scholarly journals Is Obstructive Sleep Apnoea Associated with Hypoxemia and Prolonged ICU Stay after Type A Aortic Dissection Repair?

2021 ◽  
Author(s):  
Xin Xi ◽  
Yu Chen ◽  
Wei-Guo Ma ◽  
Jiang Xie ◽  
Yong-Min Liu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Obstructive Sleep Apnoea ◽  
Multivariable Analysis ◽  
Type A ◽  
Sleep Apnoea ◽  
Prognostic Impact ◽  
Type A Aortic Dissection ◽  
Icu Stay ◽  
Obstructive Sleep ◽  
Prolonged Icu Stay

Abstract Background : Although obstructive sleep apnoea (OSA) is prevalent among patients with aortic dissection, its prognostic impact is not yet determined in patients undergoing major vascular surgery. We aimed to investigate the association of OSA with hypoxemia and with prolonged intensive care unit (ICU) stay after type A aortic dissection (TAAD) repair. Methods: This study enrolled 83 patients who underwent TAAD repair. OSA diagnosis was confirmed by a preoperative STOP-BANG questionnaire and a sleep test performed within 90 days postoperatively. OSA was defined as an apnoea hypopnea index (AHI) of ≥15/h, while an AHI of >30/h was defined severe OSA. Hypoxemia was defined as an oxygenation index (OI) of <200 mmHg, 6 h postoperatively and prolonged ICU referred to an ICU stay of >72 h. Multivariable analysis was performed to assess the association of OSA with hypoxemia and prolonged ICU stay. Results: OSA was diagnosed in 41 patients (49.4%), which was consistent with the detection by using a preoperative STOP-BANG score of ≥4 (Kappa=0.424, P<0.01). Hypoxemia occurred postoperatively in 56 patients (67.5%). Postoperatively hypoxemia developed mostly in OSA patients (52.4% vs. 83.0%, P<0.01), and particularly in those with severe OSA ( 52.4% vs. 90.5%, P<0.01). The postoperative OI could fairly predict a prolonged ICU stay (area under the curve, 0.719; 95% CI 0.595-0.843; P=0.002). Severe OSA was a predictor of both postoperative hypoxemia (odds ratio [OR] 6.65; 95% CI 1.56-46.26, P<0.01) and prolonged ICU stay (OR 5.58; 95% CI 1.54-20.24, P<0.01). Conclusions: OSA was common in patients with TAAD. Severe OSA was predictive of hypoxemia and prolonged ICU stay after TAAD repair. The STOP-BANG score may offer diagnostic clues to OSA in patients with TAAD.

scholarly journals Is obstructive sleep apnoea associated with hypoxaemia and prolonged ICU stay after type A aortic dissection repair? A retrospective study in Chinese population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xin Xi ◽  
Yu Chen ◽  
Wei-Guo Ma ◽  
Jiang Xie ◽  
Yong-Min Liu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Aortic Dissection ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Sleep Apnoea ◽  
Type A Aortic Dissection ◽  
Icu Stay ◽  
Obstructive Sleep ◽  
Operating Characteristic Curve ◽  
Prolonged Icu Stay

Abstract Background Although obstructive sleep apnoea (OSA) is prevalent among patients with aortic dissection, its prognostic impact is not yet determined in patients undergoing major vascular surgery. We aimed to investigate the association of OSA with hypoxaemia and with prolonged intensive care unit (ICU) stay after type A aortic dissection (TAAD) repair. Methods This retrospective study continuously enrolled 83 patients who underwent TAAD repair from January 1 to December 31, 2018. OSA was diagnosed by sleep test and defined as an apnoea hypopnea index (AHI) of ≥ 15/h, while an AHI of > 30/h was defined severe OSA. Hypoxaemia was defined as an oxygenation index (OI) of < 200 mmHg. Prolonged ICU stay referred to an ICU stay of > 72 h. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of postoperative OI for prolonged ICU stay. Multivariate logistic regression was performed to assess the association of OSA with hypoxaemia and prolonged ICU stay. Results A total of 41 (49.4%) patients were diagnosed with OSA using the sleep test. Hypoxaemia occurred postoperatively in 56 patients (67.5%). Postoperatively hypoxaemia developed mostly in patients with OSA (52.4% vs. 83.0%, p = 0.003), and particularly in those with severe OSA (52.4% vs. 90.5%, p = 0.003). The postoperative OI could fairly predict a prolonged ICU stay (area under the receiver-operating characteristic curve, 0.72; 95% confidence intervals [CI] 0.60–0.84; p = 0.002). Severe OSA was associated with both postoperative hypoxaemia (odds ratio [OR] 6.65; 95% CI 1.56–46.26, p = 0.008) and prolonged ICU stay (OR 5.58; 95% CI 1.54–20.24, p = 0.009). Conclusions OSA was common in patients with TAAD. Severe OSA was associated with postoperative hypoxaemia and prolonged ICU stay following TAAD repair.

