Characteristics of sleep disorders in patients with Parkinson disease and its relationship with hypotonia during rapid eye movement sleep / 中国医师进修杂志

Objective:To analyze the characteristics of sleep disorders in patients with Parkinson disease (PD) and to explore the relationship between respiratory events and rapid eye movement sleep with hypotonia.Methods:Thirty-nine PD patients compared with 75 controls matched with gender, age and body mass index(BMI) were collected in the Dalian Municipal Central Hospital from January 1, 2019 to September 31, 2019. Both groups underwent polysomnography monitoring. The characteristics of sleep disorders were analyzed and discussed.Results:Apnea and hypopnea index (AHI) during total sleep, AHI during non-rapid eye movement(NREM) sleep, AHI during rapid eye movement (REM) sleep, obstructive apnea index, mixed apnea index, central apnea index, total apnea index, hypopnea index, the time with pulse oximetry <90% and oxygen desaturation index in the PD group were lower than those in the control group: 3.70(0.80, 20.00) /h vs. 17.30(7.30, 28.20)/h, 2.30(0.70, 13.90)/h vs. 15.20(4.90, 27.50)/h, 2.30(0.00, 29.80)/h vs. 16.90(5.70, 39.50)/h, 0.30(0.00, 5.10)/h vs. 3.10(0.50, 7.80)/h, 0.00(0.00, 0.20)/h vs. 0.20(0.00, 0.60)/h, 0.00(0.00, 0.30)/h vs. 0.30(0.00, 0.80)/h, 0.70(0.00, 6.00)/h vs. 3.90(0.80, 10.70)/h, 1.70(0.50, 8.90)/h vs. 8.70(2.70, 14.90)/h, 0.00(0.00, 0.40)min vs. 0.20(0.00, 1.70)min, 4.10(1.10, 18.40)% vs. 16.50(9.30, 30.80)%, and the differences were statistically significant ( P<0.05). The mean pulse oximetry and minimum pulse oximetry in the PD group were higher than those in the control group: 96.00(95.00, 97.00)% vs. 95.00(94.00, 96.00)%, 89.00(82.00, 91.00)% vs. 85.00(81.00, 89.00)%, and the differences were statistically significant ( P<0.05). PD group was divided into PD with RSWA group (PD + RSWA) and PD without RSWA group (PD-RSWA) according to whether there was atonia or not. AHI during REM sleep in the PD+RSWA group was lower than that in the PD-RSWA group: 0.00(0.00, 5.40)/h vs. 5.75(0.52, 34.57)/h, and the difference was statistically significant ( P<0.05). Conclusions:PD has a protective effect on nocturnal respiratory events, which may be due to the increased muscle tone of upper airway.

Study of sleep features in patients with temporal lobe epilepsy / 天津医药

Objective To study sleep characteristics in patients with temporal lobe epilepsy (TLE) through polysomnography (PSG). Methods Twenty-five TLE patients (TLE group) and eighteen healthy volunteer subjects (control group) were recruited to our study. Patients of two groups were evaluated by whole-night PSG, including total time in bed (TIB), total sleep time (TST), sleep efficiency (SE), sleep latency (SL), rapid eye movement latency (REML), wake after sleep onset (WASO), the percentages of non-REM (NREM) 1, 2 and 3 stages and the percentages of rapid eye movement (REM) occupied TST (N1％, N2％, N3％and REM％), the apnea-hypopnea index (AHI), hypopnea index, mean oxygen saturation (SpO2) and nadir SpO2, periodic leg movements (PLMs) index and PLMs index of REM sleep, sleep stage shifts (SSS) and sleep stage shifts per hour (SSS/h), NREM1, NREM2, NREM3 and REM sleep stage and wake shifts (abbreviated as N1, N2, N3, REM and W) and their proportions of SSS (abbreviated as N1/SSS, N2/SSS, N3/SSS, REM/SSS and W/SSS). Results Compared with control group, WASO, PLMs, PLMs index of REM sleep, SSS, SSS/H and N2 were significantly increased in TLE group. Moreover, compared with control group, SpO2 was decreased in TLE group (P<0.05). Conclusion Our results suggest that TLE patients have sleep disorder manifested as disorder of sleep structure, increased incidents of respiratory and motion events.

Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists / Pesquisa de curarização residual no pós-operatório, eventos respiratórios agudos e abordagem de anestesiologistas

BACKGROUND AND OBJECTIVES: residual paralysis following the use of neuromuscular blocking drugs (NMBDs) without neuromuscular monitoring remains a clinical problem, even when NMBDs are used. This study surveys postoperative residual curarization and critical respiratory events in the recovery room, as well as the clinical approach to PORC of anesthesiologists in our institution. METHODS: This observational study included 415 patients who received general anesthesia with intermediate-acting NMBDs. Anesthesia was maintained by non-participating anesthesiologists who were blinded to the study. Neuromuscular monitoring was performed upon arrival in the recovery room. A CRE was defined as requiring airway support, peripheral oxygen saturation <90% and 90-93% despite receiving 3 L/min nasal O2, respiratory rate >20 breaths/min, accessory muscle usage, difficulty with swallowing or speaking, and requiring reintubation. The clinical approach of our anesthesiologists toward reversal agents was examined using an 8-question mini-survey shortly after the study. RESULTS: The incidence of PORC was 43% (n = 179) for TOFR <0.9, and 15% (n = 61) for TOFR <0.7. The incidence of TOFR <0.9 was significantly higher in women, in those with ASA physical status 3, and with anesthesia of short duration (p < 0.05). In addition, 66% (n = 272) of the 415 patients arriving at the recovery room had received neostigmine. A TOFR <0.9 was found in 46% (n = 126) of the patients receiving neostigmine. CONCLUSIONS: When routine objective neuromuscular monitoring is not available, PORC remains a clinical problem despite the use of NMBDs. The timing and optimal antagonism of the neuromuscular blockade, and routine objective neuromuscular monitoring is recommended to enhance patient safety.

JUSTIFICATIVA E OBJETIVOS: A paralisia residual após o uso de bloqueadores neuromusculares (BNMs) sem monitoração neuromuscular continua sendo um problema clínico, mesmo quando BNMs são usados. Este estudo pesquisou a curarização residual pós-operatória e os eventos respiratórios críticos em sala de recuperação, bem como a abordagem clínica da CRPO feita pelos anestesiologistas em nossa instituição. MÉTODOS: Este estudo observacional incluiu 415 pacientes que receberam anestesia geral com BNMs de ação intermediária. A manutenção da anestesia foi feita por anestesiologistas não participantes, "cegos" para o estudo. A monitoração neuromuscular foi realizada no momento da chegada à sala de recuperação. Um ERC foi definido como necessidade de suporte ventilatório; saturação periférica de oxigênio <90% e 90-93%, a despeito de receber 3 L/min de O2 via cânula nasal; frequência respiratória >20 bpm; uso de musculatura acessória; dificuldade de engolir ou falar e necessidade de reintubação. A abordagem clínica de nossos anestesiologistas, em relação aos agentes de reversão, foi avaliada usando um miniquestionário de oito perguntas logo após o estudo. RESULTADOS: A incidência de CRPO foi de 43% (n = 179) para a SQE <0 e 15% (n = 61) para a SQE <0,7. A incidência de SQE <0,9 foi significativamente maior em mulheres, pacientes com estado físico ASA III e com anestesia de curta duração (p < 0,05). Além disso, 66% (n = 272) dos 415 pacientes que chegam à sala de recuperação haviam recebido neostigmina. Uma SQE <0,9 foi encontrada em 46% (n = 126) dos pacientes que receberam neostigmina. CONCLUSÃO: Quando a monitoração neuromuscular objetiva de rotina não está disponível, a CRPO continua sendo um problema clínico, a despeito do uso de BNMs. O momento e o antagonismo ideais do bloqueio neuromuscular e a monitoração neuromuscular objetiva de rotina são recomendados para aumentar a segurança do paciente.

