Literature Updates Literature Updates

Obstructive Sleep Apnea and Longitudinal Alzheimer’s Disease Biomarker Changes

“OSA appears to accelerate increases in amyloid deposition, CSF T-tau and P-tau levels over time, both in cognitive normal and mild cognitive impaired individuals. Sleep fragmentation, intermittent hypoxia, and intrathoracic pressure swings from OSA are likely candidate mechanisms. (…) No significant variations in the biomarkers changes over time were seen in the Alzheimer disease group.”

Effect of Trendelenburg and Lower Body Positive Pressure on Neck Fluid Distribution

In this prospective study, the authors include 22 patients. The aim of this study was to achieve the impact of vascular and extravascular fluid to the total accumulation of neck fluid volume. The authors conclude that sustained elevation in neck fluid volume while supine is likely due to the extravascular fluid. This data could improve the relationship between rostral fluid load and upper-airway narrowing.

P-Wave Dispersion as a Simple Tool for Screening Childhood Obstructive Sleep Apnea Syndrome

“P-wave dispersion (PWD) as defined by the difference between the duration of maximum and minimum p-waves has been used to screen for the presence of OSAS in adults. This study looks at the utility of this tool for OSAS screening in children. The authors obtained ECGs from 77 children with documented OSAS by PSG and 44 controls. A cutoff of 26.5 ms provided 89.6% sensitivity and 61.4% specificity. PWD was significantly higher in children with severe OSA even when the authors adjusted for the presence of obesity.”

Outcome of Drug-Induced Sleep Endoscopy-Directed Surgery for Persistent Obstructive Sleep Apnea after Adenotonsillar Surgery

“Drug-induced sleep endoscopy (DISE) can be considered in children with persistent OSAS despite adenotonsillectomy. The authors described sleep-related outcomes in 20 children a year after DISE directed surgery (e.g., turbinate reductions, pharyngoplasty, lingual tonsillectomy, and tonsillectomy revisions). All children demonstrated an improvement in their sleep breathing parameters. Five children had complete resolution of OSAS whereas 15 continue to have persistent OSAS but in the mild range”.

Prenatal, Perinatal, and Early Childhood Factors Associated with Childhood Obstructive Sleep Apnea

“In this study, the authors tested associations between pre and perinatal and early childhood factors and the risk of childhood OSAS from a cohort of 2867 mother-child pairs already enrolled in the Boston Birth Cohort Study. Children conceived by in-vitro fertilization, premature deliveries due to trauma were some of the exclusions. This secondary analysis study demonstrated strong associations between childhood OSAS and prematurity/low birth weight, maternal obesity/diabetes, childhood obesity, and elevated early childhood leptin levels. “

The Effect of Dexmedetomidine on Propofol Requirements During Anesthesia Administered by Bispectral Index-Guided Closed-Loop Anesthesia Delivery System: A Randomized Controlled Study

“The addition of dexmedetomidine to propofol administered by CLADS was associated with a consistent depth of anesthesia along with a significant decrease in propofol requirements, albeit with an incidence of hemodynamic depression and early postoperative sedation.”

Association of Unrecognized Obstructive Sleep Apnea With Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery

Unrecognized obstructive sleep apnea increases cardiovascular risks in the general population, but whether obstructive sleep apnea poses a similar risk in the perioperative period remains uncertain. A prospective cohort study involving adult at-risk patients without prior diagnosis of sleep apnea and undergoing major noncardiac surgery from 8 hospitals in 5 countries was carried out to determine the association between obstructive sleep apnea and 30-day risk of cardiovascular complications after major noncardiac surgery. Among at-risk adults undergoing major noncardiac surgery, unrecognized severe obstructive sleep apnea was significantly associated with increased risk of 30-day postoperative cardiovascular complications.

Characterization of Respiratory Compromise and the Potential Clinical Utility of Capnography in the Post-Anesthesia Care Unit: A Blinded Observational Trial

The utility of capnography to detect early respiratory compromise in surgical patients after anesthesia is unclear due to limited prospective data. The purpose of this trial was to determine the frequency and duration of capnography-detected respiratory adverse events in the post-anesthesia care unit (PACU). In this prospective observational trial, 250 consenting patients undergoing elective surgery with general anesthesia were monitored by standard monitoring together with blinded capnography and pulse oximetry monitoring. Capnography and the Integrated Pulmonary Index™ algorithm (IPI) detected respiratory adverse events earlier than standard monitoring in 75% and 88% of cases, respectively, with an average early warning time of 8 ± 11 min. Respiratory adverse events are frequent in the PACU, and the addition of capnography and IPI to current standard monitoring provides potentially clinically relevant information on respiratory status, including early warning of some respiratory adverse events.

Impact of obstructive sleep apnea on perioperative complications among patients undergoing hysterectomy: a population-based analysis.

In this study data on patients who underwent a hysterectomy between 2006 and 2014 from a large nationwide database (n = 459,508) was investigated. OSA patients (identified by ICD-9 CM codes) were compared to non-OSA patients regarding perioperative outcomes: cardiac, central-nervous, gastrointestinal, genitourinary, renal, respiratory, and thromboembolic complications; as well as opioid prescription, need for blood transfusion, cost of hospitalization, length of stay and ICU admission. Results showed that among patients undergoing hysterectomies, OSA was associated with substantially increased risk of complications and modestly increased resource utilization. Therefore, further research is needed to assess perioperative care strategies to improve outcomes in patients with OSA.