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Hansen C, Markström A, Sonnesen L. Sleep-disordered breathing and malocclusion in children and adolescents-a systematic review. J Oral Rehabil 2021; 49:353-361. [PMID: 34779522 DOI: 10.1111/joor.13282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB. OBJECTIVES The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls. METHODS Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence. RESULTS The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low. CONCLUSION No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion.
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Affiliation(s)
- Camilla Hansen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agneta Markström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Molnár V, Molnár A, Lakner Z, Tárnoki DL, Tárnoki ÁD, Jokkel Z, Szabó H, Dienes A, Angyal E, Németh F, Kunos L, Tamás L. Examination of the diaphragm in obstructive sleep apnea using ultrasound imaging. Sleep Breath 2021; 26:1333-1339. [PMID: 34478056 PMCID: PMC9418095 DOI: 10.1007/s11325-021-02472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to analyze the effect of obstructive sleep apnea (OSA) on the ultrasound (US) features of the diaphragm and to determine if diaphragmatic US may be a useful screening tool for patients with possible OSA. METHODS Patients complaining of snoring were prospectively enrolled for overnight polygraphy using the ApneaLink Air device. Thickness and motion of the diaphragm during tidal and deep inspiration were measured. Logistic regression was used to assess parameters of the diaphragm associated with OSA. RESULTS Of 100 patients, 64 were defined as having OSA. Thicknesses of the left and right hemidiaphragms were significantly different between OSA and control groups. Using a combination of diaphragmatic dimensions, diaphragm dilation, age, sex, and BMI, we developed an algorithm that predicted the presence of OSA with 91% sensitivity and 81% specificity. CONCLUSION A combination of anthropometric measurements, demographic factors, and US imaging may be useful for screening patients for possible OSA. These findings need to be confirmed in larger sample sizes in different clinical settings.
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Affiliation(s)
- Viktória Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
| | - András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary.
| | - Zoltán Lakner
- Faculty of Food Science, Szent István University, Budapest, Hungary
| | | | | | - Zsófia Jokkel
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Helga Szabó
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - András Dienes
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Emese Angyal
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
| | - Fruzsina Németh
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
| | | | - László Tamás
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
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Memtsoudis SG, Cozowicz C, Nagappa M, Wong J, Joshi GP, Wong DT, Doufas AG, Yilmaz M, Stein MH, Krajewski ML, Singh M, Pichler L, Ramachandran SK, Chung F. Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea. Anesth Analg 2019; 127:967-987. [PMID: 29944522 PMCID: PMC6135479 DOI: 10.1213/ane.0000000000003434] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.
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Affiliation(s)
- Stavros G Memtsoudis
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Crispiana Cozowicz
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - David T Wong
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anthony G Doufas
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Palo Alto, California
| | - Meltem Yilmaz
- Department of Anesthesiology, Northwestern University, Chicago, Illinois
| | - Mark H Stein
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Megan L Krajewski
- Department of Anesthesia, Critical Care, and Pain Management, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mandeep Singh
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Toronto Sleep and Pulmonary Centre, Toronto, Canada.,Department of Anesthesia and Pain Management, Women's College Hospital, Toronto, Canada.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lukas Pichler
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Satya Krishna Ramachandran
- Department of Anesthesiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Obstructive sleep apnoea in adults: peri-operative considerations: A narrative review. Eur J Anaesthesiol 2019; 35:245-255. [PMID: 29300271 DOI: 10.1097/eja.0000000000000765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
: 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.
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Cozowicz C, Poeran J, Olson A, Mazumdar M, Mörwald EE, Memtsoudis SG. Trends in Perioperative Practice and Resource Utilization in Patients With Obstructive Sleep Apnea Undergoing Joint Arthroplasty. Anesth Analg 2017; 125:66-77. [PMID: 28504992 DOI: 10.1213/ane.0000000000002041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Emerging evidence associating obstructive sleep apnea (OSA) with adverse perioperative outcomes has recently heightened the level of awareness among perioperative physicians. In particular, estimates projecting the high prevalence of this condition in the surgical population highlight the necessity of the development and adherence to "best clinical practices." In this context, a number of expert panels have generated recommendations in an effort to provide guidance for perioperative decision-making. However, given the paucity of insights into the status of the implementation of recommended practices on a national level, we sought to investigate current utilization, trends, and the penetration of OSA care-related interventions in the perioperative management of patients undergoing lower joint arthroplasties. METHODS In this population-based analysis, we identified 1,107,438 (Premier Perspective database; 2006-2013) cases of total hip and knee arthroplasties and investigated utilization and temporal trends in the perioperative use of regional anesthetic techniques, blood oxygen saturation monitoring (oximetry), supplemental oxygen administration, positive airway pressure therapy, advanced monitoring environments, and opioid prescription among patients with and without OSA. RESULTS The utilization of regional anesthetic techniques did not differ by OSA status and overall <25% and 15% received neuraxial anesthesia and peripheral nerve blocks, respectively. Trend analysis showed a significant increase in peripheral nerve block use by >50% and a concurrent decrease in opioid prescription. Interestingly, while the absolute number of patients with OSA receiving perioperative oximetry, supplemental oxygen, and positive airway pressure therapy significantly increased over time, the proportional use significantly decreased by approximately 28%, 36%, and 14%, respectively. A shift from utilization of intensive care to telemetry and stepdown units was seen. CONCLUSIONS On a population-based level, the implementation of OSA-targeted interventions seems to be limited with some of the current trends virtually in contrast to practice guidelines. Reasons for these findings need to be further elucidated, but observations of a dramatic increase in absolute utilization with a proportional decrease may suggest possible resource constraints as a contributor.
