Comparison of Partial Pressure of Carbon Dioxide in Arterial Blood and Transcutaneous Carbon Dioxide Monitorizaiton in Patients with Obstructive Sleep Apnea and Sleep Related Hypoventilation/Hypoxemia Syndromes

Background Obtaining accurate end-tidal carbon dioxide pressure measurements via nasal cannula poses difficulties in postanesthesia patients who are mouth breathers, including those who are obese and those with obstructive sleep apnea (OSA); a nasal cannula with an oral guide may improve measurement accuracy in these patients. The authors evaluated the accuracy of a mainstream capnometer with an oral guide nasal cannula and a sidestream capnometer with a nasal cannula that did or did not incorporate an oral guide in spontaneously breathing non-obese patients and obese patients with and without OSA during recovery from general anesthesia. Methods The study enrolled 20 non-obese patients (body mass index less than 30 kg/m) without OSA, 20 obese patients (body mass index greater than 35 kg/m) without OSA, and 20 obese patients with OSA. End-tidal carbon dioxide pressure was measured by using three capnometer/cannula combinations (oxygen at 4 l/min): (1) a mainstream capnometer with oral guide nasal cannula, (2) a sidestream capnometer with a nasal cannula that included an oral guide, and (3) a sidestream capnometer with a standard nasal cannula. Arterial carbon dioxide partial pressure was determined simultaneously. The major outcome was the arterial-to-end-tidal partial pressure difference with each combination. Results In non-obese patients, arterial-to-end-tidal pressure difference was 3.0 +/- 2.6 (mean +/- SD) mmHg with the mainstream capnometer, 4.9 +/- 2.3 mmHg with the sidestream capnometer and oral guide cannula, and 7.1 +/- 3.5 mmHg with the sidestream capnometer and a standard cannula (P < 0.05). In obese non-OSA patients, it was 3.9 +/- 2.6 mmHg, 6.4 +/- 3.1 mmHg, and 8.1 +/- 5.0 mmHg, respectively (P < 0.05). In obese OSA patients, it was 4.0 +/- 3.1 mmHg, 6.3 +/- 3.2 mmHg, and 8.3 +/- 4.6 mmHg, respectively (P < 0.05). Conclusions Mainstream capnometry performed best, and an oral guide improved the performance of sidestream capnometry. Accuracy in non-obese and obese patients, with and without OSA, was similar.

Download Full-text

Obstructive Sleep Apnea, Continuous Positive Airway Pressure, and Surgery

Otolaryngology ◽

10.1177/019459988809900402 ◽

1988 ◽

Vol 99 (4) ◽

pp. 362-369 ◽

Cited By ~ 69

Author(s):

Nelson B. Powell ◽

Robert W. Riley ◽

Christian Guilleminault ◽

German Nino Murcia

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Cardiac Activity ◽

Blood Gases ◽

Airway Patency ◽

Arterial Blood ◽

Obstructive Sleep

Patients with obstructive sleep apnea (OSA) who have undergone upper airway surgery could be expected to improve if surgery alleviated some or all of the anatomic obstructions, or continue to desaturate at preoperative levels if the surgery was not corrective. Factors such as morbid obesity, general anesthesia recovery, and operative edema can potentially cause desaturations below preoperative levels. Because of this risk, patients with severe OSA have been considered for protective tracheostomy. The findings of our study suggest that selected patients who would have been past candidates for protective tracheostomy while undergoing surgery for severe OSA can, as an alternative, be considered for immediate postoperative use of nasal continuous positive airway pressure (CPAP). Ten surgical patients with severe OSA who elected surgical treatment were successfully treated with CPAP immediately after extubation and postoperatively to assist with airway patency and hemoglobin saturation. Postoperative followup included monitoring of continuous pulse oximetry, cardiac activity, and intermittent arterial blood gases. Preoperatively, all ten patients had marked decrease in oxygen desaturation levels during sleep, with a mean nadir oxygen saturation (SaO2) to 51.5%. after surgery, all patients in this group maintained SaO2 levels to no lower than 90%, with a mean SaO2 level of 93% while using CPAP on room air (FlO2 21%)

Download Full-text

Treatment Effects on Carbon Dioxide Retention in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome

CHEST Journal ◽

10.1378/chest.119.6.1814 ◽

2001 ◽

Vol 119 (6) ◽

pp. 1814-1819 ◽

Cited By ~ 56

Author(s):

Fang Han ◽

Erzhang Chen ◽

Hailing Wei ◽

Quanying He ◽

Dongjie Ding ◽

...

