Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation

BackgroundObstructive sleep apnea (OSA) is increasingly prevalent in the range of 2% to 24% in the US population. OSA is a well-described predictor of pulmonary complications after elective operation. Yet, data are lacking on its effect after operations for trauma. We hypothesized that OSA is an independent predictor of pulmonary complications in patients undergoing operations for traumatic pelvic/lower limb injuries (PLLI).MethodsNationwide Inpatient Sample (2009–2013) was queried for International Classification of Diseases, Ninth Revision, Clinical Modification codes for PLLI requiring operation. Elective admissions and those with concurrent traumatic brain injury with moderate to prolonged loss of consciousness were excluded. Outcome measures were pulmonary complications including ventilatory support, ventilator-associated pneumonia, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and respiratory failure. Multivariable logistic regression analysis was used, adjusting for OSA, age, sex, race/ethnicity, and specific comorbidities (obesity, chronic lung disease, and pulmonary circulatory disease). P<0.01 was considered statistically significant.ResultsAmong the 337 333 patients undergoing PLLI operation 3.0% had diagnosed OSA. Patients with OSA had more comorbidities and were more frequently discharged to facilities. Median length of stay was longer in the OSA group (5 vs 4 days, p<0.001). Pulmonary complications were more frequent in those with OSA. Multivariable logistic regression showed that OSA was an independent predictor of ventilatory support (adjusted odds ratio (aOR), 1.37; 95% CI,1.24 to 1.51), PE (aOR 1.40; 95% CI, 1.15 to 1.70), ARDS (aOR 1.36; 95% CI,1.23 to 1.52), and respiratory failure (aOR 1.90; 95% CI, 1.74 to 2.06).ConclusionOSA is an independent and underappreciated predictor of pulmonary complications in those undergoing emergency surgery for PLLI. More aggressive screening and identification of OSA in trauma patients undergoing operation are necessary to provide closer perioperative monitoring and interventions to reduce pulmonary complications and improve outcomes.Level of evidencePrognostic Level IV.

Download Full-text

Understanding the role of oxidative stress in the incidence of metabolic syndrome and obstructive sleep apnea

BMC Endocrine Disorders ◽

10.1186/s12902-021-00735-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Behnam Kargar ◽

Zahra Zamanian ◽

Majid Bagheri Hosseinabadi ◽

Vahid Gharibi ◽

Mohammad Sanyar Moradi ◽

...

Keyword(s):

Oxidative Stress ◽

Metabolic Syndrome ◽

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Sleep Apnea ◽

International Diabetes Federation ◽

Binary Logistic Regression ◽

Stress Index ◽

Obstructive Sleep

Abstract Background Understanding the causes and risk factors of metabolic syndrome is important for promoting population health. Oxidative stress has been associated with metabolic syndrome, and also obstructive sleep apnea. These are two diseases which have common prognostic characteristics for heart disease. The aim of this study was to examine the role of oxidative stress in the concurrent presence of metabolic syndrome and obstructive sleep apnea in a working population. Methods Participants were 163 artisan bakers in Shahroud, Iran, routinely exposed to significant heat stress and other oxidative stress indicators on a daily basis as part of their work. Using a cross-sectional design, data relevant to determining metabolic syndrome status according to International Diabetes Federation criteria, and the presence of obstructive sleep apnea according to the STOP-Bang score, was collected. Analyses included hierarchical binary logistic regression to yield predictors of the two diseases. Results Hierarchical binary logistic regression showed that oxidative stress – alongside obesity, no regular exercise, and smoking – was an independent predictor of metabolic syndrome, but not obstructive sleep apnea. Participants who were obese were 28 times more likely to have metabolic syndrome (OR 28.59, 95% CI 4.91–63.02) and 44 times more likely to have obstructive sleep apnea (OR 44.48, 95% CI 4.91–403.28). Participants meeting metabolic syndrome criteria had significantly higher levels of malondialdehyde (p < 0.05) than those who did not. No difference in oxidative stress index levels were found according to obstructive sleep apnea status. Conclusions Our findings suggest that oxidative stress contributes to the onset of metabolic syndrome, and that obstructive sleep apnea is involved in oxidative stress. Whilst obesity, exercise, and smoking remain important targets for reducing the incidence of metabolic syndrome and obstructive sleep apnea, policies to control risks of prolonged exposure to oxidative stress are also relevant in occupations where such environmental conditions exist.

