Literature Updates from June 2018

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Friedlander AH, Graves LL, Chang TI, Kawakami KK, Lee UK, Grabich SC, Fang ZT, Zeidler MR, Giaconi JA.
Contributors: Crispiana Cozowicz
Published: Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Jan.

A “convenience sample” referred by Sleep Medicine for oral appliances because of continuous positive airway pressure intolerance was analyzed. The investigators determined the aggregate prevalence of the 3 POAG subtypes-“classic” open-angle glaucoma (COAG), normal-tension glaucoma (NTG), and open-angle glaucoma suspect (OAGS)-among the index population and compared it with that of same hospital’s general population. Furthermore, associations between OSA severity levels (apnea-hypopnea index [AHI]) and POAG subtypes were investigated. Results showed that among the study sample of 225 patients with OSA, 20.9% had POAG, which was significantly higher than the POAG prevalence rate among the medical center’s general population at 2.5%, (P < .00001). Severity of the breathing disorder measured by AHI, however failed to identify a significant correlation to any POAG subtype (P > .05).

The significantly increased prevalence of POAG among OSA patients suggests the need for preoperative consultations from an ophthalmologist to determine eye health and possibly an anesthesiologist to avoid potential vision loss.

https://www.ncbi.nlm.nih.gov/pubmed/29506916

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Horvath CM, Jossen J, Kröll D, Nett PC, Baty F, Brill AK, Ott SR.
Contributors: Crispiana Cozowicz
Published: Obes Surg. 2018 April.

Given the importance of preoperative screening for OSA in bariatric surgery and the predominance of female gender in this intervention, the aim of the study was to assess gender-specific performance of four sleep questionnaires. These included the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), STOP Bang, and NoSAS to predict moderate to severe OSA in this morbidly obese population. Results demonstrated a gender-specific difference in the performance of the evaluated screening questionnaires. These findings suggest the need for gender-specific OSA screening algorithms in morbidly obese patients.

https://www.ncbi.nlm.nih.gov/pubmed/29616468

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Hudson AJ, Walter RJ, Flynn J, Szpisjak DF, Olsen C, Rodgers M, Capaldi VF 2nd, McDuffie B, Lettieri CJ 
Contributors: Crispiana Cozowicz
Published: J Clin Sleep Med. 2018 Mar

OSA is a significant postoperative concern in ambulatory surgery, while few data exist to guide clinical management. This prospective observational study aimed to measure changes in perioperative sleep parameters in orthopedic ambulatory surgery patients. Study subjects completed three unattended home sleep apnea tests: baseline before surgery, the first night after surgery (N1), and third night after surgery (N3), while anesthesia providers and surgeons were blinded and provided routine perioperative care. Results showed that ambulatory surgery had minimal effect on sleep parameters and there was no increase in adverse events among patients with either treated or untreated OSA.

https://www.ncbi.nlm.nih.gov/pubmed/29609705

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Lakdawala L, Dickey B, Alrawashdeh M
Contributors: Crispiana Cozowicz
Published: J Perianesth Nurs. 2018 Feb

This quality improvement project prospectively screened neurosurgical patients for OSA using the STOP-Bang questionnaire and explored its relationship with respiratory complications. Scores of 5 or greater were considered as high risk and less than 5 as low risk for moderate-to-severe OSA. Postoperative respiratory complications were compared between both OSA groups. Perioperative staff and patient education included an OSA care protocol using STOP-Bang screening. Results showed that the OSA care protocol decreased the risk for postoperative respiratory complications, demonstrating that education is essential to confer safer perioperative outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/29429821

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Lucas Oliveira J. e Silva, Daniel Cabrera, Patricia Barrionuevo, Rebecca L Johnson, Patricia J Erwin, M Hassan Murad, Fernanda Bellolio.
Contributors: Edwin Seet
Published: Ann Emerg Med 2017; 70:483-494

