK.
| | - Alan J Poots
- NIHR CLAHRC Northwest London, Imperial College London, London, UK
| | - Gary Davies
- Acute Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK
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