Clinical Adult Literature Updates from November 2013

Sleep Apnea is Associated With Subclinical Myocardial Injury in the Community: The ARIC-SHHS Study

In this population-based prospective cohort study, 1,645 adult participants free of coronary artery disease and heart failure participated in the Atherosclerosis Risk in the Communities (ARIC) and the Sleep Heart Health Studies (SHHS). They underwent overnight polysomnography and measurement of high sensitivity Troponin T (hs-TnT) – a marker of sub-myocardial injury; and N terminal pro B-type natriuretic peptide (NT-proBNP) – a marker of ventricular wall stress. After adjusting for confounders, OSA was independently associated with higher levels of hs-TNT and not NT-proBNP levels, indicating subclinical myocardial injury.


Influence of Sleep Apnea Severity on Blood Pressure Variability of Patients With Hypertension

In this cross sectional study, 107 hypertensive patients underwent ambulatory blood pressure monitoring and a level III polysomnography to detect 24hr blood pressure and sleep apnea, respectively. Patients with AHI>10 had higher blood pressure variability than those with AHI


Prescription Sleep Aid Use Among Adults: United States, 2005–2010

In this latest report from the National Health and Nutrition Examination Survey, 2005–2010, prescription sleep aid use amongst a sample of U.S. adults over the age of 20 years was studied. It was found that women(5%) used more sleep aids than men(3.1%); based on ethnicity, Non-Hispanic whites (4.7%) used more sleep aids than non-Hispanic blacks (2.5%) and Mexican-Amrerican (2%) adults. Extremes of sleep duration, less than 5 hours (6%) and more than 9 hours (5.3%) were also associated with increased usage.


Safety of Outpatient Surgery for Obstructive Sleep Apnea

This study evaluated “four hundred fifty-two adult Medicaid obstructive sleep apnea (OSA) patients (404 ambulatory, 48 inpatient) receiving head and neck airway surgeryContrary to guidelines, most OSA patients underwent ambulatory head and neck airway surgery. The observed catastrophic complication rate was zero.

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

Patients undergoing surgery for OSA are considered to be at increased risk of complications. Review of 32 patients failed to show any life-threatening risks or complications.Talei B, Cossu AL, Slepian R, Kacker A.

Association Between Obstructive Sleep Apnea and Pulmonary Embolism

The objective of this study was “to compare the prevalence of obstructive sleep apnea (OSA) in patients with pulmonary embolism (PE) with a sex-, age-, and body mass index (BMI)-matched, population-based control group and to assess the association between OSA and PE.” The authors found that “a higher prevalence of OSA was detected in patients diagnosed as having acute PE than controls” and thus “this study identified a significant and independent association between OSA and PE.

Assessment of the Relationship Between Right Ventricular Function and the Severity of Obstructive Sleep-Disordered Breathing

Some complications of obstructive sleep-disordered breathing (OSDB), such as heart failure including right ventricular (RV) overload, are more serious than an increase of the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI).”The authors of this observational study found that “RV function gradually deteriorated from the early stages of obstructive sleep apnea syndrome, even though there was no apparent increase in pulmonary artery pressure.

Obstructive Sleep Apnea: Strategies for Minimizing Liability and Enhancing Patient Safety

Jury verdict and settlement reports were examined for outcome, awards, patient demographic factors, defendant specialty, and alleged causes of malpractice by analysis of Westlaw legal database. Out of 54 identified cases, Otolaryngologists and anesthesiologists were the most frequently named defendants. Forty-seven cases (87.1%) stemmed from OSA patients who underwent procedures with resultant perioperative adverse events. Common alleged factors included death (48.1%), permanent deficits (42.6%), intraoperative complications (35.2%), requiring additional surgery (25.9%), anoxic brain injury (24.1%), inadequate informed consent (24.1%), inappropriate medication administration (22.2%), and inadequate monitoring (20.4%).

Does this Patient Have Obstructive Sleep Apnea?: The Rational Clinical Examination Systematic Review

The most useful observation for identifying patients with obstructive sleep apnea was nocturnal choking or gasping (summary likelihood ratio [LR], 3.3; 95% CI, 2.1–4.6) when the diagnosis was established by AHI ≥10/h). Snoring is common in sleep apnea patients but is not useful for establishing the diagnosis (summary LR, 1.1; 95% CI, 1.0–1.1). Patients with mild snoring and body mass index lower than 26 are unlikely to have moderate or severe obstructive sleep apnea (LR, 0.07; 95% CI, 0.03–0.19 at threshold of AHI ≥15/h).

Cardiorespiratory Complications of Neuraxial Opioids in Patients With Obstructive Sleep Apnea: A Systematic Review

The review tries to determine the rate of cardiorespiratory complications following neuraxial opioid administration in the setting of obstructive sleep apnea (OSA). Five studies, including a total of 121 patients, were selected for study. Six major cardiorespiratory complications were reported among 5 (4.1%) patients and included three deaths, one cardiorespiratory arrest, and two episodes of severe respiratory depression. Five of these complications occurred during continuous fentanyl-containing epidural infusions and without concurrent positive airway pressure treatment.