Clinical Adult Literature Updates from May 2013

Sleep Apnea in Precapillary Pulmonary Hypertension

169 patients with a diagnosis of pulmonary hypertension confirmed by right heart catheterisation and clinically stable in NYHA classes II or III were prospectively investigated by polygraphy (n = 105 females, mean age: 61.3 years, mean body mass index: 27.2 kg/m(2)). At least every fourth patient with pulmonary hypertension suffers from mild-to-moderate sleep apnea. The authors conclude, that considering the anthropometric characteristics of the patients studied, the prevalence of sleep apnea seem to be higher in pulmonary hypertension patients than in the general population.

Association Between Self Reported Snoring, STOP Questionnaire and Postoperative Pulmonary Complications in Patients Submitted to Orthopedic Surgery

The aim of this retrospective chart review was to determine the relationship among postoperative pulmonary complication, snoring and STOP questionnaire in patients with orthopedic surgery. There were 289 (20.5%) snorers and 1,117 (79.5%) non-snorers in the study group. Postoperative atelectasis was significantly more prevalent in the high risk group according to STOP questionnaire.

Predicting Postoperative Pulmonary Complications in High-Risk Populations

The objective of this manuscript was “to describe prediction models for surgical patients who have suspected obstructive sleep apnea at risk for postoperative respiratory complications and for surgical patients at risk for postoperative acute respiratory distress syndrome. The authors conclude that “evidence is emerging that early identification of modifiable risk factors and implementation of ‘protective’ management strategies may lead to reduction of severe postoperative pulmonary complications.”

Immediate Complications Related to Anesthesia in Patients Undergoing Uvulopalatopharyngoplasty for Obstructive Sleep Apnea

The objective of this retrospective chart review was to “analyze and assess the perioperative risks and complications in patients receiving general anesthesia undergoing surgery for obstructive sleep apnea. Thirty-two patients were reviewed with no severe adverse events such as reintubation, prolonged intubation, or postoperative pulmonary edema. Patients who were difficult to intubate or required nasal/oral airways failed to show any adverse outcomes”.

Management Plan to Reduce Risks in Perioperative Care of Patients with Obstructive Sleep Apnoea Averts the Need for Presurgical Polysomnography

There was no significant increase in postoperative complications in patients managed on the OSA risk management protocol. With this protocol, it is clinically safe to proceed with elective surgery without delay for formal polysomnography confirmation.

Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis

This review shows that O2 therapy significantly improves oxygen saturation in patients with OSA. However, it may also increase the duration of apnea-hypopnea events.

Obstructive Sleep Apnea Screening and Postoperative Mortality in a Large Surgical Cohort

Neither a prior diagnosis of OSA nor a positive screen for OSA risk was associated with increased 30-day or one-year postoperative mortality. Differences in 1 year postoperative mortality were noted with three screening tools.