Clinical Adult Literature Updates from March 2016

Changes in First Postoperative Night Bispectral Index After Daytime Sedation Induced by Dexmedetomidine or Midazolam Under Regional Anesthesia: A Randomized Controlled Trial

1.111 elderly male patients undergoing TURP under spinal anesthesia were randomized to no sedation, sedation with midazolam, or sedation with dexmedetomidine. Intraoperative sedation and postoperative sleep were measured using BIS monitor. Sleep efficiency following surgery was found to be lowest in the dexmedetomidine group and sleep duration was approximately 240 minutes longer in the midazolam group compared to those who had been sedated with dexmedetomidine.

Genome-Wide Association Analysis Identifies Novel Loci for Chronotype in 100,420 Individuals from the UK Biobank

Using the UK Biobank, genome-wide associations were identified linking sleep-time preference (chronotype) to genes and genetic variants related to circadian rhythm and previously uncharacterized pathways that may relate to circadian rhythm and light sensing. Central nervous system, ocular, and fear-response pathways were implicated. Correlations were noted potentially linking the genetics of chronotype to schizophrenia, educational attainment, and BMI.

The Association Between Nocturnal Cardiac Arrhythmias and Sleep Disordered Breathing: The DREAM Study

697 veterans with suspected sleep disordered breathing were observed for nocturnal arrhythmias during polysomnography. After controlling for age, sex, BMI, and cardiovascular disease, moderate to severe sleep disordered breathing was associated with a two-fold increased risk of nocturnal arrhythmias. Frequency of hypoxic events was positively associated with arrhythmia risk.

Diagnostic Capability of Biological Markers in Assessment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Kallikrein-1, uromodulin, urocotin-3, and orosomucoid-1 when combined have enough accuracy to be an OSA diagnostic test in children. IL-6 and IL-10 plasma levels have potential to be good biomarkers in identifying or excluding the presence of OSA in adults.

Biomarkers Associated with Obstructive Sleep Apnea and Morbidities: A Scoping Review

Of the potentially promising morbidity biomarkers, plasma IL-6 and high sensitivity C-reactive protein appear to exhibit a favorable profile, and may discriminate OSA patients with and without morbidities in both adults and children.

Development and Validation of a Morphologic Obstructive Sleep Apnea Prediction Score: The DES-OSA Score

The authors developed and validated a new clinical score to predict OSA based on morphologic characteristics only. The DES-OSA Score consists of 5 variables: Mallampati score, distance between the thyroid and chin, BMI, neck circumference and sex. These variables were weighted by 1, 2 or 3 points. A score of >5, 6, and 7 were associated with increased probability of mild, moderate or severe OSA.

Impact of Different Nasal Masks on CPAP Therapy for Obstructive Sleep Apnea: A Randomized Comparative Trial

In this randomized controlled trial, the authors compared the impact of different nasal masks for CPAP in patients with newly-diagnosed OSA. Patients were randomized to receive CPAP with ResMed Mirage FX® (MFX) or control mask (Fisher & Paykel Zest®, HC407® or Philips EasyLife®. Mask acceptance rate was higher in the MFX vs. control group. CPAP compliance was higher and nasal mask issue-related Home Care Provider visits were lower in the MFX group. There were less failures due to mask discomfort or unintentional leakage in the MFX group.

CPAP in the Perioperative Setting: Evidence of Support

In this review, the authors examine the evidence for the use of CPAP in the preoperative and postoperative periods in surgical patients with diagnosed and undiagnosed OSA. Barriers to diagnosing and treating OSA in the perioperative setting are examined. Identifying which surgical patients with OSA are at increased risk, and which patients may benefit from CPAP are reviewed.