Stay Up to Date with the Sleep and Anesthesia Latest Research! |
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Association of Obstructive Sleep Apnea With Postoperative Delirium in Procedures of Moderate-to-High Complexity: A Hospital-Registry Study
Soeren Wagner, Elena Ahrens, Luca J Wachtendorf, Aiman Suleiman, Tim M Tartler, Denys Shay, Omid Azimaraghi, Ricardo Munoz-Acuna, Guanqing Chen, Haobo Ma, Matthias Eikermann, Maximilian S Schaefer Abstract
Background:
Patients suffering from obstructive sleep apnea (OSA) experience chronic sleep disturbances and desaturation, factors that have been associated with postoperative delirium and that can be aggravated after anesthesia for complex procedures. We investigated whether OSA is associated with delirium after anesthesia, and whether this association is modified by procedural complexity.
Methods:
Hospitalized patients ?60 years who underwent general anesthesia or procedural sedation for procedures of moderate-to-high complexity between 2009 and 2020 at a tertiary health care network in Massachusetts were included. The primary exposure was OSA, defined based on International Classification of Diseases (Ninth/Tenth Revision, Clinical Modification) (ICD-9 / 10-CM) diagnostic codes, structured nursing interviews, anesthesia alert notes, and a validated risk score (BOSTN [body mass index, observed apnea, snoring, tiredness, and neck circumference]). The primary end point was delirium within 7 days after the procedure. Multivariable logistic regression and effect modification analyses adjusted for patient demographics, comorbidities, and procedural factors were applied.
Results:
A total of 46,352 patients were included, of which 1694 patients (3.7%) developed delirium, 537 (3.2%) with OSA, and 1,157 (4.0%) without OSA. In adjusted analyses, OSA was not associated with postprocedural delirium in the overall cohort (adjusted odds ratio [OR adj ], 1.06; 95% confidence interval [CI], 0.94-1.20; P = .35). However, a high procedural complexity modified the primary association ( P value for interaction = .002). OSA patients had a higher risk of delirium after high-complexity procedures (?40 work relative value units) such as cardiac (OR adj , 1.33; 95% CI, 1.08-1.64; P = .007, P value for interaction = .005) or thoracic surgery (OR adj , 1.89; 95% CI, 1.19-3.00; P = .007, P value for interaction = .009), but no increased risk after moderate complexity procedures, including general surgery (OR adj , 0.86; 95% CI, 0.55-1.35; P = .52).
Conclusions: Compared to non-OSA patients, a history of OSA is associated with a higher risk after high-complexity procedures such as cardiac or thoracic surgery but not after procedures of moderate complexity. |
Characteristics of Sudden Unexpected Infant Deaths on Shared and Nonshared Sleep Surfaces
Alexa B. Erck Lambert, MPH; Carrie K. Shapiro-Mendoza, PhD, MPH; Sharyn E. Parks, PhD, MPH; Carri Cottengim, MA; Meghan Faulkner, MA; Fern R. Hauck, MD, MS, FAAFP Abstract Objectives
Describe characteristics of sudden unexpected infant deaths (SUID) occurring on shared or nonshared sleep surfaces.
Methods.
We examined SUID among residents of 23 US jurisdictions who died during 2011 to 2020. We calculated frequencies and percentages of demographic, sleep environment, and other characteristics by sleep surface sharing status and reported differences of at least 5% between surface sharing and nonsharing infants.
Results
Of 7595 SUID cases, 59.5% were sleep surface sharing when they died. Compared with nonsharing infants, sharing infants were more often aged 0 to 3 months, non-Hispanic Black, publicly insured, found supine, found in an adult bed or chair/couch, had a higher number of unsafe sleep factors present, were exposed to maternal cigarette smoking prenatally, were supervised by a parent at the time of death, or had a supervisor who was impaired by drugs or alcohol at the time of death. At least 76% of all SUID had multiple unsafe sleep factors present. Among surface-sharing SUID, most were sharing with adults only (68.2%), in an adult bed (75.9%), and with 1 other person (51.6%). Surface sharing was more common among multiples than singletons.
Conclusions
Among SUID, surface sharing and nonsharing infants varied by age at death, race and ethnicity, insurance type, presence of unsafe sleep factors, prenatal smoke exposure, and supervisor impairment. Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counseling for every family at every encounter. |
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Exhibitor and sponsorship registration is OPEN!
On behalf of the Society of Anesthesia and Sleep Medicine (SASM), we invite you to exhibit at the SASM 14th Annual Meeting: “Monitoring the future of anesthesia and sleep: developments in technology and treatment” held in Philadelphia, on October 18, 2024.
The objective of this meeting is to provide a forum for discussions pertaining to the common grounds between sleep and anesthesia. The goal is to promote excellence in medical care, research and education in anesthesia, sleep medicine and perioperative medicine.
This conference is an excellent opportunity to present your organization to a relevant and influential audience. Supporting the conference is a practical way of supporting the Society of Anesthesia and Sleep Medicine.
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Member's Corner
We look forward to your continued membership with SASM as we work together to improve the care for our patients and advance the broad body of science overlapping the disciplines of Anesthesia and Sleep Medicine. |
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More information can be found on the SASM website https://www.sasmhq.org |
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