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See relatedarticle [ABSTRACT FROM AUTHOR]

See relatedarticle [ABSTRACT FROM AUTHOR]

Background: Previous study showed that in individuals with obstructive sleep apnea (OSA), the contractions of masseter muscles after respiratory events can be nonspecific motor phenomena, dependent on the duration of respiratory arousals rather than the occurrence of the respiratory events. However, the role of intermittent hypoxia in the occurrence of jaw‐closing muscle activities (JCMAs) was not taken into consideration. An exposure to intermittent hypoxia has been shown to initiate a series of activities, including muscular sympathetic activity in patients with OSA. Objective: To determine the effects of mandibular advancement appliance (MAA) therapy on JCMA time‐related to oxygen desaturation with and without arousal in individuals with OSA. Methods: Eighteen individuals with OSA (age: 49.4 ± 9.8 years, apnea‐hypopnea index (AHI): 10.0|18.4|30.3, JCMA index: 1.7|4.3|5.6), participated in a randomised controlled crossover clinical trial, in which two ambulatory polysomnographic recordings were performed: one with MAA in situ and the other without MAA in situ. JCMAs were recorded bilaterally from both masseter and temporalis muscles. Results: There was no significant effect of the MAA on the overall JCMA index (Z = −1.372, p =.170). With the MAA in situ, JCMA index time‐related to oxygen desaturation with arousal significantly decreased (Z = −2.657, p =.008), while there was no significant effect of the MAA on the JCMA index time‐related to oxygen desaturation without arousal (Z = −0.680, p =.496). Conclusion: Effective mandibular advancement appliance therapy significantly reduces jaw‐closing muscle activities time‐related to oxygen desaturation with arousal in individuals with OSA. [ABSTRACT FROM AUTHOR]

High‐altitude indoctrination (HAI) trains individuals to recognize symptoms of hypoxia by simulating high‐altitude conditions using normobaric (NH) or hypobaric (HH) hypoxia. Previous studies suggest that despite equivalent inspired oxygen levels, physiological differences could exist between these conditions. In particular, differences in neurophysiological responses to these conditions are not clear. Our study aimed to investigate correlations between oxygen saturation (SpO2) and neural responses in NH and HH. We recorded 5‐min of resting‐state eyes‐open electroencephalogram (EEG) and SpO2 during control, NH, and HH conditions from 13 participants. We applied a multivariate framework to characterize correlations between SpO2 and EEG measures (spectral power and multiscale entropy [MSE]), within each participant and at the group level. Participants were desaturating during the first 150 s of NH versus steadily desaturated in HH. We considered the entire time interval, first and second half intervals, separately. All the conditions were characterized by statistically significant participant‐specific patterns of EEG–SpO2 correlations. However, at the group level, the desaturation period expressed a robust pattern of these correlations across frequencies and brain locations. Specifically, the first 150 s of NH during desaturation differed significantly from the other conditions with negative absolute alpha power–SpO2 correlations and positive MSE–SpO2 correlations. Once steadily desaturated, NH and HH had no significant differences in EEG–SpO2 correlations. Our findings indicate that the desaturating phase of hypoxia is a critical period in HAI courses, which would require developing strategies for mitigating the hypoxic stimulus in a real‐world situation. [ABSTRACT FROM AUTHOR]

Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during rapid sequence induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for rapid sequence induction in emergency surgery at all hours of the day and night. A total of 350 adult patients from six centres in Sweden and one in Switzerland undergoing emergency surgery where rapid sequence induction was required were included and randomly allocated to pre-oxygenation with 100% oxygen using high-flow nasal oxygen or a standard tight-fitting facemask. The primary outcome was the number of patients developing oxygen saturations <93% from the start of pre-oxygenation until 1 min after tracheal intubation. Data from 349 of 350 patients who entered the study were analysed (174 in the high-flow nasal oxygen group and 175 in the facemask group). No difference was detected in the number of patients desaturating <93%, five (2.9%) vs. six (3.4%) patients in the high-flow nasal oxygen and facemask group, respectively (p = 0.77). The risk of desaturation was not increased during on-call hours. No difference was seen in end-tidal carbon dioxide levels in the first breath after tracheal intubation or in the number of patients with signs of regurgitation between groups. These results confirm that high-flow nasal oxygen maintains adequate oxygen levels during pre-oxygenation for rapid sequence induction. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: This study aimed to assess the role of capnography in objectively evaluating breathing routes during drug-induced sleep endoscopy (DISE) and further elucidate the relationship between breathing route, obstructive sleep apnea (OSA) severity, and DISE findings.Study Design: Prospective observational study.Methods: Nighty-five patients with established OSA were recruited for this study from May 2017 to May 2019. DISE was performed in the operating room. Sedation was maintained with propofol using a target-controlled infusion system and the depth of sedation was monitored based on the bispectral index. The breathing routes, which included oral breathing, oronasal breathing, and nasal breathing, were detected using capnography. DISE findings were recorded using the VOTE (velum, oropharynx, base of tongue, and epiglottis) classification.Results: Patients with mouth breathing were associated with increased OSA severity, worse oximetric variables, and higher body mass index in comparison with those with other breathing routes. Mouth breathing was associated with a higher degree and higher prevalence of lateral pharyngeal wall collapse and tongue base collapse during DISE.Conclusions: Mouth breathing was significantly associated with worse oxygen desaturation and increased degree of upper airway collapse. Therefore, patients with mouth breathing during propofol-based intravenous anesthesia should be carefully monitored.Level Of Evidence: 4 Laryngoscope, 131:E659-E664, 2021. [ABSTRACT FROM AUTHOR]

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) can prolong apnoea time in adults. Therefore, THRIVE used for pre-oxygenation in rapid sequence induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO2 ) during intubation when pre-oxygenating with either traditional facemask or THRIVE. Eighty adult patients, undergoing rapid sequence induction of anaesthesia for emergency surgery, were randomly allocated to pre-oxygenation with 100% oxygen with facemask or with THRIVE. Median (IQR [range]) lowest SpO2 until 1 min after intubation was 99% (97-100 [70-100]%) for the facemask group vs. 99% (99-100 [96-100]%) for the THRIVE group (p = 0.097). Five patients (12.5%) desaturated below 93% when pre-oxygenated with the facemask vs. none in the THRIVE group (p = 0.019). There were no differences in intubation time or apnoea time between the groups. Median intubation time was 51 (34-66 [22-261]) s in the facemask group vs. 48 (38-63 [10-146]) s in the THRIVE group (p = 0.99). Median apnoea time was 109 (86-142 [37-291]) s and 116 (92-146 [63-249]) s when using facemask and THRIVE, respectively (p = 0.49). No signs of regurgitation of gastric content were detected. The data on desaturation indicate potential benefits of oxygenation with THRIVE for rapid sequence induction compared with facemask pre-oxygenation. [ABSTRACT FROM AUTHOR]

We investigated the relationship between ambulatory blood pressure (BP) and oxygen desaturation index (ODI), while accounting for pulse rate and age. ODI was assessed by overnight finger pulse oximetry in 2342 participants on the day of ambulatory BP monitoring, and calculated as the number of desaturation episodes per sleeping hour. Both BP and pulse rate increased significantly (P ≤ .006) from normal (< 5 events/h) to mildly (5-14), moderately (15-30), and severely (≥ 30 events/h) elevated ODI. The association for BP was substantially attenuated by accounting for pulse rate (partial r² from .003-.012 to .002-.006). In adjusted analysis, the associations of 24-hour diastolic BP and 24-hour pulse rate with ODI were dependent on age (P ≤ .0001) and only significant in younger subjects (< 60 years, P ≤ .0001). In conclusion, the association between ambulatory BP and ODI was partially mediated by pulse rate, a measure of sympathetic activity, and was more prominent in younger subjects. [ABSTRACT FROM AUTHOR]

Patients with epilepsy have 20-fold risk of sudden death when compared to the general population. Uncontrolled seizures is the most consistent risk factor, and death often occurs at night or in relation to sleep. We examined seizure-related respiratory disturbances in sleep versus wakefulness, focusing on periictal oxygen saturation. Respiratory measures were examined in 48 recorded seizures (sleep, n = 23, wake, n = 25) from 20 adult patients with epilepsy. Seizures from sleep were associated with lower saturation, as compared to seizures from wakefulness, both during ictal (sleep median = 90.8, wake median = 95.5; p < 0.01) and postictal periods (sleep median = 94.3, wake median = 96.9; p = 0.05). Compared to wake-related seizures, seizures from sleep were also associated with a larger desaturation drop (sleep median = −4.2, wake median = −1.2; p = 0.01). Postictal generalized electroencephalography (EEG) suppression ( PGES) occurred more frequently after seizures from sleep (39%), as compared to wake-related seizures (8%, p = 0.01). Our findings suggest that nocturnal seizures may entail a higher sudden unexpected death in epilepsy (SUDEP) severity burden, as they are associated with more severe and longer hypoxemia events, and more frequently followed by PGES, both factors implicated in sudden death. [ABSTRACT FROM AUTHOR]

