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.
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.
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 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.
This work demonstrated that volatile anesthetics are capable of directly activating endogenous sleep-promoting networks by activating VLPO nucleus.
In this paper, we will critically review the available evidence linking OSAS to systemic inflammation in children using CRP levels as the reporter biomarker.
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.
Craniofacialmorphology may influence the severity of sleep apnea in boys but not in girls.
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.
They concluded “The CAS-15 proved useful in an office setting and correctly diagnosed 72% of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.”