Literature Updates from January 2018

Changing Faces of OSA: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort

Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy phenotypes. This study examined relationships between changes in symptoms and PAP adherence. It proved that OSA treatment response patterns differed by initial clinical phenotype and PAP adherence. Individuals with insomnia-related symptoms may require additional targeted therapy for these complaints, emphasizing the need for a personalized approach to management.

https://www.ncbi.nlm.nih.gov/pubmed/29301021

Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis of Comparative Studies

Obstructive sleep apnea (OSA) is a common comorbidity in patients undergoing cardiac surgery and may predispose patients to postoperative complications. This meta-analysis determines the evidence of postoperative complications associated with OSA patients undergoing cardiac surgery and demonstrates that after cardiac surgery, major adverse cardiac or cerebrovascular events and newly documented postoperative atrial fibrillation had 33.3% and 18.1% higher odds in OSA versus non-OSA patients, respectively.

https://www.ncbi.nlm.nih.gov/pubmed/29049073

Postoperative Oxygen Therapy in Patients With OSA: A Randomized Controlled Trial

Postoperative supplemental oxygen is commonly used, but it may contribute to respiratory depression in patients with OSA receiving opioids. This randomized controlled trial investigated the effect of postoperative supplemental oxygen on arterial oxygen saturation (Sao2), sleep respiratory events, and CO2 level in patients with untreated OSA. Postoperative supplemental oxygen was found to improve oxygenation and decrease the AHI without increasing the duration of apnea-hypopnea event or PtcCO2 level. A small number of patients had significant CO2 retention while receiving supplemental oxygen.

https://www.ncbi.nlm.nih.gov/pubmed/28007620

Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis

The American Patient Safety Foundation has called for continuous electronic monitoring for all patients receiving opioids in the postoperative period. This study evaluated the effectiveness of continuous capnography monitoring, pulse oximetry and intermittent  nursing checks  for detecting postoperative respiratory depression (PORD) and preventing postoperative adverse events in the surgical ward. The use of continuous pulse oximetry on the surgical ward is associated with significant improvement in the detection of oxygen desaturation versus intermittent nursing spot-checks. The results also pointed out that capnography provides an early warning of PORD before oxygen desaturation, especially when supplemental oxygen is administered.

https://www.ncbi.nlm.nih.gov/pubmed/29064874

Nonadherence to CPAP Associated with Increased 30-Day Hospital Readmissions

Retrospective analysis of 345 OSA patients hospitalized at a Veterans Affairs hospital showed that the all cause 30-day readmission rate was significantly higher in patient’s non-adherent to CPAP with adjusted odds of 3.52 (CI 2.04-6.08). Moreover, 30-day cardiovascular cause readmission rate was significantly higher in the CPAP non-adherent group, with adjusted odds of 2.31 (CI 1.11-4.78). Nonadherence to CPAP is associated with increased risk for hospital readmission in patients with OSA.

https://www.ncbi.nlm.nih.gov/pubmed/29351826

The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: protocol for a multi-centre prospective randomized, controlled trial

Multicenter randomized controlled trial will enroll 634 elderly patients undergoing elective lower joint replacement surgery. Patients identified with OSA will be randomized to Auto-titrating continuous airway pressure (APAP) applied during sleep for 72h postoperatively or to control group without APAP. Delirium will be evaluated by using the Confusion assessment method in all patients for 72 hours postoperatively. Since delirium is associated with increased morbidity and mortality, findings could potentially inform best practices to improve surgical outcome and increase safety in the elderly patients with OSA.

https://www.ncbi.nlm.nih.gov/pubmed/29298664

Preoperative Treatment of Obstructive Sleep Apnea With Positive Airway Pressure is Associated With Decreased Incidence of Atrial Fibrillation After Cardiac Surgery

Retrospective analysis of 192 OSA undergoing cardiac surgery with cardiopulmonary bypass, showed that 54% of the study cohort were adherent to PAP therapy. Preoperative PAP use was associated with a decreased rate of postoperative atrial fibrillation in cardiac surgery.

https://www.ncbi.nlm.nih.gov/pubmed/28111105

Nonadherence to CPAP Associated with Increased 30-Day Hospital Readmissions

Retrospective analysis of 345 OSA patients hospitalized at a Veterans Affairs hospital showed that the all cause 30-day readmission rate was significantly higher in patient’s non-adherent to CPAP with adjusted odds of 3.52 (CI 2.04-6.08). Moreover, 30-day cardiovascular cause readmission rate was significantly higher in the CPAP non-adherent group, with adjusted odds of 2.31 (CI 1.11-4.78). Nonadherence to CPAP is associated with increased risk for hospital readmission in patients with OSA.

https://www.ncbi.nlm.nih.gov/pubmed/29351826

Nonintrusive vital signs monitoring for sleep apnea patients: A preliminary study

“Current approaches for sleep-disordered breathing detection are intrusive and can affect the patient’s sleep quality. Ten patients scheduled for drug-induced sleep endoscopy were recruited to determine the utility of a novel unobtrusive microbend fiber optic sensor mattress (cardioballistography technology) to monitor heart rate, respiratory rate, apnea and hypopnea episodes. Pearson correlation coefficient between the proposed sensor and the reference device was 0.96 and 0.78 for heart rate and respiration, respectively. The proposed sensor provided a low sensitivity (24.24±12.81%) and high specificity (85.88±6.01%) for sleep apnea detection. It is expected that this preliminary research will pave the way toward unobtrusive detection of vital signs in real time.”

DOI: 10.1109/ACCESS.2017.2783939

Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis of Comparative Studies

This meta-analysis was related to adverse events in cardiac surgery. The authors demonstrate that major cardiac events and newly documented atrial fibrillation exhibit higher odds ratio in OSA versus non-OSA patients.

https://www.ncbi.nlm.nih.gov/pubmed/29049073