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Background and objective The 6-min walk test (6 MWT) is a simple test assessing functional capacity, but concerns about risks of substantial oxygen desaturation in pulmonary patients have led to non-adherence to the standardised American Thoracic Society guideline. We evaluated the safety of the 6 MWT in stable COPD patients and compared the incidence of adverse events in patients with and without substantial exertional hypoxaemia. Methods 6 MWT data were obtained for 1136 patients with moderate to very severe COPD. Demographics, adverse events, oxygen saturation ( SpO2), 6-min walk distance, lung function and quality of life measures were compared between patients with substantial exertional hypoxaemia (nadir SpO2 < 85%) and those without ( SpO2 ≥ 85%). Comparisons were made using Mann- Whitney U-test for continuous variables and Fisher's exact test for categorical variables. Results Twenty-five patients (2.2%) had adverse events, the most common being dizziness, chest tightness, chest pain and palpitations. Substantial exertional hypoxaemia did not increase the incidence of adverse events. No significant morbidity or mortality was recorded. Patients with adverse events had lower baseline SpO2, worse quality of life scores, and higher depression and anxiety scores. However, no significant differences were seen in anthropometric data, spirometric values or SpO2 during and after the 6 MWT. Conclusions Asymptomatic exertional hypoxaemia is not associated with an increased incidence of adverse events during 6 MWT in COPD patients. Our data support the ATS guideline that the 6 MWT should be continued in the absence of symptoms and that intermittent oximetry monitoring does not assist in preventing adverse events. [ABSTRACT FROM AUTHOR]