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Affiliation(s)
- Crispiana Cozowicz
- From the *Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College New York, New York; †Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria; and ‡Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Wu J, Li P, Wu X. The effect of chronic intermittent hypoxia on respiratory sensitivity to morphine in rats. Sleep Breath 2017; 21:227-233. [DOI: 10.1007/s11325-016-1448-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/23/2016] [Accepted: 12/20/2016] [Indexed: 11/24/2022]
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Xará D, Mendonça J, Pereira H, Santos A, Abelha FJ. Eventos respiratórios adversos após anestesia geral em pacientes com alto risco de síndrome da apneia obstrutiva do sono. Braz J Anesthesiol 2015; 65:359-66. [DOI: 10.1016/j.bjan.2014.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/05/2014] [Indexed: 11/27/2022] Open
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Abstract
Sleep-disordered breathing (SDB), in particular obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome (OHS) are associated with significant morbidity and mortality. The prevalence of these conditions is rapidly rising mainly due to the worldwide increase in obesity. Obesity contributes to the pathogenesis of SDB in multiple ways including altering upper airway anatomy and collapsibility, ventilatory control and increasing respiratory work load. There is also increasing evidence that OSA itself contributes to the development of obesity. Moreover, both OSA and obesity promote the activation of inflammatory pathways, which is likely a key mechanism in cardiovascular and metabolic disease processes. Early recognition of SDB is important as effective treatments are available. Public health measures to reduce the prevalence of obesity are urgently required to halt the increasing burden of SDB.
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Affiliation(s)
- S Ryan
- From the Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, The Conway Institute, University College Dublin, Dublin, Ireland From the Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, The Conway Institute, University College Dublin, Dublin, Ireland
| | - S J Crinion
- From the Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, The Conway Institute, University College Dublin, Dublin, Ireland From the Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, The Conway Institute, University College Dublin, Dublin, Ireland
| | - W T McNicholas
- From the Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, The Conway Institute, University College Dublin, Dublin, Ireland From the Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, The Conway Institute, University College Dublin, Dublin, Ireland
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Xará D, Mendonça J, Pereira H, Santos A, Abelha FJ. Adverse respiratory events after general anesthesia in patients at high risk of obstructive sleep apnea syndrome. Braz J Anesthesiol 2014; 65:359-66. [PMID: 26323734 DOI: 10.1016/j.bjane.2014.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia. METHODS This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011. Primary outcome was the development of adverse respiratory events. Demographics data, perioperative variables, and postoperative length of stay in the Post-Anesthesia Care Unit and in hospital were recorded. The Mann-Whitney test, the chi-square test and the Fisher exact test were used for comparisons. RESULTS Subjects in both pairs of study subjects had a median age of 56 years, including 25% males, and 59% were submitted to intra-abdominal surgery. High risk of obstructive sleep apnea patients had a higher median body mass index (31 versus 24kg/m(2), p<0.001) and had more frequently co-morbidities, including hypertension (58% versus 24%, p<0.001), dyslipidemia (46% versus 17%, p<0.001) and insulin-treated diabetes mellitus (17% versus 2%, p=0.004). These patients were submitted more frequently to bariatric surgery (20% versus 2%, p=0.002). Patients with high risk of obstructive sleep apnea had more frequently adverse respiratory events (39% versus 10%, p<0.001), mild to moderate desaturation (15% versus 0%, p=0.001) and inability to breathe deeply (34% versus 9%, p=0.001). CONCLUSION After general anesthesia high risk of obstructive sleep apnea patients had an increased incidence of postoperative respiratory complications.