scholarly journals Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Aorta ◽  
2019 ◽  
Vol 07 (01) ◽  
pp. 007-014
Author(s):  
Raphaelle A. Chemtob ◽  
Vibeke Hjortdal ◽  
Anders Ahlsson ◽  
Jarmo Gunn ◽  
Ari Mennander ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Postoperative Outcome ◽  
Type A ◽  
Operative Management ◽  
Chronic Obstructive ◽  
Acute Type ◽  
Type A Aortic Dissection

Background Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD. Methods The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression. Results Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, p < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m2, p < 0.001), and had more often a history of hypertension (59% vs. 48%, p = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, p = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, p = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, p = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, p < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, p = 0.17) or 30-day mortality (17.7% vs. 17.4%, p = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62–1.38, p = 0.69). Conclusions This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.

scholarly journals The results of an entry-oriented strategy for acute type A aortic dissection in octogenarians: an 18-year experience

2020 ◽  
Vol 58 (5) ◽  
pp. 949-956
Author(s):  
Takashi Igarashi ◽  
Yoichi Sato ◽  
Hirono Satokawa ◽  
Shinya Takase ◽  
Hiroki Wakamatsu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Predictive Factors ◽  
Postoperative Bleeding ◽  
Multivariable Analysis ◽  
Type A ◽  
Ascending Aorta ◽  
Hospital Death ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Direct Discharge

Abstract OBJECTIVES The aim of this study was to evaluate the 18-year results of emergency operations for acute type A aortic dissection, especially in octogenarians. METHODS We reviewed 199 patients who underwent surgical aortic repair of an acute type A aortic dissection from January 2001 to December 2018. If the primary entry existed in the ascending aorta, we limited the extent of the replacement to within the ascending aorta. We analysed the early and late outcomes and identified the predictive factors for in-hospital death and difficulty of direct discharge to home. RESULTS The hospital mortality was 16%. The causes of death were postoperative bleeding (n = 8, 4%), intestinal ischaemia (n = 6, 3%), respiratory failure (n = 5, 3%), systemic inflammatory response syndrome (n = 4, 2%), low output syndrome (n = 3, 2%), sudden death (n = 3, 2%), myonephrotic metabolic syndrome (n = 2, 1%) and stroke (n = 1, 1%). Multivariable analysis revealed that an estimated glomerular filtration rate &lt;30 (P = 0.006), malperfusion (P = 0.001), rupture (P &lt; 0.001) and cross-clamping time (P = 0.003) were independent predictive factors of in-hospital death. Age was not a significant factor for predicting in-hospital death. Ascending aorta replacement (P = 0.013), advanced age (P = 0.002) and prolonged extracorporeal circulation time (P = 0.009) were independent predictive factors of difficulty in direct discharge to home. In the late follow-up period, the 5-year survival and aortic event-free rates were 62.2% and 88.9% in octogenarians, respectively. CONCLUSIONS From the perspective of saving lives, the results of emergency surgery for octogenarians were acceptable. Avoiding the postoperative decline in activities of daily living in octogenarians is a consideration going forward.

