Clinical Adult Literature Updates

Immediate Use of Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea Following Transsphenoidal Pituitary Surgery: A Case Series.

Use of CPAP after oral surgery is always questionable. In this interesting retrospective study (n = 427, among them 64 had OSA), the authors aimed to determine the incidence of complications related to the use of early CPAP following pituitary resection. They conclude that patients who received CPAP immediately after surgery exhibit similar rates of surgical complications.

Longitudinal relationship between sleep deficiency and pain symptoms among community-dwelling older adults in Japan and Singapore.

This study investigated the association between sleep deficiency and pain among community-dwelling adults aged 65 years and older across a 2-3 year period. … In Singaporeans, sleep deficiency predicted the new onset of any pain, and any pain also predicted the new emergence of sleep deficiency.

Heart rate variability rebound following exposure to persistent and repetitive sleep restriction.

The authors examined heart rate variability and cardiovagal baroreflex sensitivity (BRS) during four blocks of repetitive sleep restriction and sequential nights of recovery sleep on 21 healthy participants. The results show that the restoration of autonomic homeostasis requires a time course that includes at least three nights, following an exposure to multiple nights of sleep curtailed to about half the normal nightly amount.

Objective sleep duration is associated with cognitive deficits in primary insomnia: BDNF may play a role.

Primary insomnia was associated with impaired neuropsychological performance, and the impairment might be related to decreased objective sleep duration. In addition, decreased peripheral BDNF might mediate the impaired cognitive functions of people with insomnia with SSD.

Pulmonary rehabilitation and oropharyngeal exercises as an adjunct therapy in obstructive sleep apnea: a randomized controlled trial

This study was a two-arm, parallel, randomized, controlled and open-label trial of 40 patients with moderate to severe obstructive sleep apnea. The patients were randomized to continuous positive airway pressure (CPAP) and CPAP + pulmonary rehabilitation (PR). The PR group underwent six weeks of 60-min twice-weekly individual PR programs. It was found that CPAP with a rehabilitation program improved functional ventilatory parameters and decreased BMI in patients with OSA. Hence, Treatment with CPAP combined with the PR program improved OSA patients to a greater extent than only CPAP and can be a useful part of comprehensive therapy in OSA.

Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies.

For several years, OSA was known to be a risk factor of difficult airway. There are two interests in this meta-analysis. Firstly, the authors found that OSA had a three to four-fold higher risk of difficult intubation or mask ventilation or both, when compared to non-sleep apnea patients. Secondly, the authors found that there was no significant difference in the supraglottic airway failure rates in the sleep apnea vs non-sleep apnea patients. This is a very interesting information for the management of the upper airway in the operating room.

Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis

Chronic pain (CP) is widespread and commonly associated with sleep disturbances. However, research has often used poor quality measures of sleep which is often focused on specific pain conditions, thereby limiting its reliability and applicability to the wider CP population. This is a meta-analysis of the studies that used objective polysomnographic measures of sleep or examined diagnosed sleep disorders in people with CP. The results found that the pooled prevalence of sleep disorders in CP was 44%, with insomnia (72%), restless legs syndrome (32%) and obstructive sleep apnea (32%) being the most common diagnoses. Also, objective polysomnographic measures indicate that individuals with CP experience significant sleep disturbances, particularly with respect to sleep initiation and maintenance. Hence, it is imperative that sleep disturbances and disorders be assessed and treated in conjunction with the CP.

Improvement in Nocturnal Hypoxemia in Obese Patients with Obstructive Sleep Apnea after Bariatric Surgery: a Meta-Analysis.

For a couple of years, there are increasing evidences that nocturnal hypoxemia may play an important role in the pathophysiology of OSA. In this meta-analysis, the authors found that bariatric surgery is effective at improving nocturnal hypoxemia in obese patients with OSA. The reduction in body weight may be the predominant factor. However, their findings must be confirmed by other studies.

Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?

In this study, conducted in Sweden, the authors found that a STOP-Bang score < 2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥ 6 have OSA. For patients with an intermediate score, the authors recommend performing a nightly pulse oximetry to detect OSA patients.

Preoperative Evaluation: Estimation of Pulmonary Risk Including Obstructive Sleep Apnea Impact.

One in 4 deaths occurring within a week of surgery are related to pulmonary complications, making it the second most common serious morbidity after cardiovascular events. The most significant predictors of the postoperative pulmonary complications (PPCs) are American Society of Anesthesiologists physical status, advanced age, dependent functional status, surgical site, and duration of surgery. The overall risk of PPCs can be predicted using scores that incorporate readily available clinical data.