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Affiliation(s)
- Daniela Xará
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Júlia Mendonça
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Helder Pereira
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Alice Santos
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Fernando José Abelha
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal; Anaesthesiology and Perioperative Care Unit, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Surgical Department of Faculty of Medicine, University of Porto, Portugal.
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Shortt CM, Fredsted A, Bradford A, O'Halloran KD. Diaphragm muscle remodeling in a rat model of chronic intermittent hypoxia. J Histochem Cytochem 2013; 61:487-99. [PMID: 23640977 DOI: 10.1369/0022155413490947] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Respiratory muscle remodeling occurs in human sleep apnea--a common respiratory disorder characterized by chronic intermittent hypoxia (CIH) due to recurrent apnea during sleep. We sought to determine if CIH causes remodeling in rat sternohyoid (upper airway dilator) and diaphragm muscles. Adult male Wistar rats were exposed to CIH (n=8), consisting of 90 sec of hypoxia (5% at the nadir; SaO₂ ~80%)/90 sec of normoxia, 8 hr per day, for 7 consecutive days. Sham animals (n=8) were exposed to alternating air/air cycles in parallel. The effect of CIH on myosin heavy-chain (MHC) isoform (1, 2a, 2x, 2b) distribution, sarcoplasmic reticulum calcium ATPase (SERCA) isoform distribution, succinate dehydrogenase activity, glycerol phosphate dehydrogenase activity, and Na⁺/K⁺ ATPase pump content was determined. Sternohyoid muscle structure was unaffected by CIH treatment. CIH did not alter oxidative/glycolytic capacity or the Na⁺/K⁺-ATPase pump content of the diaphragm. CIH significantly increased the areal density of MHC 2b fibers in the rat diaphragm, and this was associated with a shift in SERCA proteins from SERCA2 to SERCA1. We conclude that CIH causes a slow-to-fast fiber transition in the rat diaphragm after just 7 days of treatment. Respiratory muscle functional remodeling may drive aberrant functional plasticity such as decreased muscle endurance, which is a feature of human sleep apnea.
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Affiliation(s)
- Christine M Shortt
- UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
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Postoperative complications in obstructive sleep apnea. Sleep Breath 2012; 17:727-34. [PMID: 22821225 DOI: 10.1007/s11325-012-0750-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVES This study was conducted to determine whether postoperative complications are increased in patients with obstructive sleep apnea (OSA) and to study the impact of the severity of OSA and preoperative use of continuous positive airway pressure (CPAP) on the postoperative outcome. DESIGN AND SETTING This study is retrospective in nature and was undertaken at the VA Medical Center. PARTICIPANTS AND METHODS Three hundred seventy patients who had undergone both a major surgical procedure and a sleep study from 2000 to 2010 were identified. Patients were divided into four groups: OSA negative (apnea-hypopnea index (AHI) < 5/h), OSA positive; mild: AHI 5 to <15/h; moderate: AHI 15 to <30/h; and severe: AHI ≥ 30/h. No intervention was made during the course of the study. Postoperative complications namely respiratory, cardiac, neurological, and unplanned intensive care unit transfers were collected. RESULTS There were 284 (76.8 %) patients having OSA and 86 (23.2 %) without OSA. The overall incidence of total complications was significantly higher in the OSA patients compared with the control patients (48.9 vs. 31.4 %; odds ratio 2.09, 95 % CI 1.25-3.49). There was no significant difference in total complications between those using and not using CPAP prior to hospitalization. Patients with sleep apnea had a higher incidence of respiratory complications compared to patients without sleep apnea (40.4 vs. 23.2 %; odds ratio 2.24, 95 % CI 1.29-3.90). There was no significant difference in major cardiac complications in the OSA patients compared with the control patients (13.0 vs. 9.3 %; odds ratio 1.46, 95 % CI 0.65-3.26). CONCLUSION OSA is associated with a significantly increased rate of postoperative complications.
