Clinical Adult Literature Updates from July 2013

Obstructive Sleep Apnea is a Predictor of Abnormal Glucose Metabolism in Chronically Sleep Deprived Obese Adults

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.

http://www.ncbi.nlm.nih.gov/pubmed/23734252

Independent Association Between Nocturnal Intermittent Hypoxemia and Metabolic Dyslipidemia

In a sample of 2,018 patients who underwent measurement of fasting lipid levels and nocturnal recording for assessment of obstructive sleep apnea, total cholesterol and LDL were not associated with the oxygen desaturation index. However, nocturnal intermittent hypoxemia and OSA severity were associated with higher triglycerides and lower HDL-C, independent of confounders. This may provide a mechanism through which OSA is associated with cardiovascular risk.

http://www.ncbi.nlm.nih.gov/pubmed/23699812

Associations Between Change in Sleep Duration and Inflammation: Findings on C-Reactive Protein and Interleukin 6 in the Whitehall II Study

In a sample of 5,003 midlife men and women, shorter sleep (< 5 hours per night) was associated with higher levels of CRP and IL-6 and in longitudinal analyses, a greater increase in sleep duration was associated with a significant 5-year increase in CRP and IL-6.

http://www.ncbi.nlm.nih.gov/pubmed/23801012

Sleep Apnea and Total Joint Arthroplasty Under Various Types of Anesthesia: A Population-Based Study of Perioperative Outcomes

The authors “analyzed data from approximately 400 hospitals in the United States. Perioperative outcomes were compared between patients receiving general, neuraxial, or combined neuraxial-general anesthesia. “They concluded that “neuraxial anesthesia may convey benefits in the perioperative outcome of SA patients undergoing joint arthroplasty.”

http://www.ncbi.nlm.nih.gov/pubmed/23558371

Sleep–Disordered Breathing and Postoperative Outcomes After Bariatric Surgery: Analysis of the Nationwide Inpatient Sample

In this large nationally representative sample, despite the increased association of SDB/OSA with postoperative cardiopulmonary complications, the diagnosis of SDB/OSA was negatively, rather than positively, associated with in-hospital mortality and resource use.

http://www.ncbi.nlm.nih.gov/pubmed/23690272

Development and Validation of a Score for Prediction of Postoperative Respiratory Complications

The authors developed and validated a score for the prediction of postoperative respiratory complications, a simple, 11-point score that can be used preoperatively by anesthesiologists to predict severe postoperative respiratory complications. Independent predictors for reintubation were: American Society of Anesthesiologist Score 3 or more, emergency surgery, high-risk surgical service, history of congestive heart failure, and chronic pulmonary disease.

http://www.ncbi.nlm.nih.gov/pubmed/23571640

Dissociation of Electromyogram and Mechanical Response in Sleep Apnoea During Propofol Anaesthesia

During propofol anaesthesia, pharyngeal occlusion persists despite large increases in genioglossus EMG, in the presence of a preserved mechanical response to electrical stimulation.

http://www.ncbi.nlm.nih.gov/pubmed/22556023

Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients

The STOP-Bang score was validated in 310 obese and morbidly obese surgical patients. For identifying severe OSA, a STOP-Bang score of 4 has high sensitivity of 88 %. For confirming severe OSA, a score of 6 is more specific.

http://www.ncbi.nlm.nih.gov/pubmed/23771818