Severe obstructive sleep apnoea, aortic dissection and aortopulmonary fistula in a 56-year-old patient with syncope

2021 ◽  
Vol 14 (8) ◽  
pp. e244029
Author(s):  
Muzzamil Anwar Jelani ◽  
Shravan Nosib
Keyword(s):  
Aortic Dissection ◽  
Obstructive Sleep Apnoea ◽  
Acute Decompensated Heart Failure ◽  
Rare Complication ◽  
Pulseless Electrical Activity ◽  
Decompensated Heart Failure ◽  
Sleep Apnoea ◽  
Acute Type ◽  
Obstructive Sleep ◽  
Aortopulmonary Fistula

We present a case of a 56-year-old patient with obstructive sleep apnoea (OSA) presenting with acute decompensated heart failure and signs of cardiogenic shock. Echocardiography and CT imaging led to the diagnosis of acute type A aortic dissection (AD) complicated by aortopulmonary fistula (APF). The patient underwent successful surgical repair with complicated postoperative course including pulseless electrical activity arrest. This case highlights the underappreciated role of untreated OSA as a risk factor for AD. Furthermore, it presents an opportunity to review APFs as a rare complication of AD. We discuss the available evidence linking OSA and AD, review currently reported cases of APF, briefly outline the haemodynamics of this acute left-to-right shunt and discuss management of this rare but deadly complication.

scholarly journals Impact of obstructive sleep apnoea on cardiometabolic health in an ageing population in rural South Africa: Building the case for the treatment of sleep disorders in deprived settings

2020 ◽  
Author(s):  
Johanna Roche ◽  
Dale Rae ◽  
Kirsten Redman ◽  
Kristen L Knutson ◽  
Malcolm von Schantz ◽  
...  
Keyword(s):  
South Africa ◽  
Obstructive Sleep Apnoea ◽  
Low Income ◽  
Multivariable Analysis ◽  
Sleep Apnoea ◽  
Rural Setting ◽  
Cardiometabolic Health ◽  
Ageing Population ◽  
Arterial Blood ◽  
Obstructive Sleep

AbstractObjectivesThe association between obstructive sleep apnoea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in Southern Africa. We measured polysomnography (PSG)-derived sleep characteristics, OSA prevalence and its association with cardiometabolic diseases in a rural, low-income, aging African-ancestry population in South Africa.MethodsSeventy-five participants were recruited. BMI, hypertension, diabetes, dyslipidaemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference (WC), random glucose, HDL-cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnoea-hypopnea index (AHI) for detection of OSA (AHI≥15) were assessed by home-based PSG. Associations between CMR score and age, sex, socio-economic status (SES), AHI and TST were investigated by multivariable analysis.ResultsIn our sample (53 women, 66.1±10.7y, 12 HIV+), 60.7% were overweight/obese, 61.3% hypertensive and 29.3% had undiagnosed OSA. Being older (p=0.02), having a greater BMI (p=0.02) and higher WC (p<0.01) were associated with OSA. AHI severity (ß=0.011p=0.01) and being a woman (ß=0.369, p=0.01) were independently associated with a greater CMR score in SES- and age-adjusted analyses.ConclusionsIn this ageing South African community with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We demonstrate feasibility of detecting OSA in a rural setting using PSG. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population, to prevent future cardiovascular morbidity, especially among women.

scholarly journals Untreated severe obstructive sleep apnoea and development of acute aortic dissection

2012 ◽  
Vol 2012 (jun21 1) ◽  
pp. bcr0220125741-bcr0220125741 ◽  
Author(s):  
T. Inami ◽  
Y. Seino ◽  
K. Mizuno
Keyword(s):  
Aortic Dissection ◽  
Obstructive Sleep Apnoea ◽  
Acute Aortic Dissection ◽  
Sleep Apnoea ◽  
Obstructive Sleep

scholarly journals Diagnostic accuracy of a two-stage model for detecting obstructive sleep apnoea in chronic tetraplegia

Thorax ◽  
2018 ◽  
Vol 73 (9) ◽  
pp. 864-871 ◽  
Author(s):  
Marnie Graco ◽  
Rachel Schembri ◽  
Susan Cross ◽  
Chinnaya Thiyagarajan ◽  
Shirin Shafazand ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Sleep Apnoea ◽  
Original Model ◽  
Stage Model ◽  
Two Stage ◽  
Data Set ◽  
Obstructive Sleep ◽  
Cord Injury

