Literature Updates from July 2012

Pulse Transit Time and Assessment of Childhood Sleep Disordered Breathing

Pulse transit time shows promise as a screening test for SDB associated with an AHI greater than 3. For less severe SDB, the validity of using the PTT to separate these conditions from primary snoring has not been demonstrated in a clinical setting.

Interactions of Obstructive Sleep-Disordered Breathing with Recurrent Wheezing or Asthma and Their Effects on Sleep Quality

When one of the two disorders is diagnosed, the possibility of the other disease being present should be entertained.

Utility of Preoperative Cardiac Evaluation in Pediatric Patients Undergoing Surgery for Obstructive Sleep Apnea

The lack of clinically relevant findings during preoperative cardiac evaluations suggests that aggressive cardiac workup in pediatric patients with OSA may not be indicated unless dictated by comorbidities

Algorithms for Using an Activity-Based Accelerometer for Identification of Infant Sleep-Wake States During Nap Studies

The Actical accelerometer, designed to measure physical activity, can reliably identify sleep in infants during napping…

Clinical Predictors of Apnoea-Hypopnoea During Propofol Sedation in Patients Undergoing Spinal Anaesthesia

This study assessed the relationship between the occurrence of apnoea-hypopnoea during propofol sedation for spinal anaesthesia and two different predictive tests of sleep apnoea: the STOP-Bang score (snoring while sleeping, daytime tiredness, observed breathing stoppages, high blood pressure-body mass index, age, neck circumference, gender); and the obstructive sleep apnoea (OSA) score. Both assessment tools have some predictive value for the occurrence of apnoea-hypopnoea during propofol sedation in patients undergoing spinal anaesthesia.

Obesity Hypoventilation Syndrome: A Review of Epidemiology, Pathophysiology, and Perioperative Considerations

Obesity hypoventilation syndrome (OHS) is defined by the triad of obesity, daytime hypoventilation, and sleep-disordered breathing without an alternative neuromuscular, mechanical, or metabolic cause of hypoventilation. It is a disease entity distinct from simple obesity and obstructive sleep apnea. OHS is often undiagnosed but its prevalence is estimated to be 10–20% in obese patients with obstructive sleep apnea and 0.15–0.3% in the general adult population. Compared with eucapnic obese patients, those with OHS present with severe upper airway obstruction, restrictive chest physiology, blunted central respiratory drive, pulmonary hypertension, and increased mortality.

Active Emergence from Propofol General Anesthesia is Induced by Methylphenidate

In this study, Chemali et al. demonstrate in rats that methylphenidate (Ritalin) not only decreases time to emergence after a single bolus of propofol, but also induces emergence during continuous propofol general anesthesia. These findings suggest that methylphenidate may be a useful arousal-promoting agent for patients oversedated with propofol.

Intramuscular Dexmedetomidine: An Effective Route of Sedation Preserves Background Activity for Pediatric Electroencephalograms

This article studies the administration of dexmedetomidine through IM route, as an efficacious drug that preserves background EEG activity to provide safe and effective sedation for EEG studies.

The EEG Signal: A Window on the Cortical Brain Activity

This review presents the main features of EEG, in adults and children, during the awake state and during sleep and also updates how anesthetic drugs(particularly hypnotics) influence the EEG signal, and how the main available monitors analyze these drug-induced modifications.