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Abdelmageed WM, Elquesny KM, Shabana RI, Abushama HM, Nassar AM. Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Saudi J Anaesth 2011; 5:150-6. [PMID: 21804794 PMCID: PMC3139306 DOI: 10.4103/1658-354x.82782] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Dexmedetomidine is an alpha2 -adrenergic agonist with sedative and analgesic properties. This study aimed to investigate if the use of a continuous dexmedetomidine infusion with i.v. morphine patient-controlled analgesia (PCA) could improve postoperative analgesia while reducing opioid consumption and opioid-related side effects. Methods: In this prospective randomized, double-blinded, controlled study, 39 patients with obstructive sleep apnea syndrome undergoing uvulopalatopharyngoplasty were assigned to two groups. Group D (dexmedetomidine group) received a loading dose of dexmedetomidine 1 μg.kg-1 i.v., 30 minutes before the anticipated end of surgery, followed by infusion at 0.6 μg.kg-1 h-1 for 24 hours. Group P (placebo group) received a bolus and infusion of placebo. In both groups, postoperative pain was initially controlled by i.v. morphine titration and then PCA with morphine. Cumulative PCA morphine consumption, pain intensities, sedation scores, cardiovascular and respiratory variables and opioid-related adverse effects were recorded for 48 hours after operation. Results: Compared with placebo group, patients in the dexmedetomidine group required 52.7% less PCA morphine during the first 24 hours postoperatively, with significantly better visual analogue scale scores, less incidence of respiratory obstruction (5 vs. 12 patients, respectively; P = .037) and longer time to first analgesic request (21 (11) vs. 9 (4) minutes; P = .002). Fewer patients in group D experienced nausea and vomiting than those in group P (7 vs. 24 patients, respectively; P < .05). Conclusion: Continuous dexmedetomidine infusion may be a useful analgesic adjuvant for patients susceptible to opioid-induced respiratory depression.
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Affiliation(s)
- Waleed M Abdelmageed
- Department of Anesthesia, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Corcoran TB, Hillyard S. Cardiopulmonary aspects of anaesthesia for the elderly. Best Pract Res Clin Anaesthesiol 2011; 25:329-54. [DOI: 10.1016/j.bpa.2011.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/12/2011] [Indexed: 02/03/2023]
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Adesanya AO, Lee W, Greilich NB, Joshi GP. Perioperative Management of Obstructive Sleep Apnea. Chest 2010; 138:1489-98. [DOI: 10.1378/chest.10-1108] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Obstructive sleep apnea is the most prevalent breathing disturbance in sleep. It is linked to a host of preexisting medical conditions, and associated with poorer postoperative outcomes. Screening and vigilance during the preoperative assessment identifies patients at high risk of obstructive sleep apnea. Further diagnostic tests may be performed, and plans can be made for tailored intraoperative care. The STOP and the STOP-Bang questionnaires are useful screening tools. Patients with a known diagnosis of obstructive sleep apnea should be seen in the preoperative clinic, where risk stratification and optimization may be done before surgery. This review article presents functional algorithms for the perioperative management of obstructive sleep apnea based on limited clinical evidence, and a collation of expert knowledge and practices. These recommendations may be used to assist the anesthesiologist in decision-making when managing the patient with obstructive sleep apnea.
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Affiliation(s)
- Edwin Seet
- Department of Anesthesia, Alexandra Health Private Limited, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore
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Ead H. Meeting the challenge of obstructive sleep apnea: developing a protocol that guides perianesthesia patient care. J Perianesth Nurs 2009; 24:103-10; quiz 111-13. [PMID: 19332283 DOI: 10.1016/j.jopan.2009.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 11/10/2008] [Accepted: 01/03/2009] [Indexed: 11/18/2022]
Abstract
Caring for a patient postoperatively with a medical history of diagnosed or suspected obstructive sleep apnea (OSA) is not uncommon. OSA is estimated to be present in 2%-26% of the general population, and the National Sleep Foundation proposes that one in four Americans are at high risk for OSA. Also of concern is that the incidence of OSA may increase as our population ages. Despite published guidelines, it can be difficult to implement recommendations that include increased monitoring of patients in critical care settings, particularly when these resources are already stretched. Although health care professionals want to provide a high level of care, it is recognized that patients with OSA can place a strain on health care systems. This article reviews the impact OSA can have on the patient in the perioperative phase and the implications to care providers. Also outlined are the challenges of initiating an OSA screening tool and management protocol. Although updating an institution's policies around perioperative management of the patient with OSA is vital, it can appear to be an overwhelming task to comply with all evidence-based recommendations.
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Mackiewicz M, Zimmerman JE, Shockley KR, Churchill GA, Pack AI. What are microarrays teaching us about sleep? Trends Mol Med 2009; 15:79-87. [PMID: 19162550 DOI: 10.1016/j.molmed.2008.12.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/09/2008] [Accepted: 12/09/2008] [Indexed: 01/10/2023]
Abstract
Many fundamental questions about sleep remain unanswered. The presence of sleep across phyla suggests that it must serve a basic cellular and/or molecular function. Microarray studies, performed in several model systems, have identified classes of genes that are sleep-state regulated. This has led to the following concepts: first, a function of sleep is to maintain synaptic homeostasis; second, sleep is a stage of macromolecule biosynthesis; third, extending wakefulness leads to downregulation of several important metabolic pathways; and, fourth, extending wakefulness leads to endoplasmic reticulum stress. In human studies, microarrays are being applied to the identification of biomarkers for sleepiness and for the common debilitating condition of obstructive sleep apnea.
