Postoperative cognitive decline, comprising of a relatively short-lived delirium and a more persistent cognitive dysfunction, can have devastating long-term consequences including both a higher mortality rate and costs associated with the care of the cognitively impaired. To date several risk factors have been identified. This is the first prospective study employing validated measures of delirium to identify an association between preexisting obstructive sleep apnea and postoperative delirium. This study includes 106 nondemented patients 65 yr or older undergoing elective knee arthroplasty that were prospectively evaluated for postoperative delirium. The results show an incidence of 25.5% incidence of postoperative delirium.
This study was performed to determine the mechanisms by which lung volume and upper airway collapsibility are related and whether phrenic nerve stimulation has therapeutic potential in preventing or treating upper airway obstruction.
The authors found that tonic phrenic nerve stimulation decreases upper airway collapsibility. These findings suggest that the decrease in collapsibility is primarily mediated through lung volume increase related changes in airway wall compliance and/or airway transmural pressure gradients rather than through mediastinal traction secondary to diaphragm descent. Phrenic nerve stimulation deserves further exploration as a therapy for OSA.
Corticotropin-releasing factor in the basolateral amygdala is involved in regulating stress-induced alterations in sleep and it plays a role in modulating how stressful memories influence sleep.
By using microarrays the authors compared gene expression in tissue from sleep and sleep deprived mice. The results support the notion that the molecular consequences of sleep/wake behavioral state extend beyond the brain to include peripheral tissues. Sleep state induces a highly overlapping response in both heart and lung.
MCH stimulation increased both non-REM and REM sleep against a very strong circadian waking drive. This has significant potential for the insomnia associated with shift-work and jet-lag, conditions where a strong waking drive blocks sleep onset
…complaints can be ranked according to a severity hierarchy: shake child to breathe, apnea during sleep, struggle breathing when asleep, and breathing concerns while asleep, followed by loudness of snoring and snoring while asleep. As a result, the set of six hierarchically arranged questions will aid the screening of children at high risk for SDB but cannot be used as the sole diagnostic approach.
The goals of the task force were (1) to clarify and simplify the current scoring rules, (2) to review evidence for new monitoring technologies relevant to the scoring rules, and (3) to strive for greater concordance between adult and pediatric rules.
Certain age groups (younger and older) are particularly susceptible to the negative effects of OSA on cognition. Other influences that increase the risk for cognitive dysfunction in OSA include premature birth, apolipoprotein e4 allele status and other genetic polymorphisms, lower socioeconomic status, fewer years of education, and ethnicity.
The STBUR questionnaire appears promising as a simple, clinically useful tool for identifying children at risk for PRAE. Further studies to validate the STBUR questionnaire as a diagnostic tool may be warranted.
Sleep duration and quality, OSA, and glucose metabolism were assessed in 96 obese individuals reporting to sleep less than 6.5 hrs on a regular basis. OSA severity was associated with higher fasting glucose and insulin. Those with moderate to severe OSA had higher glucose at 120 min while undergoing a glucose tolerance test.