Clinical Adult Literature Updates from March 2012

Postoperative Complications in Patients with Obstructive Sleep Apnea

In this historical cohort study, 471 patients who had undergone noncardiac surgery within 3 years of polysomnography were included in the study. The presence of OSA (defined as AHI ≥5/h) was associated with higher incidence of postoperative hypoxemia, overall complications, transfer to ICU, and increased hospital length of stay.

Does Difficult Mask Ventilation Predict Obstructive Sleep Apnea? A Prospective Pilot Study to Identify the Prevalence of OSA in Patients with Difficult Mask Ventilation Under General Anesthesia

Patients with difficult mask ventilation under general anesthesia were subsequently evaluated with nocturnal polysomnography (PSG) to determine the presence of a sleep-related breathing disorder. Of 10 patients who underwent PSG, 9 demonstrated OSA and 1 had an elevated RDI (> 5) with excessive daytime sleepiness (categorized as upper airways resistance syndrome). This study suggests that anesthesiologists can identify individuals de novo with increased risk of OSA based on the difficulty of mask ventilation during surgical procedures.

Oxygen Desaturation Index from Nocturnal Oximetry: A Sensitive and Specific Tool to Detect Sleep-Disordered Breathing in Surgical Patients

The oxygen desaturation index >10 demonstrated a sensitivity of 93% and a specificity of 75% to detect moderate and severe sleep disordered breathing. Oxygen desaturation index from a high-resolution nocturnal oximeter is a sensitive and specific tool to detect undiagnosed SDB in surgical patients.

Obstructive Sleep Apnea and Incidence of Postoperative Delirium after Elective Knee Replacement in the Nondemented Elderly

Twenty five percent developed postoperative delirium after elective knee replacement. In this study, obstructive sleep apnea was the only significant predictor using multivariate analysis.