Literature Updates from January 2016

Effect of Melatonin on Sleep in the Perioperative Period After Breast Cancer Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

48 patients were randomized to receive 6mg melatonin or placebo for three preoperative nights, continuing into the postoperative period. As measured by actigraphy, melatonin was shown to increase sleep efficiency and decrease waking during the two weeks following surgery.

Effects of Caffeine on the Human Circadian Clock in Vivo and in Vitro

This paper outlines the effect of caffeine on the human circadian clock, and verifies previously assumed yet unproven interactions between the drug and sleep timing. Using human subjects the authors determined that caffeine (a timed double shot of espresso) indeed delays the circadian phase (delays sleep onset), but more saliently perhaps, the authors demonstrate that bright light (3000 lux [about 1/3 of light on a sunny day] for 3 hours around the normal bed-time hour) was associated with an increased magnitude of delayed circadian phase. Using a human U2OS bmal:luc in vitro system the authors then show that the caffeine prolongs the circadian period through a adenosine receptor/cAMP pathway. This work is the first to mechanistically tie the widely used drug caffeine to delayed circadian phase in humans but understatedly also calls attention to the significant effect of light on circadian rhythm, which has implications for both hospital recovery environments and optimal bed-time routines for the population at large.

Associations Between Different Sedatives and Ventilator-Associated Events, Length-of-Stay, and Mortality in Mechanically Ventilated Patients

Some years ago a multicenter clinical trial (MENDS) was conducted to evaluate optimal sedation in the critical care setting based on possible effects of the drugs used on patient’s outcomes. They concluded that dexmedetomidine was superior to benzodiacepines in several aspects like length of ICU stay or duration of mechanical ventilation amongst others (Pandharipande PP, JAMA 2007). The present manuscript reports how three different sedation agents, benzodiacepines, propofol or dexmedetomidine, might impact patient outcomes on a sample of more than 9000 episodes of mechanical ventilation in the ICU. Even though the three arms of the study (benzodiazepine, propofol and dexmedetomidine) are not equally represented, with significantly less number of patients in the dexmedetomidine group it is clear that legth of stay was longer in the benzodiacepine group. Also patients sedated with dexmedetomidne had shorter stay in the ICU than propofol. Further detailed studies should be published comparing propofol and dexmedetomidine.

Efficacy Outcome Measures for Procedural Sedation Clinical Trials in Adults: An ACTTION Systematic Review

The present systematic review focuses on an interesting aspect: how to measure the outcomes of clinical trials involving procedural sedation. Out of more than 4000 titles regarding different aspects of procedural sedation the authors read in a detailed and critical manner 245 to learn about the different scoring systems and domain explored. After their thorough review the authors conclude that there is room to improve how clinicians measure sedation and that the best approach to come up with an optimal sedation measurement system, including patient reported outcomes, should be undertaken by multidisciplinary teams.

Does Primary Indication for Tonsillectomy Influence Post-Tonsillectomy Haemorrhage Rates in Children?

The bleed rate for OSA was unexpectedly higher than for recurrent tonsillitis. The primary indication for tonsillectomy affects secondary bleeding rate. 25575427

Complications of Adenotonsillectomy for Obstructive Sleep Apnea in School-Aged Children

This study showed a low risk of post-adenotonsillectomy complications in school-aged healthy children with obstructive apnea although many children met published criteria for admission due to obesity, or polysomnographic severity. In this specific population, none of the polysomnographic or demographic parameters predicted post-operative complications. Further research could identify the patients at greatest risk of post-operative complications.

Effects of Continuous Positive Airway Pressure Therapy on Glycaemic Control, Insulin Sensitivity and Body Mass Index in Patients with Obstructive Sleep Apnoea and Type 2 Diabetes: A Systematic Review and Meta-Analysis

The limited available evidence from randomised controlled trials and prospective observational studies suggests that CPAP does not decrease HbA1c level or BMI in patients with OSA and T2DM but may improve insulin sensitivity.

The Effect of Obstructive Sleep Apnea Syndrome on Growth and Development in Non-Obese Children: A Parallel Study of Twins

OSAS impairs growth and development. Significant growth recovery occurs after T&A, and early surgical intervention is an important factor for improvement in growth.

Oxidative Stress in Obstructive Sleep Apnea and Intermittent Hypoxia–Revisited–the Bad Ugly and Good: Implications to the Heart and Brain

This review presents the currently available data on redox biology in physiological/pathophysiological conditions and in OSA/IH, in order to better understand the apparently contradictory findings on damage vs. repair.

Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children.