Keyword(s):

Carbon Dioxide ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Effects ◽

Obstructive Sleep ◽

Hypopnea Syndrome

Download Full-text

Unilateral Tonsillar Hypertrophy in a 4-Year-Old Girl with Focal Dermal Hypoplasia (Goltz Syndrome)

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v32i2.97 ◽

2018 ◽

Vol 32 (2) ◽

pp. 43-46

Author(s):

John Emmanuel L. Ong ◽

Emmanuel Tadeus S. Cruz ◽

Clydine Maria Antonette G. Barrientos

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Severe Obstructive Sleep Apnea ◽

Gorlin Syndrome ◽

Tonsillar Hypertrophy ◽

Arterial Blood ◽

Focal Dermal Hypoplasia ◽

Goltz Syndrome ◽

Obstructive Sleep ◽

Tertiary Teaching

Objective: To report a case of unilateral tonsillar hypertrophy resulting in severe Obstructive Sleep Apnea in a 4-year-old girl with focal dermal hypoplasia (FDH, Goltz or Goltz-Gorlin) Syndrome. Methods: Design: Case Report Setting: Tertiary Teaching Hospital Subject: One Results: A 4-year-old girl with Goltz Syndrome (classical features of cutaneous and osteopathic disorders since birth) and unilateral tonsillar hypertrophy manifested with snoring and apneic episodes at two years of age. Polysomnography revealed severe Obstructive Sleep Apnea, and Arterial Blood Gases revealed metabolic acidosis with hypoxemia. A tonsillectomy and adenoidectomy improved breathing, appetite and sleep with resolution of snoring and apneic spells and final tonsil histopathology revealed lymphoepithelial polyp. Conclusion: A 4-year-old child with Goltz syndrome, who developed severe obstructive sleep apnea due to tonsillar hypertrophy was presented. Otolaryngologists should be aware of this syndrome, which may manifest with oral and mucosal lesions. Although rare, Goltz syndrome may be considered in the differential diagnosis of tonsillar hypertrophy especially in the presence of the inherent clinical features. Physicians should educate patients and address the co-morbidities associated with it through individualized treatment. Keywords: Focal Dermal Hypoplasia, Unilateral Tonsillar Hypertrophy, Goltz Syndrome, Goltz-Gorlin Syndrome

Download Full-text

Interlink between Obesity Hypoventilation Syndrome and Obstructive Sleep Apnea. Do we need to screen patients for OHS in obese OSA patients?

Journal of Diabetes and Endocrine Association of Nepal ◽

10.3126/jdean.v4i1.30058 ◽

2020 ◽

Vol 4 (1) ◽

pp. 17-20

Author(s):

S.S. Dhakal ◽

R. Maskey ◽

M. Bhattarai

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Research Centre ◽

Apnea Hypopnea Index ◽

Obese Patients ◽

Obesity Hypoventilation Syndrome ◽

Arterial Blood ◽

Obstructive Sleep ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation

Introduction: Around 90% of patients with OHS have coexistent obstructive sleep apnea (OSA) defined by an apnea–hypopnea index (AHI) >5 events/h, with nearly 70% having severe OSA (AHI > 30 events/h). Prevalence of OHS is between 8% and 20% in obese patients referred to sleep centers for evaluation of SDB. As prevalence of OHS in OSA patients data from Nepal is not available we planned to carry out the study and to address gaps in diagnosis and management. Methodology: This is a cross sectional observational study done in OM hospital and research centre from 2018 January to 2019 June. Awake daytime Arterial blood gas ( ABG) was obtained and patients having PaCO2 more than 45 mmHg were diagnosed as obesity hypoventilation syndrome in a recently diagnosed patients with OSA. Results: 32 patients diagnosed to have OSA and whose BMI is more than 30 were included in the study. Among 32 patients 26 (81.25%) were male and 6 (18.75) were female. Among all patients who underwent level A polysomnography 3 (12.5%) had mild OSA,4(16.66%) had moderate and 17 (53.12%) had severe OSA. 8 (25%) patients had normal diagnostic polysomnography. Among these patients 3(12.5%) who had mild OSA has BMI between 30-35,16 (66.66%) patients who had BMI between 30-35, 2 had mild 3 had moderate and 11 had severe OSA. Patients with BMI more than 40,5 (28.3%) had OSA among which 21 had moderate and 4 had severe OSA. Conclusions: As OHS is often misdiagnosed even in patients with severe obesity, we strongly recommended screening in obese patients with OSA for OHS as early recognition and effective treatment are important in improving morbidity and mortality in this group of patients.

