Changes in cortical thickness are present in children with OSA and likely indicate disruption to neural developmental processes, including maturational patterns of cortical volume increases and synaptic pruning. Regions with thicker cortices may reflect inflammation or astrocyte activation. Both the thinning and thickening associated with OSA in children may contribute to the cognitive and behavioral dysfunction frequently found in the condition.
Perioperative myocardial injury is transcriptionally orchestrated by the circadian clock in patients undergoing aortic valve replacement, and Rev-Erbα antagonism seems to be a pharmacological strategy for cardioprotection. Afternoon surgery might provide perioperative myocardial protection and lead to improved patient outcomes compared with morning surgery.
The compromised hippocampal-cortical functional connectivity in OSA may underlie depression and anxious mood levels in OSA, while impaired caudate-cortical FC may indicate deficits in reward processing and cognition. These findings provide insights into the neural mechanisms underlying the comorbidity of mood and cognitive deficits in OSA.”
OSA is a risk factor for perioperative complications, however data on the impact of various anesthesia regimens on postoperative outcome is scarce. Randomized controlled study to assess the impact of propofol/remifentanil versus sevoflurane/remifentanil based anesthesia on nocturnal apnea-hypopnea index (AHI) and oxygen saturation. Neither the volatile agent sevoflurane nor the intravenous anesthetic propofol altered nocturnal AHI or oxygen saturation when combined with the short acting opioid remifentanil.
To identify knowledge gaps in the perioperative management of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). Further research is urgently needed to improve health outcomes for these patients. Currently evidence is insufficient to guide screening and optimization of OSA and OHS in the perioperative setting. Patients who are at greatest risk of respiratory or cardiac complications related to OSA and OHS are not well defined, and the effectiveness of monitoring and other interventions remains to be determined. Centers involved in sleep research need to develop collaborative networks to allow multicenter studies to address the knowledge gaps identified.
Noninvasively applied positive airway pressure therapy (PAP) is available in 3 basic modes: continuous positive airway pressure (CPAP), bi-level positive airway pressure (BPAP), and adaptive servo-ventilation. They are increasingly being used perioperatively to prevent or treat upper airway obstruction, hypoventilation, and periodic breathing, and they have been found to improve postoperative outcomes in the case of obstructive sleep apnea. An impediment to their use in this setting is a lack of familiarity with their application by hospital clinical staff. This review describes the modes of PAP therapy available, their indications, how therapy is initiated, how efficacy is assessed, common problems encountered with its use, and how these problems can be addressed.
Enhanced Recovery after Surgery (ERAS) protocols lead to expedited discharges and decreased cost. Bariatric centers have adopted such programs for safely discharging patients after sleeve gastrectomy (LSG) on the first postoperative day (POD1), however this cannot be achieved in all patients.
In a retrospective review of patients undergoing LSG, from 2013 through 2016, using a standardized enhanced recovery pathway, treated OSA was associated with earlier hospital discharge. Understanding clinical and operative factors that enhance the success of ERAS as well as the causes and corrections for failed implementation allow teams to optimally direct care pathway resources.
This study demonstrates that OSA is associated with an increased risk of ventricular arrhythmias after coronary artery bypass graft surgery.
This narrative review includes epidemiology, pathogenesis, and diagnosis of adult OSA patients. The article is well documented. It will help clinicians to deliver the best perioperative care.
This article demonstrates that the use of DISE (Drug-induced sleep endoscopy) must be expanded to improve CPAP compliance.