Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Oct 2014
ReviewSleep and sleep disordered breathing in hospitalized patients.
Sleep is a fundamental physiological process necessary for recovery from acute illness. Unfortunately for hospitalized patients, sleep is often short, fragmented, and poor in quality, and may be associated with adverse outcomes including inpatient delirium. ⋯ Mitigating the sequelae associated with poor sleep quality and sleep disordered breathing requires early identification of modifiable factors impacting a patient's sleep, including engagement of a multidisciplinary team. In this article, we review the current knowledge of sleep in hospitalized patients with a detailed focus on patients with sleep disordered breathing.
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Semin Respir Crit Care Med · Oct 2014
ReviewEnhancing adherence to positive airway pressure therapy for sleep disordered breathing.
Sleep disordered breathing is made up of a group of conditions that include obstructive sleep apnea, central sleep apnea, complex sleep apnea, and sleep-related hypoventilation. Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea. The other forms of sleep disordered breathing require different types of positive airway pressure (PAP). ⋯ Addressing side effects such as nasal symptoms and equipment usability issues is also beneficial. Compliance can be monitored by the data download cards present in PAP machines, but clinicians must be aware of the limitations of the data obtained. The challenges of improving adherence occur along with the increasing need to demonstrate to payers a patient's adherence to and benefit from PAP therapy.
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Semin Respir Crit Care Med · Oct 2014
ReviewDiagnosis and management of obstructive sleep apnea in the perioperative setting.
Obstructive sleep apnea (OSA) is a chronic prevalent condition which may be under-recognized in surgical populations. Patients with OSA may be at increased perioperative risk, in part due to the effects sedatives and anesthetics have on upper airway tone and respiratory drive. ⋯ Several screening tools have been developed to identify patients at risk for OSA preoperatively, but it remains to be seen whether routine implementation of these tools improves outcomes. In this review, we discuss the perioperative complications of OSA, the tools with which physicians can screen surgical patients, and the perioperative management of these patients.
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Semin Respir Crit Care Med · Oct 2014
ReviewObstructive sleep apnea: role of intermittent hypoxia and inflammation.
Obstructive sleep apnea results in intermittent hypoxia via repetitive upper airway obstruction leading to partial or complete upper airway closure, apneas and hypopneas, respectively. Intermittent hypoxia leads to sympathetic nervous system activation and oxidative stress with a resultant systemic inflammatory cascade. The putative mechanism by which obstructive sleep apnea has been linked to numerous pathologic conditions including stoke, cardiovascular disease, hypertension, and metabolic derangements is through these systemic effects. Treatment of obstructive sleep apnea appears to reduce systemic markers of inflammation and ameliorates the adverse sequelae of this disease.