Download Full-text

Physical Examination: Mallampati Score as an Independent Predictor of Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/29.7.903 ◽

2006 ◽

Vol 29 (7) ◽

pp. 903-908 ◽

Cited By ~ 136

Author(s):

Thomas J. Nuckton ◽

David V. Glidden ◽

Warren S. Browner ◽

David M. Claman

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Physical Examination ◽

Independent Predictor ◽

Mallampati Score ◽

Obstructive Sleep

Download Full-text

OBSTRUCTIVE SLEEP APNEA AS AN INDEPENDENT PREDICTOR OF CARDIOVASCULAR MORTALITY

Bulletin of Pirogov National Medical & Surgical Center ◽

10.25881/bpnmsc.2020.95.30.022 ◽

2020 ◽

Vol 15 (2) ◽

pp. 126-128

Author(s):

V.P. Tyurin ◽

О.V. Savchuk ◽

V.V. Proskurnova ◽

E.A. Dobrikov ◽

A.M. Kulagina

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cardiovascular Mortality ◽

Independent Predictor ◽

Obstructive Sleep

Download Full-text

Understanding The Role Of Oxidative Stress In The Incidence Of Metabolic Syndrome And Obstructive Sleep Apnea

10.21203/rs.3.rs-279301/v1 ◽

2021 ◽

Author(s):

Behnam KARGAR ◽

Zahra ZAMANIAN ◽

Majid Bagheri HOSSEINABADI ◽

Vahid Gharibi ◽

Mohammad Sanyar MORADI ◽

...

Keyword(s):

Oxidative Stress ◽

Metabolic Syndrome ◽

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Sleep Apnea ◽

Prolonged Exposure ◽

International Diabetes Federation ◽

Stress Index ◽

Obstructive Sleep

Abstract Background: Understanding the causes and risk factors of metabolic syndrome is important for promoting population health. Oxidative stress has been associated with metabolic syndrome, and also obstructive sleep apnea. These are two diseases which have common prognostic characteristics for heart disease. The aim of this study was to examine the role of oxidative stress in the concurrent presence of metabolic syndrome and obstructive sleep apnea in a working population. Methods: Participants were 163 artisan bakers in Shahroud, Iran, routinely exposed to oxidative stress indicators on a daily basis as part of their work. Using a cross-sectional design, data relevant to determining metabolic syndrome status according to International Diabetes Federation criteria, and the presence of obstructive sleep apnea according to the STOP-Bang score, was collected. Analyses included hierarchical binary logistic regression to yield predictors of the two diseases. Results: Logistic regression showed that oxidative stress – alongside obesity, no regular exercise, and smoking – was an independent predictor of metabolic syndrome, but not obstructive sleep apnea. Participants who were obese were 28 times more likely to have metabolic syndrome (OR 28.59, 95% CI 4.91-63.02) and 44 times more likely to have obstructive sleep apnea (OR 44.48, 95% CI 4.91-403.28). Participants meeting metabolic syndrome criteria had significantly higher levels of malondialdehyde (p < 0.05) than those who did not. No difference in oxidative stress index levels were found according to obstructive sleep apnea status. Conclusions: Our findings suggest that oxidative stress contributes to the onset of metabolic syndrome, and that obstructive sleep apnea is involved in oxidative stress. Whilst obesity, exercise, and smoking remain important targets for reducing the incidence of metabolic syndrome and obstructive sleep apnea, policies to control risks of prolonged exposure to oxidative stress are also relevant in occupations where such environmental conditions exist.