Sleep disordered breathing has a strong association with difficult airways and postoperative adverse outcomes (including desaturation and reintubation). Apneic oxygenation may have an important role to play during emergency intubation. This group from Mayo Clinic conducted a systematic review and meta-analysis to evaluate the effectiveness of apneic oxygenation in airway management. Fourteen studies were included for qualitative review and 8 studies (comprising of 1,837 patients) for quantitative analysis. Apneic oxygenation decreased hypoxemia (OR 0.66; 95%CI 0.52-0.84), increased first-pass intubation success (OR 1.59; 95%CI 1.04-2.44), and increased lowest peri-intubation SpO2 (weighted mean difference 2.2%; 95%CI 0.8%-3.6%). This novel but under-utilized airway modality may have a role to play in difficult airway management in sleep-disordered breathing patients and other emergency intubations.

https://www.ncbi.nlm.nih.gov/pubmed/28712606

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Leong SM, Tiwari A, Chung F, Wong DT.
Contributors: Edwin Seet
Published: J Clin Anesth. 2018 Mar; 45:63-68

It has been known that obstructive sleep apnea (OSA) is strongly associated with difficult airways, however the detailed relationship has not been clearly defined in a comprehensive review previously. The group from Toronto Western Hospital undertook a review of English-language literature up to April 2016 to determine the association between OSA and difficult airways. Ten studies were included for the qualitative analysis. The incidence of difficult tracheal intubation was found to be 2-fold higher in OSA patients versus non-OSA patients (14.5% vs. 7.7%; p=0.0002). Difficult mask ventilation occurred 3.5X more in OSA patients (2.5% vs. 0.7%; p<0.0001). This study did not find a difference in airway management difficulty with supraglottic airway devices (1.5% vs. 1.1%; p=0.38). The narrative review determined that OSA is indeed a risk factor for difficult airway.

https://www.ncbi.nlm.nih.gov/pubmed/29291467

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Kaminska M, Mery VP, Lafontaine AL, Robinson A, Benedetti A, Gros P, Kimoff RJ.
Contributors: Jean Wong
Published:  J Clin Sleep Med. 2018 Apr 30. pii: jc-17-00563

In this prospective observational study, 67 patients with idiopathic Parkinson’s Disease had polysomnography. Those with moderate to severe OSA were offered CPAP. Subjects were divided into those with or without CPAP and assessed at 6 and 12 months. At 6 months, patients were considered CPAP users if they had used CPAP at home for at least one month. Those who did not use CPAP or declined further treatment were considered non-users. At 12 months, those still using CPAP were considered CPAP users. At 6 months, 30 participants were using CPAP and 11 patients were not using CPAP. At 12 months 21 patients were using CPAP. The Unified Parkinson’s Disease Rating Scale part 1 and Parkinson’s Disease Sleep Scale improved from baseline in the CPAP compliant group at 6 and 12 months. The Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale improved at 12 months. The MoCA improved in those with low baseline score and with REM sleep behavior disorder. Mean CPAP use was 3 hrs and 36 minutes at 12 months in CPAP users.

https://www.ncbi.nlm.nih.gov/pubmed/29734988

Posted in Clinical Adult, Literature Updates
Posted: June 5, 2018
Authors: Ning Y, Zhang TS, Wen WW, Li K, Yang YX, Qin YW, Zhang HN, Du YH, Li LY, Yang S, Yang YY, Zhu MM, Jiao XL, Zhang Y, Zhang M, Wei YX
Contributors: Jean Wong
Published: Sleep Breath. 2018 Apr 22. doi: 10.1007/s11325-018-1662-2.

This meta-analysis sought to quantify the effects of CPAP on cardiovascular biomarkers (high sensitivity CRP, IL-6, TNF-alpha, augmentation index, pulse wave velocity and flow-mediated dilatiationand to establish predictors of response to CPAP. The authors included 15 RCTs with 1090 patients in the meta-analysis. They found that CPAP improves inflammatory markers hs-CRP, arterial stiffness marker Alx, and endothelial function marker FMD. The authors concluded that these biomarkers may provide information about response to treatment with CPAP.

https://www.ncbi.nlm.nih.gov/pubmed/29682699