Clinical Adult Literature Updates from January 2015

Cumulative Association of Obstructive Sleep Apnea Severity and Short Sleep Duration With the Risk for Hypertension

In this multi-center, cross-sectional study, 410 out of 1,499 patients suspected to have OSA were evaluated for association between short sleep duration (TST<6 hours) and prevalent hypertension. The odds ratio (OR) (95% confidence intervals) for having HTN was 2.51 (1.35-4.68) in normal sleepers (TST >/= 6 hours) with OSA and 4.37 (2.18-8.78) in short sleepers with OSA after adjustment for confounders such as age, gender, obesity, diabetes, depression, current smoking, use of thyroid hormones, daytime sleepiness, poor sleep complaint, time in bed, sleep architecture and fragmentation, and study site. The authors found a highly statistically significant linear trend between risk of hypertension and worsening severity of OSA and short sleepers. Future studies may target short sleep duration in conjunction with treatment of OSA to lower BP and long-term outcomes.

Postoperative CPAP Use Impacts Long-Term Weight Loss Following Bariatric Surgery

This long-term observational study of bariatric surgery patients with OSA evaluated patients with PSG preoperatively and 1 year postoperatively, and again at a mean of 7.2 years later. Persistent OSA was found in 95% of subjects 1 year after surgery, and long-term compliance was poor. Non-adherence with CPAP was associated with weight gain.

Obstructive Sleep Apnea as a Predictor of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis

The evidence associating OSA with post-coronary artery bypass grafting was reviewed. Five prospective cohort studies including 642 patients were included. OSA was associated with a higher risk (odds ration 1.86, 95%CI 1.24-2.8, p=0.003: I2 =35%).

Preoperative Adherence to Continuous Positive Airway Pressure Among Obstructive Sleep Apnea Patients

The authors performed a multivariate binary logistic regression analysis of 90 patients, 75 of whom were adherent to CPAP to identify factors that would predict patient adherence to CPAP. They identified three criteria of adherence: awareness of the risk of complications, awareness of treatment efficacy, and feeling less tired with CPAP. The feeling of breathlessness was associated with non-adherence.

Association of Metabolic Syndrome and Surgical Factors With Pulmonary Adverse Events, and Longitudinal Mortality in Bariatric Surgery

The authors “examined the incidence of postoperative pulmonary complications (PPC) in a large national bariatric database”. A total of 158 405 patients had a low incidence of PPC (0.91%) and a low mortality (0.6%) after bariatric surgery. Among other risk factors, obstructive sleep apnea was a risk factor for PPC.

Early Major Medical Complications After Surgical Management of Obstructive Sleep Apnea: A Retrospective Cohort Analysis and Case Series

The purpose of this study was to determine the frequency and relative risk (RR) of early postoperative major medical complications after surgery for the management of obstructive sleep apnea.” The authors conclude that “the overall frequency of early major medical postoperative complications in upper airway surgery for obstructive sleep apnea is low, with no statistically significant difference in frequency and RR between intrapharyngeal and extrapharyngeal surgery. There may, however, be a clinically significance difference in RR possibly because of associated differences in risk factors between the groups.

Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies

The authors “evaluated the effects of OSA on postoperative complications and hospital outcomes in patients undergoing coronary artery bypass graft (CABG) surgery.” The incidence of OSA was 41% and was associated with prolonged intubation.