Background Problems with intravenous patient-controlled analgesia ( IV PCA) are well known, including invasive route of delivery and pump programming errors. The primary objective of this study was to evaluate patient satisfaction with a novel sublingual sufentanil PCA system (sufentanil sublingual tablet system 15 mcg with a 20-minute lockout interval; SSTS) to IV PCA morphine sulfate 1 mg with a 6-minute lockout interval ( IV PCA MS) for the management of acute postoperative pain. Methods This was a randomized, open-label, 48-hour non-inferiority study with optional extension to 72 hours at 26 U.S. sites enrolling patients scheduled for elective major open abdominal or orthopedic (hip or knee replacement) surgery. The primary outcome measure was the proportion of patients who responded 'good' or 'excellent' (collectively 'success') at the 48-hour timepoint on the Patient Global Assessment of method of pain control ( PGA48). Results A total of 357 patients received study drug and 78.5% vs. 65.6% of patients achieved PGA48 'success' for SSTS vs. IV PCA MS, respectively, demonstrating non-inferiority ( P < 0.001 using the one-side Z-test against the non-inferiority margin) as well as statistical superiority for treatment effect ( P = 0.007). Patients using SSTS reported more rapid onset of analgesia and patient and nurse ease of care and satisfaction scores were higher than IV PCA MS. Adverse events were similar between the 2 groups; however, SSTS had fewer patients experiencing oxygen desaturations below 95% compared to IV PCA MS ( P = 0.028). Conclusions Sufentanil sublingual tablet system is a promising new analgesic technology that may address some of the concerns with IV PCA. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To identify clinical risk factors for oxygen desaturation in the first 24 hours post-tonsillectomy, thus permitting the identification of those patients who warrant inpatient monitoring. Study Design A retrospective analysis of 4092 consecutive patients undergoing tonsillectomy over a two-year period. Methods Detailed clinical data were recorded for all patients who desaturated in the postoperative period (n = 294) and randomly selected controls (n = 368). Univariate and Multivariate analysis was performed in order to identify independent risk factors for desaturation. Results There were 294/4092 patients (7.2%) who experienced desaturations (defined as sustained saturations <90%) in the first 24 hours postoperatively (mean nadir, 78.7%). Multivariate analysis identified seven independent clinical risk factors for desaturation in the initial 24 hours post-tonsillectomy: trisomy 21, weight, coexistent cardiac disease, a coexistent syndromic diagnosis, a clinical diagnosis of obstructive sleep apnea ( OSA), a coexistent neurologic diagnosis, and a prior diagnosis of pulmonary disease. A policy that admits all patients exhibiting any one of these risk factors except OSA would have identified 92% of the patients who subsequently desaturated. However, such a policy would also have required admission of 60% of the patients in our control group. Conclusions These findings are generally consistent with the Clinical Practice Guidelines recently published by the American Academy of Otolaryngology. In a tertiary care center, it may not be possible to identify an algorithm that admits all children at risk of desaturation while permitting the discharge of a high percentage of patients. Level of Evidence 3b. Laryngoscope, 123:2554-2560, 2013 [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption as well as overweight is known to aggravate the severity of sleep-disordered breathing (SDB), but little is known about alcohol consumption in truck drivers. The aim of this study was to examine the relationship between alcohol consumption and SDB among truck drivers. Methods: We conducted a cross-sectional study of 1,465 men aged 20–69 years who were registered with the Japanese Trucking Association. The 3% oxygen desaturation index (3%ODI) was selected as an indicator of SDB, representing the number of desaturation events per hour of recording time in which blood oxygen fell by ≥3% based on overnight pulse-oximetry. Participants completed a self-administered questionnaire including alcohol consumption on the same night for SDB assessment. Results: The prevalence of 3%ODI ≥5, ≥10, and ≥15/h was 25.4%, 11.1%, and 6.6% respectively. The multivariable odds ratios (OR) of 3%ODI ≥ 10/h were 1.5(0.9–2.5) for 0.5 to <1.0 g of alcohol intake/kg and 3.4(1.8–6.6) for ≥1.0 g of alcohol intake/kg compared with non-drinkers. Similar associations with alcohol consumption were observed for 3%ODI ≥5 and ≥15/h. The relation between alcohol consumption (≥1.0 g of alcohol intake/kg) and 3%ODI ≥ 10/h tended to be more evident among men with body mass index (BMI) <23.4 kg/m2 than those with BMI ≥ 23.4 kg/m2 [11.4 (3.2–41) vs. 1.2 (0.6–2.7), p = 0.18 for interaction]. A similar trend was observed for 3%ODI ≥ 5/h. Conclusions: The prevalence of undiagnosed SDB and the significant association of alcohol consumption with SDB severity emphasize the need for SDB screening and alcohol modification as well as weight control to prevent and control SDB among truck drivers. [ABSTRACT FROM AUTHOR]

Aim: Tracheal and chest auscultation for wheeze and transcutaneous oximetry have both been suggested as outcome measures of bronchial provocation tests in young children. The aims of this study were to compare the sensitivity of these two techniques as endpoints for methacholine challenge in young children with cough-variant asthma (CVA) and with classic asthma (CA), and to investigate whether oxygen saturation levels at the presence of wheezing differ in these two groups. Methods: We performed a retrospective analysis of methacholine challenge test data from 4- to 6-year-old children with CVA (n = 41) and from those with CA (n = 53). The challenges used a modified auscultation method that set wheeze detection and/or oxygen desaturation for determining the endpoint. Results: The frequency of wheeze detection at the endpoint was significantly lower than that of oxygen desaturation (46.3% vs. 78.0%) in the CVA group, which contrasted with findings (75.5% vs. 50.9%) in the CA group. Oxygen saturation levels at the presence of wheezing were significantly lower in the CVA group than in the CA group (94.5 ± 1.5% vs. 95.9 ± 1.8%, p = 0.006). Conclusion: Wheeze detection is a less sensitive outcome measure than oxygen desaturation and is associated with a lower oxygen saturation level in young children with CVA, compared to those with CA. [ABSTRACT FROM AUTHOR]

