Literature Updates from January 2014

Does One Hour of Bright or Short-Wavelength Filtered Tablet Screenlight Have a Meaningful Effect on Adolescents’ Pre-Bedtime Alertness, Sleep, and Daytime Functioning?

In this experimental study, 16 healthy adolescent volunteers were recruited to be exposed to a bright tablet screen, dim screen and a filtered short-wavelength screen for 1hr before their usual bedtime in a within-subjects protocol. Significant effects occurred between bright and dim screens for pre-sleep alertness (GO/NOGO speed and accuracy), although these were minor and may have little clinical significance. However, no significant effects were found for sleep onset latency, slow-rolling eye movements, or the number of SWS and REM minutes in the first two sleep cycles. More studies are required to examine effects of prolonged screen exposure on pre-sleep alertness and morning daytime functioning amongst vulnerable groups such as adolescents.


Cognitive Unbinding: A Neuroscientific Paradigm of General Anesthesia and Related States of Unconsciousness

A very interesting review that explores the concept of cognitive unbinding. “It is concluded that cognitive unbinding is a viable neuroscientific framework for unconscious processes across the fields of anesthesiology, sleep neurobiology, neurology and psychoanalysis”.

The Association of Pre-Operative STOP-BANG Scores With Postoperative Critical Care Admission

Obstructive sleep apnea is known to be under diagnosed with an estimated 1 in 3 elective surgical patients possible suffering from this disease. Sleep apnea is of concern to the anesthesiologist and critical care physician for a variety of reasons, none the least of which are an associated increase in myocardial infarction, respiratory failure and cardiac arrest. The STOP-BANG questionnaire is an easy to use, well know, validated tool to screen for obstructive sleep apnea. In this study, the authors retrospectively analyzed the association of STOP-BANG score with ICU admission. The authors hypothesized that a high score would be associated with greater ICU admission. After evaluating 5432 patients who underwent elective surgery, 338 (6.2%) were admitted postoperatively to a critical care unit. The authors found that the STOP-BANG score; age; asthma; a history of obstructive sleep apnea; and ASA physical status was independent predictors of ICU admission. With regards to the STOP-BANG questionnaire, A STOP-BANG score of 6 or more was associated with a fivefold increased rate of postoperative critical care unit admission when compared to a score of 2 or less. Therefore, it appears that the STOP-BANG questionnaire could be a useful tool to also stratify patients for ICU admission.

Newer Treatment Modalities for Pediatric Obstructive Sleep Apnea

Current research has focused on newer therapies for pediatric obstructive sleep apnea, such as anti-inflammatories, dental treatments, high-flow nasal cannula, and weight loss. However, there are few randomized controlled trials assessing the effectiveness of these therapies. Further research is warranted.

A Pilot Staging System to Predict Persistent Obstructive Sleep Apnea in Children Following Adenotonsillectomy

A trend toward a dose-response relationship was seen between physical exam staging and persistent OSA after TA. Further data collection and analysis with a larger sample size are warranted.

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy.

Tonsilloplasty Versus Tonsillectomy in Children With Sleep-Disordered Breathing: Short– and Long-Term Outcomes

TP is an alternative surgical method for treatment of SDB related to tonsillar hypertrophy with favorable postoperative course and comparable long-term results.

Evaluating the Management of Obstructive Sleep Apnea in Neonates and Infants

Although adenoidectomy is the most common surgical intervention overall, the prevalence increases with age. Supraglottoplasty is the most common surgical intervention in neonates and infants aged 0 to 3 months and offers the greatest objective improvement in this age group.