Clinical Adult Literature Updates from July 2017

Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults

Authors:  Sprecher KE, Koscik RL, Carlsson CM, Zetterberg H, Blennow K, Okonkwo OC, Sager MA, Asthana S, Johnson SC, Benca RM, Bendlin BB.

“Self-report of poor sleep was associated with greater AD-related pathology in cognitively healthy adults at risk for AD. Effective strategies exist for improving sleep; therefore sleep health may be a tractable target for early intervention to attenuate AD pathogenesis.”

Assessment of neuroinflammation in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a case-control study

Authors: Stokholm MG, Iranzo A, Østergaard K, Serradell M, Otto M, Svendsen KB, Garrido A, Vilas D, Borghammer P, Santamaria J, Møller A, Gaig C, Brooks DJ, Tolosa E, Pavese N.

In patients with idiopathic rapid-eye-movement sleep behaviour disorder, increased microglial activation was detected by PET in the substantia nigra along with reduced dopaminergic function in the putamen.

Anaesthetic management of sleep-disordered breathing in adults

Authors: Hillman DR, Chung F.

Patients with sleep-related breathing disorders are more vulnerable to hypoventilation and asphyxia when deeply sedated. Addressing this vulnerability requires a systematic approach to identification of patients and circumstances that magnify this risk, and methods of managing it that seek to reconcile the need for safety with cost-effective use of resources.”

The Cognitive Effects of Obstructive Sleep Apnea: An Updated Meta-analysis

Authors: Stranks EK, Crowe SF.

This meta-analysis investigated the cognitive functioning of patients prior to receiving any treatment such as CPAP. A total of 19 studies were included. The authors found statistically significant negative effect sizes in many cognitive domains. The clinical implications, possible causal mechanisms and future implications for research are discussed.

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

Authors: Subramani Y, Singh M, Wong J, Kushida CA, Malhotra A, Chung F

This review article summarizes the different pathophysiological mechanisms contributing to different endotypes and phenotypes of OSA, and discusses the possible perioperative implications and future directions of research.

Continuous positive airway pressure treatment impact on memory processes in obstructive sleep apnea patients: a randomized sham-controlled trial

Authors: Joyeux-Faure M, Naegelé B, Pépin JL, Tamisier R, Lévy P, Launois SH

This study was conducted in a French outpatient sleep clinic. 36 patients with OSA were randomized to receive either CPAP (n=18) or sham CPAP (n=18) for 6 weeks. The patients underwent an extensive battery of tests evaluating 3 separate memory systems before and after treatment. The authors did not find improvement in memory performance after 6 weeks of treatment.

Laser-Assisted Uvulopalatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Authors: Camacho M, Nesbitt NB, Lambert E, Song SA, Chang ET, Liu SY, Kushida CA, Zaghi S.

A systematic review and meta-analysis on laser-assisted uvulopalatoplasty (LAUP) for treatment of obstructive sleep apnea (OSA). LAUP reduced AHI by 32% among all patients; while the LSAT only changed minimally. Individual data demonstrated a success rate of 23%, cure rate of 8%, and worsening of the AHI among 44% of patients.