Clinical Adult Literature Updates from November 2012

Is Obstructive Sleep Apnea Syndrome a Risk Factor for Pulmonary Thromboembolism?

This study aimed to evaluate if obstructive sleep apnea syndrome (OSAS) is a risk factor for pulmonary embolism. The authors concluded, that in patients with PTE, OSA rates were much higher than in the general population. Moreover, the rate for patients with clinically significant moderate and severe OSA was quite high.

Preoperative Screening and Perioperative Care of the Patient with Sleep-Disordered Breathing

OSA is quite common in patients presenting for elective surgery and has been linked to increased perioperative complications. Attempts to identify these patients preoperatively appear prudent. Protocols on how best to manage these patients are available, although validation of their effectiveness is needed.

A Multisite Randomized Trial of Portable Sleep Studies and Positive Airway Pressure Autotitration Versus Laboratory-Based Polysomnography for the Diagnosis and Treatment of Obstructive Sleep Apnea: The HomePAP Study

A home-based strategy for diagnosis and treatment compared with in-laboratory PSG was not inferior in terms of acceptance, adherence, time to treatment, and functional improvements.

CPAP Adherence in Patients with Newly Diagnosed Obstructive Sleep Apnea Prior to Elective Surgery

Adherence to prescribed CPAP therapy during the perioperative period was extremely low. African American race, male gender, and depressive symptoms were independently associated with reduced CPAP usage.

Predictive Abilities of the STOP-Bang and Epworth Sleepiness Scale in Identifying Sleep Clinic Patients at High Risk for Obstructive Sleep Apnea

The STOP Bang correctly identified more patients with OSA and SDB (sleep-disordered breathing) than the ESS alone. The ESS had the highest specificity for OSA and SDB.

Perinatal Outcomes Associated with Obstructive Sleep Apnea in Obese Pregnant Women

Obstructive sleep apnea among obese pregnant women is associated with higher rates of preeclampsia, neonatal intensive care unit admissions, and cesarean delivery.

The Use of Practice Guidelines by the American Society of Anesthesiologists for the Identification of Surgical Patients at High Risk of Sleep Apnea

The ASA checklist offers a highly sensitive tool to identify the patients at a higher risk of OSA during the perioperative period. Patients at high risk for OSA have a higher incidence of adverse events in the postoperative period when compared with those with low risk for OSA.

Obstructive Sleep Apnea As a Risk Factor for Postoperative Complications After Revision Joint Arthroplasty

Obstructive sleep apnea (n=16,608) was associated with increased in-hospital mortality, pulmonary embolism, wound hematomas or seromas and increased postoperative charges ($61 044 vs $58 813; P < 0.001).

Meta-Analysis of the Association Between Obstructive Sleep Apnoea and Postoperative Outcome

Thirteen studies were included in the final analysis (n=3942). The incidence of postoperative desaturation, respiratory failure, postoperative cardiac events, and ICU transfers was higher in patients with OSA.