Clinical Adult Literature Updates from March 2014

Sleep Apnea and Risk of Pneumonia: A Nationwide Population-Based Study

In this large population based study, over 34,000 patients were followed to explore the risk of incident pneumonia among adults with sleep apnea, either with or without the need of CPAP therapy. Using administrative databases, patients with sleep apnea were compared to controls matched for age, sex, and comorbidities. Kaplan-Meier analysis showed that patients with sleep apnea had a higher incidence of pneumonia. After multivariate adjustment, a 1.20-fold increase in incident pneumonia was noted in patients with sleep apnea. It was interesting to note that the risk was even higher among patients who received CPAP therapy, however data on compliance to therapy was not available. The limitations of the study include reliability of the administrative database codes for the diagnosis of sleep apnea possibly resulting in a misclassification bias.

Inpatient Falls After Total Knee Arthroplasty: The Role of Anesthesia Type and Peripheral Nerve Blocks

The aim of the study is to characterize cases of in-patient falls, identify risk factors.” Amongst anesthesia related risk factors, the authors identified the presence of sleep apnea as a significant risk factor for this event.

Sleep Apnoea Adversely Affects the Outcome in Patients Who Undergo Posterior Lumbar Fusion: A Population-Based Study

Using a national database, patients who underwent lumbar fusion between 2006 and 2010 were identified, and sub-grouped by diagnosis of sleep apnoea and compared. Sleep apnoea emerged as an independent risk factor for the development of peri-operative complications (odds ratio (OR) 1.50, confidence interval (CI) 1.38;1.62), blood product transfusions (OR 1.12, CI 1.03;1.23), mechanical ventilation (OR 6.97, CI 5.90;8.23), critical care services (OR 1.86, CI 1.71;2.03), prolonged hospitalisation and increased cost (OR 1.28, CI 1.19;1.37; OR 1.10, CI 1.03;1.18).