Pediatric Postoperative Outcomes for Severe and Very Severe Obstructive Sleep Apnea Syndrome.

OBJECTIVE: To determine if increasing obstructive sleep apnea syndrome (OSAS) severity, as determined by preoperative polysomnography data, is an independent risk for respiratory complications and level of follow-up care after adenotonsillectomy or tonsillectomy. METHODS: A retrospective analysis of patients ≤21 years of age with severe OSAS (obstructive apnea-hypopnea index [OAHI] >10) undergoing adenotonsillectomy or tonsillectomy. Patients were categorized based on preoperative polysomnography data (PSG). Outcome measures including respiratory complications were collected via chart review. Logistic regression was used in the analysis of all parameters, and Wilcoxon Rank Sum tests were used for analysis of both OAHI and oxygen saturation nadir as continuous variables. All surgeries were performed at Johns Hopkins Hospital, a tertiary care center. RESULTS: We identified 358 patients with severe OSAS who had adenotonsillectomy or tonsillectomy. OAHI >40 and oxygen saturation nadir <80% were significantly associated with postoperative respiratory complications. Increasing OAHI and O2 saturation <80% was each associated with unplanned continuous positive airway pressure (CPAP) initiations postoperatively. There was no association between hypercarbia and presence of any complications. CONCLUSION: Patients with very severe OSAS (preoperative OAHI ≥40) as determined by preoperative PSG may be at higher risk of developing respiratory complications postoperatively. However, there does not appear to be a linear association with increasing severity of OAHI on regression analysis. Further research is needed to understand factors associated with complications in severe and very severe OAHI. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Translational studies of estradiol and progesterone in fear and PTSD.

Translational models of fear have greatly informed our understanding of PTSD and its underlying fear circuitry. One of the most replicated findings in the field is the two-fold higher PTSD incidence in females compared to males. While sociocultural factors play a role, the most robust biological influencers to date are gonadal hormones, such as estradiol and progesterone, which fluctuate across the menstrual cycle. Among studies that account for these hormones, most do so in isolation or collect both and only report one. Variation in study findings suggests that the ratio between these two hormones (the P/E ratio) may be an important and missing variable to further understand gonadal hormone influences on fear. Here we review cross-species examinations of fear and PTSD, within the contexts of estradiol and progesterone as well as P/E ratios that were calculated based on extant literature. We then provide recommendations for best practices in assay methods and reporting to improve research on the P/E ratio in fear and PTSD. Ultimately, greater understanding of this important variable will advance efforts to characterize gonadal hormone influences on fear learning processes in humans and animals.

Los modelos traslacionales del miedo han enriquecido nuestro conocimiento sobre el TEPT y el circuito del miedo subyacente. Uno de los hallazgos más replicados en el campo es la incidencia dos veces mayor de TEPT en mujeres en comparación a los hombres. Aunque los factores socioculturales juegan un rol, las influencias biológicas más robustas a la fecha son las hormonas gonadales, tales como el estradiol y la progesterona, que fluctúan durante el ciclo menstrual. Entre los estudios que dan cuenta de estas hormonas, la mayoría las estudian de forma aislada u obtienen ambas y solo reportan una. La variación en los hallazgos de los estudios sugiere que la razón entre estas dos hormonas (la razón P/E) puede ser una variable poco estudiada e importante para mejorar la comprensión de la influencia de las hormonas gonadales en el miedo. En este trabajo hacemos una revisión de hallazgos trans-especie sobre el miedo y el TEPT, dentro del contexto del estradiol y la progresterona así como de la razón P/E que fue calculada basándose en la literatura existente Posteriormente proveemos recomendaciones para mejorar las prácticas en los métodos de ensayo y reportes para mejorar la investigación sobre la razón P/E en miedo y TEPT. En última instancia, mayor comprensión de esta importante variable hará que progresen los esfuerzos para caracterizar la influencia de las hormonas gonadales en procesos de aprendizaje del miedo en humanos y animales.