Download Full-text

Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea

Journal of Applied Physiology ◽

10.1152/jappl.1985.59.5.1364 ◽

1985 ◽

Vol 59 (5) ◽

pp. 1364-1368 ◽

Cited By ~ 72

Author(s):

T. D. Bradley ◽

D. Martinez ◽

R. Rutherford ◽

F. Lue ◽

R. F. Grossman ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Linear Regression Analysis ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Pulmonary Mechanics ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Nocturnal Hypoxemia ◽

Obstructive Sleep

Among patients with similar degrees of obstructive sleep apnea (OSA) there is considerable variability in the degree of associated nocturnal hypoxemia. The factors responsible for this variability have not been clearly defined. Therefore we studied 44 patients with OSA to identify the physiological determinants of nocturnal arterial O2 saturation (SaO2). All patients underwent pulmonary function testing, arterial blood gas analysis, and overnight polysomnography. Mean nocturnal SaO2 ranged from 96 to 66% and apnea-hypopnea index from 11 to 128 per hour of sleep. Several anthropometric, respiratory physiological, and polysomnographic variables that could be expected to influence nocturnal SaO2 were entered into a stepwise multiple linear regression analysis, with mean nocturnal SaO2 as the dependent variable. Three variables [awake supine arterial PO2 (PaO2), expiratory reserve volume, and percentage of sleep time spent in apnea] were found to correlate strongly with mean nocturnal SaO2 (multiple R, 0.854; P less than 0.0001) and accounted for 73% of its variability among patients. Body weight, other lung volumes, and airflow rates influenced awake PaO2 and expiratory reserve volume but had no independent influence on nocturnal SaO2. In a further group of 15 patients with OSA a high correlation was obtained between measured nocturnal SaO2 and that predicted by the model (r = 0.87; P less than 0.001). We conclude that derangements of pulmonary mechanics and awake PaO2 (generally attributable to obesity and diffuse airway obstruction) are of major importance in establishing the severity of nocturnal hypoxemia in patients with OSA.

Download Full-text

Relationship Between End Tidal Carbon Dioxide Level and Epworth Sleepiness Scores in Patients With Obstructive Sleep Apnea

CHEST Journal ◽

10.1378/chest.10566 ◽

2010 ◽

Vol 138 (4) ◽

pp. 915A

Author(s):

Ruckshanda Majid ◽

Paresh Patel ◽

Amit Vaid ◽

Richard Castriotta

Keyword(s):

Carbon Dioxide ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Carbon Dioxide Level ◽

Obstructive Sleep ◽

End Tidal Carbon Dioxide ◽

End Tidal

Download Full-text

Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

10.21203/rs.3.rs-770372/v1 ◽

2021 ◽

Author(s):

Chong Pei ◽

Shuyu Gui

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Statistical Significance ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Arterial Blood ◽

Obstructive Sleep

Abstract Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening.

Download Full-text

Abstract 2477: Repetitive Apneic Events Augment Arterial Blood Pressure Fluctuation in Patients with Central and Obstructive Sleep Apnea Syndrome

Circulation ◽

10.1161/circ.118.suppl_18.s_733-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Takeshi Takamura ◽

Kaoru Dohi ◽

Katsuya Onishi ◽

Emiyo Ogawa ◽

Hiroshi Nakajima ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Pressure Fluctuation ◽

Sleep Apnea Syndrome ◽

Arterial Blood ◽

Obstructive Sleep ◽

Apnea Syndrome ◽

Blood Pressure Fluctuation

Background: Sleep apnea-hypopneas induce transient increases in arterial blood pressure (BP). We test the hypothesis that periodic nocturnal apneic events augment those hemodynamic responses in patients both with central and obstructive sleep apnea syndrome (SAS). Methods: Eleven patients with central SAS (CSAS: mean age 70 ± 10 years), 11 patients with obstructive SAS (OSAS: mean age 64 ± 12 years), and 8 normal controls (Control) were studied. Polysomnography was performed and BP was measured on a beat-by-beat basis by finger plethysmography all through the sleep. Severity of SAS was assessed by apnea-hypopnea index (AHI). The degree of BP fluctuation associated with periodic nocturnal apnea-hypopnea was assessed by spectral analysis of mean BP variability. Spectral plots of mean BP were calculated in 2-min segments using a maximum entropy method. Power spectrum of mean BP variability was quantified by measuring the area in the very-low-frequency band which coincides with frequency of apnea-hypopneas (sleep apnea band: 0.01– 0.03 Hz), and was normalized by dividing by the total power in the spectrum up to 0.4 Hz. Results: AHI was similar in CSAS and OSAS (38.3 ± 9.5* and 39.8 ± 11.3*, *p<0.05 vs. Control: 2.5±1.6*). Repetitive fluctuations in BP coincided with periodic apnea-hypopneas were clearly observed in patients with SAS, and were more prominent in CSAS (Normalized spectral power of mean BP in sleep apnea band: 0.72 ± 0.10*† in CSAS, 0.62 ±0.13* in OSAS, and 0.46±0.07 in Control, * p<0.05 vs. Control, and †p<0.05 vs. OSAS). Conclusion: Periodic nocturnal apneic events augment blood pressure fluctuation in patients both with central and obstructive SAS.smoking.

Download Full-text