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Affiliation(s)
- Margaret M Chapman
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
| | - Victorine V Muse
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
| | - James E Mojica
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
| | - Melis N Anahtar
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
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Timm FP, Zaremba S, Grabitz SD, Farhan HN, Zaremba S, Siliski E, Shin CH, Muse S, Friedrich S, Mojica JE, Kurth T, Ramachandran SK, Eikermann M. Effects of Opioids Given to Facilitate Mechanical Ventilation on Sleep Apnea After Extubation in the Intensive Care Unit. Sleep 2019; 41:4647355. [PMID: 29182729 DOI: 10.1093/sleep/zsx191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives Following extubation in the intensive care unit (ICU), upper airway (UA) edema and respiratory depressants may promote UA dysfunction. We tested the hypothesis that opioids increase the risk of sleep apnea early after extubation. Methods Fifty-six ICU patients underwent polysomnography the night after extubation. Airflow limitation during wakefulness was identified using bedside spirometry. Correlation and ordinal regression analyses were used to quantify the effects of preextubation opioid dose on postextubation apnea-hypopnea index (AHI) and severity of sleep apnea and whether or not inspiratory airway obstruction (ratio of maximum expiratory and inspiratory airflows at 50% of vital capacity [MEF50/MIF50] ≥ 1) during wakefulness predicts airway obstruction during sleep. Data were adjusted for age, gender, body mass index, as well as a generalized propensity score balanced for APACHE II, score for preoperative prediction of obstructive sleep apnea, duration of mechanical ventilation, chronic obstructive pulmonary disease, and a procedural severity score for morbidity. Results Sleep apnea (AHI ≥ 5) was present in 40 (71%) of the 56 patients. Morphine equivalent dose given 24 hours prior extubation predicted obstructive respiratory events during sleep (r = 0.35, p = .01) and sleep apnea (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.02-1.34). Signs of inspiratory UA obstruction (MEF50/MIF50 ≥ 1) assessed by bedside spirometry were strongly associated with sleep apnea (OR 5.93; 95% CI 1.16-30.33). Conclusions High opioid dose given 24 hours prior to extubation increases the likelihood of postextubation sleep apnea in the ICU, particularly in patients with anatomical vulnerability following extubation.
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Affiliation(s)
- Fanny P Timm
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Sebastian Zaremba
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Neurology, Sleep Medicine, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Hassan N Farhan
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Stefanie Zaremba
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Elizabeth Siliski
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Christina H Shin
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Sandra Muse
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Sabine Friedrich
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - James E Mojica
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Tobias Kurth
- Harvard Medical School, Boston, MA.,Institute of Public Health, Charite Universitaetsmedizin, Berlin, Germany
| | - Satya-Krishna Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Matthias Eikermann
- Harvard Medical School, Boston, MA.,Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Anesthesia and Critical Care, University Hospital Essen, Essen, Germany
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Affiliation(s)
- James E Mojica
- From the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Harvard Medical School - both in Boston
| | - Christopher J Richards
- From the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Harvard Medical School - both in Boston
| | - Jad S Husseini
- From the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Harvard Medical School - both in Boston
| | - Lida P Hariri
- From the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Harvard Medical School - both in Boston
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Abstract
Depending on the subpopulation, obstructive sleep apnea (OSA) can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery.
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Affiliation(s)
- Sebastian Zaremba
- Department of Anaesthesia Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA; Department of Neurology, Rheinische-Friedrich-Wilhelms-University, Bonn, D-53127, Germany; German Center for Neurodegenerative Diseases, Bonn, D-53127, Germany
| | - James E Mojica
- Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA
| | - Matthias Eikermann
- Department of Anaesthesia Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA; Department of Anaesthesia and Critical Care, University Hospital Essen, Essen, 45147, Germany
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