Clinical Adult Literature Updates from November 2014

Sleep-Disordered Breathing and Functional Decline in Older Women

In this prospective cohort study of 302 patients enrolled in the Minneapolis and Pittsburgh sites of the Study of Osteoporotic Fracture. Sleep disordered breathing (SDB, defined as apnea-hypopnea index >15) had more than twice the odds of an increase in number of IADL difficulties [adjusted odds ratio (aOR) = 2.22, 95% confidence interval (CI) = 1.09-4.53]. Hypoxemia was also found to be another important risk factor. Functional decline was measured using instrumental activities of daily living (IADLs) and mobility. Future research is need to determine the causal relationship between SDB and functional decline and whether treatment of SDB has a role in preventing this decline.

Short and Long Sleep Durations Are Both Associated with Increased Risk of Stroke: A Meta-Analysis of Observational Studies

In this systematic review and meta-analysis of 12 cohort and 6 cross-sectional studies, both short and long sleep durations were found to have significant association with higher risk of stroke. Pooled results from cohort studies were significantly higher odds of developing stroke for short sleepers [HR 1.13; 95% CI 1.02-1.25] and long sleepers [HR 1.40; 95%CI 1.16-1.64]. Similarly the odds rations from the cross-sectional studies were also high for developing stroke for short sleepers 1·71 [1·39-2·02]; and long sleepers, OR 2·12 [1·51-2·73]. Future research is needed to study the impact of various interventions and determine impact on long-term stroke-related outcomes in patients with habitual long or short sleep duration.

Morbidity and Mortality Risk Ratios Are Elevated in Severe Supine Dominant OSA: A Long-Term Follow-up Study

The authors performed a retrospective review of 793 polygraphic recordings of males referred for clinical suspicion of obstructive sleep apnea (OSA) in Finland. The risk ratios of morbidity and mortality of supine dominant OSA and non-supine dominant OSA patients were compared. They found higher mortality and morbidity risk ratios in supine dominant OSA patients with severe OSA than non-supine OSA patients.

Enhancing Adherence to Positive Airway Pressure Therapy for Sleep Disordered Breathing

The author discusses the challenges associated with adherence to positive airway pressure therapy. Multiple factors including educating the patient, attention to social, psychological, demographic factors, side effects and monitoring compliance are addressed.

Obesity Hypoventilation Syndrome Epidemiology and Diagnosis

The authors review the diagnostic criteria, risk factors, associated morbidity, and current data on the prevalence of OHS. The authors suggest maintaining a high index of suspicion of OHS in hospitalized patients and bariatric surgery patients.

Clinical Outcomes in Patients with Pulmonary Hypertension Undergoing Total Hip Arthroplasty

The authors “identified a total of 132 patients undergoing primary total hip replacements with a diagnosis of pulmonary hypertension. The primary outcome assessed was the incidence of adverse events that occurred during the postoperative hospital stay.” The authors conclude that “that pulmonary hypertension patients undergoing total hip arthroplasty are more prone to adverse outcomes, especially cardiac dysrhythmias, and longer hospital stays. “

A Matched Cohort Study of Postoperative Outcomes in Obstructive Sleep Apnea: Could Preoperative Diagnosis and Treatment Prevent Complications?

The authors studied “postoperative outcomes in adult OSA patients up to 5 years before (undiagnosed OSA, n = 1,571), and any time after (diagnosed OSA, n = 2,640) polysomnography and prescription of continuous positive airway pressure therapy for a new diagnosis of OSA, were compared with controls at low risk of having sleep apnea (n = 16,277).” They concluded that “diagnosis of OSA and prescription of continuous positive airway pressure therapy were associated with a reduction in postoperative cardiovascular complications.”