Abstract The aims of this study were to calculate the apnea–hypopnea index (AHI), which represented as the number of apnea–hypopnea occurrences per hour, the 4% oxygen desaturation index (ODI4) and the breathing-related arousal index (B-ArI) in polysomnographic studies of obstructive sleep apnea/hypopnea syndrome (OSAHS) patients and to investigate whether there was any relationship between each pair of scoring schemes. Thirty-four cases of OSAHS were studied. Total OSAHS patients were subdivided into those with a high AHI (> 25), and those with a low AHI (< 25). The correlation between each pair of scoring schemes for OSAHS with a high AHI showed high value. The correlation between AHI and ODI4 for OSAHS with a low AHI was 0.18 and that between AHI and B-ArI showed a weak correlation of 0.59, while that between ODI4 and B-ArI was only -0.078. Our results mean that oxygen desaturation and arousal occur separately in mild or moderate OSAHS patients, even though they are diagnosed with the same level of OSAHS by means of AHI. Breathing-related arousal without oxygen desaturation often occurs in mild or moderate OSAHS patients. We previously reported that AHI does not accurately reflect the severity of the increase in negativity of esophageal pressure manifested as respiratory efforts. We consider that the comprehension and assessment of OSAHS can be improved by the systematic differentiations among the three components: oxygen desaturation, arousals and respiratory efforts. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the effect of a very low-calorie diet (VLCD)-induced weight loss on the severity of obstructive sleep apnoea (OSA), blood pressure and cardiac autonomic regulation in obese patients with obstructive sleep apnoea syndrome (OSAS). A total of 15 overweight patients (14 men and one woman, body weight 114 ± 20 kg, age 52 ± 9 years, range 39–67 years) with OSAS were studied prospectively. They were advised to follow a 2·51–3·35 MJ (600–800 kcal) diet daily for a 3-month period. In the beginning of the study, the patients underwent nocturnal sleep studies, autonomic function tests and 24-h electrocardiograph (ECG) recording. In addition, 15 age-matched, normal-weight subjects were studied. They underwent the Valsalva test, the deep-breathing test and assessment of heart rate variability at rest. The sleep studies and autonomic function tests were repeated after the weight loss period. There was a significant reduction in weight (114 ± 20 kg to 105 ± 21 kg, P< 0·001), the weight loss being 9·2 ± 4·0 kg (range 2·3–19·5 kg). This was associated with a significant improvement in the oxygen desaturation index (ODI4) during sleep (31 ± 20–19 ±18, P< 0·001). Before the weight loss the OSAS patients had significantly higher blood pressure (150 ± 18 vs. 134 ± 20, P< 0·05, for systolic blood pressure, 98 ± 10 vs. 85 ± 13, P< 0·05, for diastolic blood pressure) and heart rate (67 ± 10 beats min-1 vs. 60 ± 13, P< 0·05) at rest than the control group. They had also lower baroreflex sensitivity (4·7 ± 2·8 ms mmHg-1 vs. 10·8 ± 7·1 ms mmHg-1... [ABSTRACT FROM AUTHOR]

Sleep‐disordered breathing is a common condition, related to a higher cardiometabolic and neurocognitive risk. The main risk factors for sleep‐disordered breathing include obesity, craniofacial characteristics, male sex and age. However, some studies have suggested that adverse socioeconomic circumstances and lifestyle‐related behaviours such as smoking and alcohol use, may also be risk factors for sleep‐disordered breathing. Here, we investigate the associations between socioeconomic status and sleep‐disordered breathing, as measured by sleep apnea–hypopnea and oxygen desaturation indexes. Furthermore, we assess whether these associations are explained by lifestyle‐related factors (smoking, sedentary behaviour, alcohol use and body mass index [BMI]). We used data from the CoLaus|HypnoLaus study, a population‐based study including 2162 participants from Lausanne (Switzerland). Socioeconomic status was measured through occupation and education. Sleep‐disordered breathing was assessed through polysomnography and measured using the apnea–hypopnea index (AHI: number of apnea/hypopnea events/hr: ≥15/≥30 events), and the ≥3% oxygen desaturation index (ODI: number of oxygen desaturation events/hr: ≥15/≥30 events). Lower occupation and education were associated with higher AHI and ODI (occupation: AHI30, odds ratio (OR) = 1.88, 95% confidence interval (CI) [1.07; 3.31]; ODI30, OR = 2.29, 95% CI [1.19; 4.39]; education: AHI30, OR = 1.21, 95% CI [0.85; 1.72]; ODI30, OR = 1.26, 95% CI [0.83; 1.91]). BMI was associated with socioeconomic status and AHI/ODI, and contributed to the socioeconomic gradient in SDB, with mediation estimates ranging between 43% and 78%. In this Swiss population‐based study, we found that low socioeconomic status is a risk factor for sleep‐disordered breathing, and that these associations are partly explained by BMI. These findings provide a better understanding of the mechanisms underlying social differences in sleep‐disordered breathing and may help implement policies for identifying high‐risk profiles for this disorder. [ABSTRACT FROM AUTHOR]