In children deterioration in EF during the night significantly correlated with the severity of OSA. Furthermore, the reactive hyperemia test can be reliably performed with only 60 seconds of arterial flow occlusion in children.
Obstructive sleep apnea (OSA) is common among surgical patients. The STOP-Bang questionnaire is a validated screening tool with a high sensitivity. However, its moderate specificity may yield fairly high false positive rate. We hypothesized that the specific combinations of predicting factors in the STOP-Bang questionnaire would improve its specificity.
The authors reported that when the STOP-Bang score was ≥ 3 (any 3 positive items), the sensitivity and specificity for identifying moderate severe OSA was 87% and 31%, respectively. The specificity for any 2 positive items from the 4 STOP questions plus BMI > 35 kg/m2, male gender, or neck circumference > 40 cm for identifying moderate-severe OSA was 85%, 77%, and 79%, respectively. Compared with STOP-Bang score ≥ 3, the predicted probability for severe OSA of the specific combinations of STOP score ≥ 2 + male and STOP score ≥ 2 + BMI increased by 36% and 42%, respectively. For severe OSA, the specific combination of STOP score ≥ 2 + BMI + male demonstrated a specificity of 97% and 86% increase in predicted probability versus any 4 positive items of STOP-Bang questionnaire.
A propofol infusion strategy that requires limited experience with propofol dose selection and only 1 pump dosing change reliably produced airway obstruction in patients with severe sleep apnea.
This study demonstrates that the beneficial effect of hyperoxia on OSA severity is primarily based on its ability to reduce Loop Gain. The effects of hypoxia may explain the disappearance of OSA and the emergence of central sleep apnoea in conditions such as high altitude.
The STOP-Bang score may be used as an effective predictor of difficult airway in obese patients. Obese surgical patients with unknown/undiagnosed OSA status should be evaluated using the STOP-Bang questionnaire score.
The authors performed a survey and asked questions about attitudes and practice patterns regarding OSA in the perioperative setting. Of 783 respondents, 94 % felt OSA was a risk factor for perioperative complications. Perioperative management guidelines for OSA are not available at most institutions.
The authors report on a novel, non-invasive respiratory volume monitor that provides a real time respiratory curve demonstrating lung volumes as well as a continuous, display of minute ventilation, tidal volume and respiratory rate. They discuss its potential use in OSA patients.
Major surgery might have a modulating effect on nocturnal breathing patterns. The incidence and course of perioperative sleep-disordered breathing in individuals without a previous diagnosis of obstructive sleep apnea has not been investigated sufficiently so far.” They found in their study of 37 individuals without previous OSA diagnosis “that significant increase in the AHI occurred frequently after major surgical procedures in the late postoperative period. Sleep-disordered breathings in the late postoperative period deserve attention, as they potentially increase the risk of postoperative complications.
84 patients (aged 67 ± 9 years) scheduled for sub-inguinal surgical revascularisation were enrolled for preoperative polysomnography. the primary predictors of MACCE were significant OSA (hazard ratio (HR) 5.1 (95% CI 1.9–13.9); p=0.001) and pre-existing coronary artery disease (HR 4.4 (95% CI 1.8–10.6); p=0.001).
In this case series of 27 CPAP-intolerant patients with obstructive sleep apnea, the effect of upper airway stimulation (USA) using unilateral implantable hypoglossal nerve neurostimulator on airway dimensions was studied. Airway dimensions were studied while awake (n=15) and under drug-induced sedation (n=12). Authors found that UAS increased both retropalatal and retrolingual areas, and the effect was more in responders than the non-responders of UAS therapy. This finding could explain the beneficial effects of UAS therapy in select group of patients as seen by a reduction in the apnea-hypopnea index.