Sleep & breathing = Schlaf & Atmung
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Observational Study
Association of opioid prescription and perioperative complications in obstructive sleep apnea patients undergoing total joint arthroplasties.
Obstructive sleep apnea (OSA) has been linked to higher rates of perioperative complications. Practice guidelines recommend minimizing opioids in this cohort to reduce complications. However, a paucity of evidence exists relating different levels of opioid prescription to perioperative complications. Our aim was to investigate if different levels of opioid prescription are related to perioperative complication risk in patients with OSA. ⋯ Higher levels of opioid prescription were associated with higher odds for gastrointestinal complications and adverse effects on cost and length of stay but lower odds for pulmonary complications in OSA patients undergoing joint arthroplasties. The latter finding is unlikely causal but may represent more preventive measures and early interventions among those patients. Attempts to reduce opioid prescription should be undertaken to improve quality and safety of care in this challenging cohort in the perioperative setting.
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We report a case of firing a loaded gun during sleep in a geriatric patient with undiagnosed major sleep disorders and multiple risk factors for sleep violence. Polysomnographic findings, diagnostic challenges, and forensic implications in this unprecedented geriatric case are discussed. ⋯ In this case, there was a "perfect storm" of sleep and psychological risk factors that converged to strongly promote precipitous arousals with sleep-related violence in a patient with documented sleep motor dyscontrol. Primary care physicians, including geriatric specialists, should question patients and their spouses about any symptoms of sleep disorders.
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Clinical Trial
Phenotyping-based treatment improves obstructive sleep apnea symptoms and severity: a pilot study.
Obstructive sleep apnea is a common disorder characterized by multiple pathogenetic roots. Continuous positive airway pressure (CPAP) is almost always prescribed as the first-line treatment to all patients regardless of the heterogeneous pathophysiology, because it mechanically splints the airways open and reduces the collapsibility of the upper airway. Despite its high efficacy, CPAP is burdened by poor adherence and compliance rates. In this pilot study, we treated OSA patients with composite approaches different than CPAP, tailoring the therapeutic choice on OSA phenotypic traits. ⋯ Treating OSA patients with a personalized combination of pharmacological and behavioral therapies according to phenotypic traits leads to a significant improvement in AHI, ODI, and subjective sleepiness.
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The NoSAS score was developed to identify subjects at high risk of sleep-disordered breathing (SDB). We aimed to validate the NoSAS score in a multiethnic Asian cohort and compare its performance to the STOP-Bang and Berlin questionnaires. ⋯ The NoSAS score performed similarly to the STOP-Bang and Berlin questionnaires in a multiethnic Asian cohort. All three questionnaires had high negative predictive values in ruling out severe SDB and may have utility as screening tools.
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Comparative Study
Assessing the likelihood of obstructive sleep apnea: a comparison of nine screening questionnaires.
Several questionnaires are available for the screening of obstructive sleep apnea (OSA). Herein, we compare the performance characteristics of nine available questionnaires for assessing the likelihood of OSA. ⋯ The SACS and the STOP-Bang questionnaires (BMI threshold of 25 kg/m2) were found to provide the best positive and negative LRs, respectively, for the prediction of OSA. We believe that information from these questionnaires may help in prioritizing patients for sleep studies in high-volume centers.