Download Full-text

Correlation Between Oxygen Saturation and Pulse Tracing Patterns on Overnight Oximetry With Normal Desaturation Index Is an Independent Predictor of Obstructive Sleep Apnea

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.7614 ◽

2019 ◽

Vol 15 (02) ◽

pp. 195-200 ◽

Cited By ~ 1

Author(s):

Nura Festic ◽

Muhammad Zuberi ◽

Vikas Bansal ◽

Paul Fredrickson ◽

Emir Festic

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Oxygen Saturation ◽

Independent Predictor ◽

Desaturation Index ◽

Obstructive Sleep ◽

Overnight Oximetry

Download Full-text

Obstructive sleep apnea as an independent predictor of postoperative delirium and pain: protocol for an observational study of a surgical cohort

F1000Research ◽

10.12688/f1000research.14061.2 ◽

2018 ◽

Vol 7 ◽

pp. 328 ◽

Cited By ~ 2

Author(s):

Patricia Strutz ◽

William Tzeng ◽

Brianna Arrington ◽

Vanessa Kronzer ◽

Sherry McKinnon ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Observational Study ◽

Postoperative Delirium ◽

Pain Perception ◽

Independent Predictor ◽

Pain Severity ◽

Visual Analogue Pain Scale ◽

Visual Analogue Pain ◽

Obstructive Sleep

Introduction: Postoperative delirium and pain are common complications in adults, and are difficult both to prevent and treat. Obstructive sleep apnea (OSA) is prevalent in surgical patients, and has been suggested to be a risk factor for postoperative delirium and pain. OSA also might impact pain perception, and alter pain medication requirements. This protocol describes an observational study, with the primary aim of testing whether OSA is an independent predictor of postoperative complications, focusing on (i) postoperative incident delirium and (ii) acute postoperative pain severity. We secondarily hypothesize that compliance with prescribed treatment for OSA (typically continuous positive airway pressure or CPAP) might decrease the risk of delirium and the severity of pain. Methods and analysis: We will include data from patients who have been enrolled into three prospective studies: ENGAGES, PODCAST, and SATISFY-SOS. All participants underwent general anesthesia for a non-neurosurgical inpatient operation, and had a postoperative hospital stay of at least one day at Barnes Jewish Hospital in St. Louis, Missouri, from February 2013 to May 2018. Patients included in this study have been assessed for postoperative delirium and pain severity as part of the parent studies. In the current study, determination of delirium diagnosis will be based on the Confusion Assessment Method, and the Visual Analogue Pain Scale will be used for pain severity. Data on OSA diagnosis, OSA risk and compliance with treatment will be obtained from the preoperative assessment record. Other variables that are candidate risk factors for delirium and pain will also be extracted from this record. We will use logistic regression to test whether OSA independently predicts postoperative delirium and linear regression to assess OSAs relationship to acute pain severity. We will conduct secondary analyses with subgroups to explore whether these relationships are modified by compliance with OSA treatment.

Download Full-text

Abstract TMP55: Polysomnographic and Sleep-related Variables Associated to Leukoaraiosis in Patients with Obstructive Sleep Apnea

Stroke ◽

10.1161/str.48.suppl_1.tmp55 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kevin R Duque ◽

Brian Villafuerte ◽

Fiorella Adrianzen ◽

Rodrigo Zamudio ◽

Andrea Mendiola ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Sleep Apnea ◽

Multinomial Logistic Regression ◽

Sleep Time ◽

Cross Sectional Study ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Obstructive Sleep ◽

