Literature Updates from November 2014

Effect of Sedative-Hypnotics, Anesthetics and Analgesics on Sleep Architecture in Obstructive Sleep Apnea

This article critically reviewed the literature relevant to preoperative screening for OSA, prevalence of OSA in surgical populations and changes in postoperative sleep architecture relevant to OSA patients … in regard to the effects of sedative-hypnotics, anesthetics and analgesics on sleep architecture, the underlying mechanisms and the relevance to OSA.

A Systematic Review of Peri-Operative Melatonin

A very importat review on the use of melatonin in perioperative setting. “Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements.”

Chronic Sleep Fragmentation Induces Endothelial Dysfunction and Structural Vascular Changes in Mice

Long-term sleep fragmentation induces vascular endothelial dysfunction and mild blood pressure increases. Sleep fragmentation also leads to morphologic vessel changes characterized by elastic fiber disruption and disorganization, increased recruitment of inflammatory cells, and altered expression of senescence markers, thereby supporting a role for sleep fragmentation in the cardiovascular morbidity of OSA.

Delirium Transitions in the Medical ICU: Exploring the Role of Sleep Quality and Other Factors

Written by one of the more productive groups in the field, the authors evaluated the link of perceived sleep quality ratings along with other patient and ICU risk factors with the development of delirium on a daily basis in 223 medical ICU patients over a 201 day period. Interestingly, the author’s found no association between daily perceived sleep quality ratings and transition to delirium. As reported in other publications, the authors found infusion of benzodiazepines and opioids in mechanically ventilated patients as risk factors for the development of delirium.

Sleep in the Intensive Care Unit: A Review

In this article, the authors review and update the reader on what is currently known with regards to staging and measuring sleep. It offers a nice review on the characteristics of sleep in the ICU. There is a very nice section of sleep deprivation and immune function. Most of the article focuses on causes of abnormal sleep in the ICU and reviews much of what is already known. It concludes with a nice review of how to promote sleep in the ICU.

Sleep Disturbance in Older ICU Patients

In this study, the authors note aging is associated with specific changes to both the quantity and quality of sleep and that these changes make it hard to adjust sleep and wake rhythms to changing environmental conditions. In the context of the ICU, an environment already known to alter sleep, the authors evaluated sleep in patients admitted to the ICU who were older than age 80. The authors reviewed four studies on sleep in the elderly. This study was helpful in bring much of the resaerch of sleep in elderly ICU patients into one location. However, much is still needed in the study of sleep in this frail and vulnerable population.

Genotype-Phenotype Interactions in Pediatric Obstructive Sleep Apnea

Here, we examine some of the potential underpinnings of phenotypic variability in PSDB, and further propose a conceptual framework aimed at facilitating the process of advancing knowledge in this frequent disorder.

National UK Survey on the Assessment and Surgical Management of Suspected Paediatric Obstructive Sleep Apnoea Syndrome

The availability of paediatric PSG is very limited and because of a lack of normative data, uncertainty about interpretation of abnormal results, the recognition that even moderate snoring without sleep apnoea has detrimental neuro-cognitive effects and the fact that adenotonsillectomy is a very effective treatment for paediatric OSA we felt that a pragmatic and safe approach was to treat selected patients as if they had a positive PSG with appropriate anaesthetic technique and post operative care and monitoring.