Literature Updates from January 2015

Nasopharyngeal Airway Stenting Devices for Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis

In this systematic review and meta-analysis, outcomes of adults with obstructive sleep apnea treated with nasopharyngeal airway stenting devices were studied. Of 573 potential studies, 29 were retrieved for detailed evaluation and 16 met the study criteria. Only case series or case studies were identified. Short-term benefits were identified in polysomnographic indices such as the apnea-hypopnea index and oxygen saturation, especially in postoperative patients. However, long-term data with respect to patient tolerance and adherence was lacking. Future research should be directed towards designing randomized controlled trials, comparing these devices to other interventions such as CPAP, with extensive follow up and long-term clinical outcomes

The Influence of Environmental Factors on Sleep Quality in Hospitalized Medical Patients

In this prospective cohort study, 118 consecutive inpatients were screened and 99 patients were enrolled to assess sleep quality in a group of medical inpatients, in relation to environmental factors, and the switch to daylight-saving time. Thirty three percentage of the patients reported one/more sleepless nights. Patients who slept near the window were exposed to more light in the morning and tended to sleep better. Noise levels were higher than recommended for care units. Future research is needed to evaluate interventions designed to improve sleep quality for inpatients in medical and surgical wards.

Environmental Disruption of the Circadian Clock Leads to Altered Sleep and Immune Responses in Mouse

Mice chronically maintained on a shortened day schedule (20 hours – 10 hours light : 10 hours dark) as a model of circadian disruption have no total sleep deprivation but lose the nocturnal-diurnal oscillation in REM and NREM percentage present in control animals. When exposed to an in vivo LPS challenge experimental animals demonstrate altered peripheral immune responses notably the chemokine MCP-1, and altered hippocampal cytokine mRNA expression. This work intimates the importance of intact circadian rhythm in generating immune responses and maintaining normal sleep quality.

Differential Acute Effects of Sleep on Spontaneous and Stimulated Production of Tumor Necrosis Factor in Men

This study looked at the effect of sleep deprivation on serum, and released TNF-α from monocytes in human subjects. Sleep deprivation resulted in a blunted oscillation of TNF-α release in-vivo, decreased oscillation of circulating monocytes during the study period and was associated with decreased TNF-α production from LPS stimulated monocytes ex-vivo. Correlation analysis in the normal sleep group points towards a regulatory association of circulating hormones including cortisol, norepinephrine and prolactin. This study is objectively supportive of a widely held belief that normal sleep is necessary for a robust immune response to an innate immune challenge.

Death or Neurologic Injury After Tonsillectomy in Children With a Focus on Obstructive Sleep Apnea: Houston, We Have a Problem!

A validated pediatric-specific risk assessment scoring system is needed to assist with identifying children at risk for OSA who are not appropriate to be cared for on an outpatient basis.

Predictors of Persistent Sleep Apnea After Surgery in Children Younger Than 3 Years

In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.

Role of Subtotal Tonsillectomy (‘tonsillotomy’) in Children With Sleep Disordered Breathing

In children, subtotal tonsillectomy is associated with fewer post-operative complications whilst having a comparable effect in improving sleep disordered breathing, compared with total tonsillectomy.

Adenotonsillectomy vs Observation for Management of Mild Obstructive Sleep Apnea in Children

Quality of life significantly improves in children with mild OSA after adenotonsillectomy. In children with mild OSA who are observed, QOL improvements at early follow-up are less pronounced, but significant improvements in QOL are evident after 8 months.