BackgroundObstructive sleep apnoea (OSA) is highly prevalent in people with spinal cord injury (SCI). Polysomnography (PSG) is the gold-standard diagnostic test for OSA, however PSG is expensive and frequently inaccessible, especially in SCI. A two-stage model, incorporating a questionnaire followed by oximetry, has been found to accurately detect moderate to severe OSA (MS-OSA) in a non-disabled primary care population. This study investigated the accuracy of the two-stage model in chronic tetraplegia using both the original model and a modified version for tetraplegia.MethodsAn existing data set of 78 people with tetraplegia was used to modify the original two-stage model. Multivariable analysis identified significant risk factors for inclusion in a new tetraplegia-specific questionnaire. Receiver operating characteristic (ROC) curve analyses of the questionnaires and oximetry established thresholds for diagnosing MS-OSA. The accuracy of both models in diagnosing MS-OSA was prospectively evaluated in 100 participants with chronic tetraplegia across four international SCI units.ResultsInjury completeness, sleepiness, self-reported snoring and apnoeas were included in the modified questionnaire, which was highly predictive of MS-OSA (ROC area under the curve 0.87 (95% CI 0.79 to 0.95)). The 3% oxygen desaturation index was also highly predictive (0.93 (0.87–0.98)). The two-stage model with modified questionnaire had a sensitivity and specificity of 83% (66–93) and 88% (75–94) in the development group, and 77% (65–87) and 81% (68–90) in the validation group. Similar results were demonstrated with the original model.ConclusionImplementation of this simple alternative to full PSG could substantially increase the detection of OSA in patients with tetraplegia and improve access to treatments.Trial registration numberResults, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, NCT02176928 (clinicaltrials.gov).

scholarly journals Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Yiping Chen ◽  
Yanjuan Lin ◽  
Haoruo Zhang ◽  
Yanchun Peng ◽  
Sailan Li ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Mortality Risk ◽  
Multivariable Analysis ◽  
Type A ◽  
Rank Test ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Hazard Regression ◽  
Platelet Counts ◽  
Prediction Probability

Markers of prothrombotic state and inflammation are associated with the prognosis of patients with acute type A aortic dissection (AAAD). However, it is unclear that the relationship between these biomarkers and their combined impact on risk stratification. The present study evaluated the prognostic value of platelet counts, lymphocyte to neutrophil ratio (LNR), and lymphocyte to monocyte ratio (LMR), alone and in combination. A retrospective analysis of clinical data of 744 AAAD patients was conducted to identify whether these biomarkers were related to the 30-day mortality risk. A Kaplan-Meier analysis and log-rank test were used to compare survival between groups. A Cox hazard regression multivariable analysis was performed for 30-day mortality. Individual biomarker (platelet count, LNR, or LMR) was unable to predict 30-day mortality. However, combinations of all three biomarkers provided additive predictive value over either marker alone, the receiver operating characteristic (ROC) model had a prediction probability of 0.739 when platelet counts, LNR, and LMR were included. Cox hazard regression multivariable analysis showed that combinations of all three biomarkers were the strongest predictor of 30-day mortality (p<0.021). Combined with these three easily measurable biomarkers at admission, they could help identify AAAD patients with a high risk of 30-day mortality.

scholarly journals Research on clinical characteristics and prognostic analysis of heparin-induced thrombocytopenia after surgery for acute type a aortic dissection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chu-zhi Zhou ◽  
Dong-jie Feng ◽  
Yuan Fang ◽  
Feng-yan Zha ◽  
Er-hui Wang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Characteristics ◽  
Blood Platelets ◽  
Type A ◽  
Acute Type ◽  
Heparin Induced Thrombocytopenia ◽  
Type A Aortic Dissection ◽  
Icu Stay ◽  
Prognostic Analysis ◽  
Length Of Icu Stay

Abstract Purpose The present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis. Methods After continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes. Results In the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time (223 min on average vs. 164 min) and delayed aortic cross-clamp time (128 min on average vs. 107 min), and these differences between HIT patients and non-HIT patients were significant (P < 0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences (P > 0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7 ± 5.0u and 15.6 ± 7.34 u, respectively. In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P < 0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P > 0.05). The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group (P < 0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P > 0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group (2.7 ± 0.8 U/mL vs. 0.3 ± 0.2 U/mL) (P < 0.05). Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction. Conclusions After surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.

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