STOP-BANG: a Mandatory Tool for Targeted Respiratory Therapy in Bariatric Patients

Identification of patients with obstructive sleep apnea syndrome and high respiratory risk, optimization of the screening algorithm for these patients and administration of preventive non-invasive lung ventilation, makes it possible to prevent the development of perioperative complications, reduce duration of hospital stay and reduce mortality in patients undergoing surgery and bariatric surgery specifically.The objective: to evaluate the effectiveness of STOP-BANG questionnaire for preventive targeted respiratory therapy to reduce the risk of complications in bariatric patients. Subjects and Methods. We examined 60 patients with BMI above 30 kg/m2 referred to elective secondary surgery, the age made 44.2 ± 10.1 years, 23 men and 37 women. Before the operation, patients underwent STOP-BANG questionnaire survey, night respiratory monitoring with the calculation of the apnea/hypopnea index (AHI) and/or saturation during sleep. The standard preoperative examination included clinical and biochemical analyzes.Results. Based on results of STOP-BANG survey, a correlation was revealed between the score and AHI as well as the score and average saturation. The higher score the patients had according to the STOP-BANG questionnaire, the higher AHI was (r = 0.4748, p = 0.002), and the lower mean SpO2 was (r = -0.6958, p < 0.001). Using the ROC analysis, we chose the optimal threshold value - 4 points according to STOP-BANG questionnaire, where the sensitivity of the method was 93% for the AHI, the specificity was 56%, and for the average saturation it was 100% and 63%, respectively. Of the total number of bariatric patients included in the study, 30% required preventive ventilation. In the high respiratory risk group, no significant intraoperative incidents and deaths were reported by the surgical and anesthetic teams. All patients were discharged on time (5‒7 days). Based on the results, a screening procedure has been offered for bariatric patients with high respiratory risk associated with obstructive sleep apnea syndrome.Conclusion. The STOP-BANG questionnaire is a reliable screening tool for high respiratory risk in morbid obese patients. Early diagnosis of high respiratory risk and implementation of preventive ventilation reduces the incidence of perioperative respiratory and cardiovascular complications.

MORPHOLOGICAL CHANGES IN SOFT PALATINE TISSUES STANDING BEHIND OBSTRUCTIVE SLEEP APNEA SYNDROME: GENERAL PATTERN AND ROLE OF HUMAN PAPILLOMA VIRUS

snoring and obstructive sleep apnea syndrome (OSAS) are a serious medical problem, as they lead to a complex of complications from various body systems, disrupt the socio-economic sphere and stigmatize patients. To date, a set of treatments has been developed, the most effective of which are conservative therapy using CPAP and surgical interventions - various modifications of uvulopalatopharyngoplasty. However, only a small number of studies have elucidated soft palate tissue pathology in patients with chronic and OSAS. But understanding the morphological changes is one of the key aspects for the development of treatment tactics. The aim of current study is to justify the choice of surgical intervention in the treatment of snoring and OSAS by description of morphological changes of the soft palate and to estimate the impact of HPV infection on the progression of soft palatine remodeling. The study included soft palatine tissue samples, which were removed during surgery for snoring and OSAS in 15 patients. Histological (H&E) and immunohistochemical techniques (Ki-67, p16, Human Papilloma Virus). All patients were divided in two groups according HPV-positivity: 5 persons in HPV-positive group and 10 persons in HPV-negative group. For indicators were estimated: number of cellular layers (CL), number of intraepithelial lymphocytes (per 100 epitheliocytes) (IEL), number of vessels per x100 field (NV), Ki-67 proliferation index (PI). Results shows in HPV+ group: CL - 24,2 (±2,17); IEL - 37,8 (±20,97), NV - 21 (±8,46); PI - 17,6 (±2,51). In HPV- group: CL - 6 (±4,78); IEL - 3,3 (±1,77); NV - 10,7 (±2,67); PI - 7,3 (±2,71). Mann-Whitney criterion shows statistical significant difference between groups for all mentioned indicators. In conclusion: patients with snoring and obstructive sleep apnea syndrome had hypertrophy of the soft palate structures caused by changes in epithelial and connective tissue components. Subepithelial structures underdo the disorganization of connective tissue components with a violation of the histoarchitectonics of collagen fibers, edema and angiomatosis. Thus, the study revealed a number of irreversible pathological processes of soft palate tissues, which is the basis for the choice of surgical treatment tactics including the resection of excess tissue. At the same time HPV-infection leads to more pronounced changes in the epithelial layer and subepithelial tissue with concomitant inflammation that likely to create a negative background for further treatment of OSA syndrome.

Obstructive Sleep Apnea Syndrome: The Effect of Acute and Chronic Responses of Exercise

Obstructive Sleep Apnea Syndrome (OSAS) is a sleep disorder with high prevalence in general population, but alarmingly low in clinicians' differential diagnosis. We reviewed the literature on PubMed and Scopus from June 1980–2021 in order to describe the altered systematic pathophysiologic mechanisms in OSAS patients as well as to propose an exercise program for these patients. Exercise prevents a dysregulation of both daytime and nighttime cardiovascular autonomic function, reduces body weight, halts the onset and progress of insulin resistance, while it ameliorates excessive daytime sleepiness, cognitive decline, and mood disturbances, contributing to an overall greater sleep quality and quality of life.

The Use of Auto-Titrating Continuous Positive Airway Pressure (AutoCPAP) for Obstructive Sleep Apnea Syndrome in Children with Obesity

Background: Positive airway pressure can be an effective and safe therapy for children with obstructive sleep apnea syndrome (OSAS). Few studies have assessed the safety and efficacy of autoCPAP in pediatric patients with obesity. Methods: This was a retrospective chart review of children with obesity (Body Mass Index (BMI) > 99th percentile), ages 2–18, diagnosed with OSAS (Obstructive Apnea-Hypopnea Index (OAHI) > 1/h) and used autoCPAP with 30-day adherence. Exclusion criteria included patients with complex comorbidities. Adherence was defined as autoCPAP use ≥4 h/night for at least 21/30 days. Baseline PSG OAHI was compared to the AHI from the 30-day autoCPAP compliance report. We also compared autoCPAP 30-day 95th percentile pressures with the pressures from PAP titration. Results: The study included 19 children, ranging 5–15 years old. The median BMI was 99.6th percentile and average adherence was 25/30 nights with mean of 7.3 h/night. The median OAHI was 12.3/h on baseline PSG and the 30-day autoCPAP download AHI decreased to 1.7/h. No adverse outcomes were identified. The average difference between 95th percentile autoCPAP pressure and PAP titration pressure was 0.89 cmH20. Conclusion: Our study suggests autoCPAP is effective and safe for the treatment of OSAS in pediatric patients with obesity. Using autoCPAP may reduce delays in treatment. Additional research is needed to verify the long-term effectiveness of autoCPAP in this population.