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Chung SA, Yuan H, Chung F. A Systemic Review of Obstructive Sleep Apnea and Its Implications for Anesthesiologists. Anesth Analg 2008; 107:1543-63. [DOI: 10.1213/ane.0b013e318187c83a] [Citation(s) in RCA: 229] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ticehurst K, Zaki S, Hunt GB, Macpherson C, Nicholson H. Use of continuous positive airway pressure in the acute management of laryngeal paralysis in a cat. Aust Vet J 2008; 86:395-7. [DOI: 10.1111/j.1751-0813.2008.00350.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riha RL, Diefenbach K, Jennum P, McNicholas WT. Genetic aspects of hypertension and metabolic disease in the obstructive sleep apnoea–hypopnoea syndrome. Sleep Med Rev 2008; 12:49-63. [DOI: 10.1016/j.smrv.2007.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Wåhlin Larsson B, Kadi F, Ulfberg J, Piehl Aulin K. Skeletal Muscle Morphology and Aerobic Capacity in Patients with Obstructive Sleep Apnoea Syndrome. Respiration 2008; 76:21-7. [DOI: 10.1159/000126492] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 01/14/2008] [Indexed: 01/06/2023] Open
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Fritscher LG, Canani S, Mottin CC, Fritscher CC, Berleze D, Chapman K, Chatkin JM. Bariatric surgery in the treatment of obstructive sleep apnea in morbidly obese patients. Respiration 2007; 74:647-52. [PMID: 17728530 DOI: 10.1159/000107736] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 06/01/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Weight loss has been shown effective in the treatment of the obstructive sleep apnea-hypopnea syndrome. Regrettably, many obese patients are unable to achieve sustained and useful weight loss by dietary means. Recently, bariatric surgery has emerged as an alternative to treat obesity and many of its comorbidities, although its role for sleep apnea treatment is still not defined. OBJECTIVES To evaluate the impact of bariatric surgery on obstructive sleep apnea in morbidly obese patients. METHODS In this cohort study, polysomnography, Epworth Sleepiness Scale questionnaire and clinical assessment were performed in 12 of 13 morbidly obese patients with moderate to severe obstructive sleep apnea treated with bariatric surgery through Roux-en-Y gastric bypass procedure after a minimum of 18 months post surgery. RESULTS The mean (+/-SD) loss of excess body weight was 70.5 +/- 24%. The mean level obtained in the Epworth Scale was 4.8. There was a significant reduction in the apnea-hypopnea index, from a median of 46.5 (range: 33-140) to 16 (range: 0.9-87) events per hour (p < 0.05), an improvement in mean oxygen saturation from 85.7 +/- 5.1 to 94.5 +/- 3.6% (p < 0.05) and in minimum oxygen saturation from 64.7 +/- 13.4 to 78.7 +/- 13.7% (p < 0.05). The magnitude of the weight loss and the improvements in mean and minimum oxygen saturation were positively correlated, (r = 0.76; p <or= 0.05, and r = 0.59; p <or= 0.05, respectively). CONCLUSIONS Weight loss achieved by bariatric surgery is associated with significant long-term improvements in obstructive respiratory event, oxygenation and resolution of daytime somnolence.
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Affiliation(s)
- Leandro G Fritscher
- Department of Medicine, Division of Respirology, University of Toronto, Toronto, Ontario, Canada.
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Ahmed I, Thorpy MJ. CLASSIFICATION OF SLEEP DISORDERS. Continuum (Minneap Minn) 2007. [DOI: 10.1212/01.con.0000275603.69539.cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lee YCG, Beasley R. Respirology year-in-review 2006: Clinical science. Respirology 2007; 12:6-15. [PMID: 17207019 PMCID: PMC7192212 DOI: 10.1111/j.1440-1843.2006.01004.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y C Gary Lee
- Centre for Respiratory Research, University College London, London.
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Wiesner TD, Stumvoll M. Obstructive sleep apnea and insulin resistance: correlation or causation? Expert Rev Endocrinol Metab 2006; 1:575-578. [PMID: 30754097 DOI: 10.1586/17446651.1.5.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tobias D Wiesner
- a University of Leipzig, 3rd Medical Department, Philipp-Rosenthal-Str. 27, D - 04103, Leipzig, Germany.
| | - Michael Stumvoll
- b University of Leipzig, 3rd Medical Department, Philipp-Rosenthal-Str. 27, D - 04103 Leipzig, Germany.
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