Serum Bicarbonate Level Improves Specificity of STOP-Bang Screening for OSA

A STOP-Bang score ≥3 is highly sensitive but only moderately specific. Apnea/hypopnea during sleep can lead to intermittent hypercapnia and may result in serum bicarbonate (HCO3-) retention. The addition of serum HCO3– to the STOP-Bang questionnaire may improve its specificity. With the addition of HCO3– ≥28 mmol/L to the STOP-Bang score ≥3, the specificity for all OSA, moderate/severe OSA and severe OSA improved to 85.2%, 81.7%, 79.7%, respectively. Serum HCO3– level increases the specificity of STOP-Bang screening in predicting moderate/severe OSA. The authors propose a 2-step screening process. The first step uses a STOP-Bang score to screen patients and the second step uses serum HCO3– in those with a STOP-Bang score ≥3 for increased specificity.

The ASPAN Obstructive Sleep Apnea in the Adult Patient Evidence-Based Practice Recommendation

A vision of the American Society of PeriAnesthesia Nurses (ASPAN) is to provide empirical support to guide the safe care of perianesthesia patients. Biannually, the Perianesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements are revised to include the most current evidence-based findings. The development of an OSA Practice Recommendation was identified as a priority for 2012 by the ASPAN Board of Directors. Clinical practice (CP) questions relating to the safe care of patients with obstructive sleep apnea (OSA) are received monthly by ASPAN from national and international perianesthesia nurses. Eighteen questions were refined from the CP questions relating to OSA. ASPAN’s evidence based practice process was used for the literature search, critical review of the evidence and consensus of recommendations for the development and refinement of the OSA-Practice Recommendation.

Toll-Like Receptor Activity in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea has been linked to chronic inflammation and cardiovascular diseases. This work demonstrated that OSA is associated with enhanced expression and signaling events downstream of TLR2 and TLR4 in circulating monocytes. These observations were mitigated by CPAP therapy, which suggest that TLR2 and TLR4 activation may be involved as a signaling mechanism in immune-mediated progression of atherosclerosis in OSA.

Adenosine A1 Receptors in Mouse Pontine Reticular Formation Depress Breathing, Increase Anesthesia Recovery Time, and Decrease Acetylcholine Release

Adenosine has several actions depending on the receptors targeted. This work supports the interpretation that an adenosinergic-cholinergic interaction within the –tailed hypothesis that adenosine A1 receptors in the pontine comprises one neurochemical mechanism underlying the wakefulness stimulus for breathing.

Predictors of Positive Airway Pressure Therapy Adherence in Children: A Prospective Study

PAP adherence in children and adolescents is related primarily to family and demographic factors rather than severity of apnea or measures of psychosocial functioning. Further research is needed to determine the relative contributions of maternal education, socioeconomic status and cultural beliefs to PAP adherence in children, in order to develop better adherence programs.

Measuring Sleep Quality After Adenotonsillectomy in Pediatric Sleep Apnea

The aim of this study was to demonstrate postoperative changes in sleepquality in children with obstructive sleep apnea (OSA), using both conventional sleep staging and electrocardiogram-based cardiopulmonary coupling (CPC) analysis. In pediatric OSA, postoperative improvement of sleepquality is more readily discernible by CPC analysis than EEG-based sleep staging.