Adverse respiratory events after general anesthesia in patients at high risk of obstructive sleep apnea syndrome / Eventos respiratórios adversos após anestesia geral em pacientes com alto risco de síndrome da apneia obstrutiva do sono

ABSTRACTINTRODUCTION: Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia.METHODS: This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011. Primary outcome was the development of adverse respiratory events. Demographics data, perioperative variables, and postoperative length of stay in the Post-Anesthesia Care Unit and in hospital were recorded. The Mann-Whitney test, the chi-square test and the Fisher exact test were used for comparisons.RESULTS: Subjects in both pairs of study subjects had a median age of 56 years, including 25% males, and 59% were submitted to intra-abdominal surgery. High risk of obstructive sleep apnea patients had a higher median body mass index (31 versus 24 kg/m2, p < 0.001) and had more frequently co-morbidities, including hypertension (58% versus 24%, p < 0.001), dyslipidemia (46% versus 17%, p < 0.001) and insulin-treated diabetes mellitus (17% versus 2%, p = 0.004). These patients were submitted more frequently to bariatric surgery (20% versus 2%, p = 0.002). Patients with high risk of obstructive sleep apnea had more frequently adverse respiratory events (39% versus 10%, p < 0.001), mild to moderate desaturation (15% versus 0%, p = 0.001) and inability to breathe deeply (34% versus 9%, p = 0.001).CONCLUSION: After general anesthesia high risk of obstructive sleep apnea patients had an increased incidence of postoperative respiratory complications.

RESUMOJUSTIFICATIVA E OBJETIVO: Os pacientes com escore STOP-BANG > 3 possuem alto risco de desenvolver apneia obstrutiva do sono. O objetivo deste estudo foi avaliar as complicações respiratórias no pós-operatório imediato em adultos com escore STOP-BANG > 3 após anestesia geral.MÉTODOS: Estudo prospectivo de dupla-coorte, comparando 59 pares de pacientes adultos com escore STOP-BANG > 3 (alto risco de apneia obstrutiva do sono) e pacientes com escore STOP-BANG < 3 (baixo risco de apneia obstrutiva do sono), similares no que diz respeito ao gênero, idade e tipo de cirurgia, admitidos após a cirurgia eletiva em sala de recuperação pós-anestésica (SRPA) em maio de 2011. O desfecho primário foi o desenvolvimento de eventos respiratórios adversos. Dados demográficos, variáveis no perioperatório e tempos de permanência na SRPA e no hospital após a cirurgia foram registrados. Os testes de Mann-Whitney, qui-quadrado e exato de Fisher foram usados para comparação.RESULTADOS: Os indivíduos de ambos os grupos de pacientes do estudo tinham uma média de idade de 56 anos, 25% eram do sexo masculino e 59% foram submetidos à cirurgia intra-abdominal. Os pacientes com alto risco de apneia obstrutiva do sono apresentavam uma mediana maior do índice de massa corporal (31 versus 24 kg/m2, p < 0,001) e comorbidades mais frequentes, como hipertensão (58% vs. 24%, p < 0,001), dislipidemia (46% vs. 17%, p < 0,001) e diabetes melito dependente de insulina (17% vs. 2%, p = 0,004). Esses pacientes foram submetidos com mais frequência à cirurgia bariátrica (20% vs. 2%, p = 0,002). Os pacientes com alto risco de apneia obstrutiva do sono apresentaram mais eventos respiratórios adversos (39% vs. 10%, p < 0,001), dessaturação de leve a moderada (15% vs. 0%, p = 0,001) e incapacidade de respirar profundamente (34% vs. 9%, p = 0,001).CONCLUSÕES: Após a anestesia geral, os pacientes com alto risco de apneia obstrutiva do sono apresentaram um aumento da incidência de complicações respiratórias no período pós-operatório.

Association between Intraoperative and Post- Anesthetic Care Unit Respiratory Events among 12,641 Children in Southern Thailand.

Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care unit respiratory events (PARE) in children as well as the risk factors for PARE have not been described. The objectives of this study were to describe the association between IRE and PARE and to identify the risk factors of PARE in children at a tertiary care hospital in southern Thailand. Methodology: A historical cohort study based on the surveillance anesthetic database and chart review of children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 was conducted. Demographic, surgery and anesthesia-related data were collected. The association between IRE and PARE and other potential risk factors were analyzed using cross tabulation. Multivariate logistic regression was employed to identify independent predictors for PARE, indicated by adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Overall, perioperative respiratory event (PRE) occurred in 531 out of 14153 children (315 IRE, 348 PARE). The association between PARE and IRE was strong, with adjusted odds ratios ranging from 3.1 (laryngospasm) to 18.5 (desaturation). Anesthesia-related risk factors for PARE were ASA classification 3 (aOR=3.1, 95%CI=1.9-5.0), jet ventilation (aOR=3.4, 95%CI=1.6-7.1), intubation with succinylcholine vs non-depolarizing muscle relaxant (aOR=1.9, 95%CI=1.4-2.5), use of intraoperative morphine vs fentanyl (aOR=2.4, 95%CI=1.7-3.3) and duration of anesthesia ≥ 3 hours (aOR=3.2, 95%CI=2.1-4.9). Conclusion: The magnitude of association between IRE and PARE was high. Increased vigilance and close monitoring by anesthesia personnel in high risk children and high risk surgery may prevent IRE and therefore also PARE, so that overall PRE can be reduced. Preventable risk factors for PARE such as using succinylcholine and morphine can be managed under discretion of the anesthesiologist.

Análisis multicanal de un sensor no obstructivo para la detección del Síndrome de Apnea-Hipopnea del Sueño / Multichannel Analysis of an Unobtrusive Sensor for Sleep Apnea-Hypopnea Detection

Este artículo presenta un método no obstructivo para la detección del síndrome de apnea-hipopnea del sueño (SAHS). El flujo respiratorio es medido indirectamente a través de un colchón sensorizado (PBS Pressure Bed Sensor) que incluye 8 transductores de presión. Mediante la transformada de Hilbert se obtiene la amplitud instantánea de las señales respiratorias y se reduce la información a través del análisis de componentes principales (ACP). Los eventos respiratorios (ERs apneas/hipopneas) se localizan como una reducción en la amplitud instantánea resultante y se contabilizan en el índice de eventos respiratorios (IER), un índice de severidad similar al oficial apnea-hypopnea index (AHI). El PBS se analiza agrupando primero la información de pares de canales y después utilizando los 8 canales. Los IER se evalúan comparándolos con el AHI en diferentes niveles de severidad. En el diagnóstico de pacientes sanos y patológicos se obtuvo una sensibilidad, especificidad y exactitud de 92%, 100% y 96% respectivamente, utilizando la información de dos u ocho canales. Con estos resultados podemos proponer el uso del PBS como una alternativa para el diagnóstico del SAHS en ambientes fuera del hospital, ya que no requiere la presencia de un clínico especialista para su uso.

This manuscript presents an unobtrusive method for sleep apneahypopnea syndrome (SAHS) detection. The airflow is indirectly measured through a sensitive mattress (Pressure Bed sensor, PBS) that incorporates multiple pressure sensors into a bed mattress. The instantaneous amplitude of each sensor signal is calculated through Hilbert transform, and then, the information is reduced via principal component analysis. The respiratory events (ERs -apneas/hypopneas) are detected as a reduction in the resulting instantaneous amplitude and accounted in the respiratory event index (IER), which is a severity indicator similar to the offcial apnea-hypopnea index (AHI). The respiratory signals extracted from PBS are analyzed first by clustering the information coming from channel pairs, and then using the eight channels. The IER performance is compared with the AHI for different severity categories. For the diagnosis of healthy and pathological patients we obtain a sensitivity, specificity and accuracy of 92%, 100% and 96%, respectively using two or eight PBS channels. These results suggest the possibility to propose PBS as an alternative tool for SAHS diagnosis in home environment.