Medical Histories

Introduction: Obstructive sleep apnea (OSA) is a biological plausible risk factor for leukoaraiosis (LA). We tested the hypothesis that polysomnographic (PSG) and sleep-related variables are associated to LA in OSA patients. Methods: Cross-sectional study in which PSG records, medical histories and brain 1.5T MRI were collected from all consecutive patients who had attended a Sleep Medicine Center between 2009-2014. LA was graded from 0 to 9 with the ’Atherosclerosis Risk In Communities’ study scale. OSA was defined by The International Classification of Sleep Disorders, 2014, and its severity categorizing according to apnea-hypopnea index (AHI, <15 mild, 15 to <30 moderate, 30 to <45 severe and ≥45 very severe). A multinomial logistic regression was performed to describe the association between OSA severity and LA (divided into 2 groups: mild-to-moderate LA and non-to-minimal LA). The covariates for all regression models were age, gender, BMI, hypertension, ischemic stroke, myocardial infarction, diabetes and pack-year of smoking. Results: From 82 OSA patients (77% male; mean age 58±9 years, range 19-91), 54 (66%) had LA. Mild-to-moderate LA was found in 13 patients (8 mild and 5 moderate LA) and non-to-minimal LA in 69 (41 minimal and 28 non LA). Spearman’s correlation coefficient between AHI and LA grade was 0.41 (p<0.001). Furthermore, the higher OSA severity, the higher LA severity (p<0.001, for Jonckheere-Terpstra test for ordered alternatives). In the multinomial logistic regression model adjusted for cofounders, severe OSA patients had higher risk for mild or moderate LA (HR 12.8, 95% IC 1.2-141) compared to mild-to-moderate OSA patients. Additionally, self-reported habitual sleep duration from 7 to 9 hours (HR 0.36, 90% IC 0.14-0.90) and proportion of time in apnea/hypopnea over total sleep time (HR 1.04 for one unit increase, 90% IC 1.01-1.08) could be associated with the presence of LA (adjusted only for age and gender). In a multiple regression analysis with all the aforementioned variables, age (p=0.002), diabetes (p=0.003), and OSA severity (p=0.04) were predictors of the presence of LA. Conclusion: Patients with severe OSA had higher risk for mild to moderate LA when compared to patients with mild or moderate OSA.

Download Full-text

0705 High Incidence Of Inadequate Health Literacy In Adults With Obstructive Sleep Apnea Is Not Associated With Positive Airway Pressure Use

SLEEP ◽

10.1093/sleep/zsaa056.701 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A268-A269

Author(s):

A J Watach ◽

B Saconi ◽

A M Sawyer

Keyword(s):

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Health Literacy ◽

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Lead Author ◽

Obstructive Sleep ◽

The Relationship ◽

Inadequate Health Literacy

Abstract Introduction Inadequate health literacy (HL) is associated with 1.5 - 3 times increased risk for poor health outcomes, nonadherence and lack of skills needed to manage one’s own health. Inadequate HL prevalence in adults with obstructive sleep apnea (OSA) may be as high as 30%. The relationship between HL and positive airway pressure (PAP) adherence has been rarely examined. Methods A secondary analysis of prospective observational data was conducted to: 1) examine the prevalence of inadequate HL in adults with newly-diagnosed OSA and 2) determine if inadequate HL is associated with 1-wk and 1-mo PAP use. HL was measured using a 3-item Health Literacy Screening Questionnaire. Descriptive statistics, multiple linear regression, and logistic regression were used. Results Participants (n=67) were white (85%), males (52%) and females (48%), middle-aged (50±12 yrs), 64.2% had a middle to high school education and severe OSA (mean AHI 38.2±21 events/hr). Mean PAP use was 4.62±2.43 hrs/night at 1-wk and 4.33±2.27hrs/night at 1-mo. Using a threshold of ≥4 hrs/night, 64% were adherent at 1-wk and 60% at 1-mo. Sixty two percent (n=42) screened positive for inadequate HL. A positive screen for inadequate HL (by individual screening items or by cumulative number of items screened positive) was not associated with PAP use (mean hr/night) at 1-wk or 1-mo (not retained in the final model). HL was also not associated with PAP non-adherence (<4hrs/night) or PAP failure (<2hrs/night) by logistic regression. Conclusion Inadequate HL may be prevalent in adults with OSA. OSA and PAP patient education content and design should align with HL abilities and skills. Disease and treatment education are influential on PAP adherence. Future research should consider adequacy of three generalized items to assess HL and disease-specific HL as more robust measures are available. Larger, heterogeneous sample sizes are needed to precisely estimate the relationship between HL and PAP adherence. Support Lead author receives support from NIH/NHLBI Award T32 HL07953.

Download Full-text