Sueño, melatonina, UCI / ICU, sleep, and melatonine

Mayo 21, 2018. No. 3087

Calidad del sueño y alteraciones del ritmo circadiano en UCI. Una revisión Sleep quality and circadian rhythm disruption in the intensive care unit: a review. Boyko Y1, Jennum P2, Toft P1. Author information Nat Sci Sleep. 2017 Nov 10;9:277-284. doi: 10.2147/NSS.S151525. eCollection 2017. Abstract Sleep and circadian rhythm are reported to be severely abnormal in critically ill patients. Disturbed sleep can lead to the development of delirium and, as a result, can be associated with prolonged stay in the intensive care unit (ICU) and increased mortality. The standard criterion method of sleep assessment, polysomnography (PSG), is complicated in critically ill patients due to the practical challenges and interpretation difficulties. Several PSG sleep studies in the ICU reported the absence of normal sleep characteristics in many critically ill patients, making the standard method of sleep scoring insufficient in this patient group. Watson et al proposed a modified classification for sleep scoring in critically ill patients. This classification has not yet been validated. Sleep disturbance in the ICU is a multifactorial problem. The ICU environment, mechanical ventilation, medication, as well as the critical illness itself have been reported as important sleep disturbing factors. Secretion of sleep hormone, melatonin, expressing circadian rhythmicity was found abolished or phase delayed in critically ill patients. Various interventions have been tested in several studies aiming to improve sleep quality and circadian rhythm in the ICU. The results of these studies were inconclusive due to using the sleep assessment methods other than PSG or the absence of a reliable sleep scoring tool for the analysis of the PSG findings in this patient population. Development of a valid sleep scoring classification is essential for further sleep research in critically ill patients. KEYWORDS: critically ill patients; environmental factors; mechanical ventilation; melatonin; polysomnography; sedation; sleep patterns PDF Patrón de secreción de melatonina en paciente graves. Estudio piloto descriptivo Melatonin Secretion Pattern in Critically Ill Patients: A Pilot Descriptive Study. Boyko Y1, Holst R2, Jennum P3, Oerding H4,5, Nikolic M6, Toft P1. Author information Crit Care Res Pract. 2017;2017:7010854. doi: 10.1155/2017/7010854. Epub 2017 May 11. Abstract Critically ill patients have abnormal circadian and sleep homeostasis. This may be associated with higher morbidity and mortality. The aims of this pilot study were (1) to describe melatonin secretion in conscious critically ill mechanically ventilated patients and (2) to describe whether melatonin secretion and sleep patterns differed in these patients with and without remifentanil infusion. Eight patients were included. Blood-melatonin was taken every 4th hour, and polysomnography was carried out continually during a 48-hour period. American Academy of Sleep Medicine criteria were used for sleep scoring if sleep patterns were identified; otherwise, Watson's classification was applied. As remifentanil was periodically administered during the study, its effect on melatonin and sleep was assessed. Melatonin secretion in these patients followed a phase-delayed diurnal curve. We did not observe any effect of remifentanil on melatonin secretion. We found that the risk of atypical sleep compared to normal sleep was significantly lower (p < 0.001) under remifentanil infusion. Rapid Eye Movement (REM) sleep was only observed during the nonsedation period. We found preserved diurnal pattern of melatonin secretion in these patients. Remifentanil did not affect melatonin secretion but was associated with lower risk of atypical sleep pattern. REM sleep was only registered during the period of nonsedation. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Congreso Nacional de Residentes de Anestesiología 7 al 9 de junio, 2018. Lima, Perú  Informes / Information  X Foro Internacional de Medicina del Dolor y Paliativa Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information V Congreso Internacional de Vía Aérea, EVALa, México Junio 7-9, 2018. Guadalajara. México Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Libro de Apnea del sueño / Book on Sleep apnea

Abril 12, 2017. No. 2657

Apnea del sueño. Avances recientes Sleep Apnea - Recent Updates Edited by Mayank G. Vats, ISBN 978-953-51-3056-7, Print ISBN 978-953-51-3055-0, 114 pages, Publisher: InTech, Chapters published April 05, 2017 under CC BY 3.0 license Edited Volume Sleep medicine is developing rapidly with more than 100 sleep disorders discovered till now. Despite that, sleep specialty is in neonatal stage especially in developing and underdeveloped countries. Sleep medicine is still evolving with ongoing worldwide clinical research, training programs, and changes in the insurance policy disseminating more awareness in physicians and patients. Sleep apnea is one of the most common sleep disorders, found in around 5-7 % of the general population with high prevalence in the obese, elderly individuals but largely unrecognized and hence undiagnosed with untreated and life-threatening consequences. In the last decade, new complex sleep disorders and their pathophysiology have been discovered, new treatment options (pharmacological and nonpharmacological) are available, and hence we planned a book on the recent developments on the most common sleep disorder, sleep apnea. We have incorporated chapters from the eminent clinicians and authors around the globe to produce a state-of-the-art book with the target audience from internal medicine, pulmonary, sleep medicine, neurology, ENT, and psychiatry discipline. Libro / Book Vacante para Anestesiología Pediátrica El Hospital de Especialidades Pediátricas de León, Guanajuato México  ofrece un contrato laboral en el departamento de anestesiología  Informes con la Dra Angélica García Álvarez  angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Apnea del sueño y anestesia / Sleep apnea and anaesthesia

Abril 13, 2017. No. 2658

Examen preoperatorio de la apnea obstructiva del sueño. Pre-operative screening for obstructive sleep apnoea. Verbraecken J1, Hedner J2, Penzel T3. Eur Respir Rev. 2017 Jan 3;26(143). pii: 160012. doi: 10.1183/16000617.0012-2016. Print 2017 Jan. Abstract Sleep disordered breathing, especially obstructive sleep apnoea (OSA), has a high and increasing prevalence. Depending on the apnoea and hypopnoea scoring criteria used, and depending on the sex and age of the subjects investigated, prevalence varies between 3% and 49% of the general population. These varying prevalences need to be reflected when considering screening for OSA. OSA is a cardiovascular risk factor and patients are at risk when undergoing medical interventions such as surgery. Screening for OSA before anaesthesia and surgical interventions is increasingly considered. Therefore, methods for screening and the rationale for screening for OSA are reviewed in this study. PDF Manejo anestésico de los adultos con apnea del sueño. Anaesthetic management of sleep-disordered breathing in adults. Hillman DR1,2, Chung F3. Respirology. 2017 Feb;22(2):230-239. doi: 10.1111/resp.12967. Epub 2016 Dec 17. Abstract Anaesthesia and sleep are different states of unconsciousness with considerable physiological common ground. Because of their shared depressant effects on muscle activation and ventilatory drive, patients with anatomically compromised airways will tend to obstruct in either state and those with impaired ventilatory capacity will tend to hypoventilate. Breathing behaviour in one state is predictive of that in the other. An essential difference is that while arousal responses are preserved during sleep, they are depressed during sedation and abolished by anaesthesia. This renders patients with sleep-related breathing disorders vulnerable to hypoventilation and asphyxia when deeply sedated. Addressing this vulnerability requires a systematic approach to identification of patients and circumstances that magnify this risk, and methods of managing it that seek to reconcile the need for safety with cost-effective use of resources. KEYWORDS: anaesthesia; obstructive sleep apnoea; perioperative management; sleep; sleep-disordered breathing PDF Una actualización de las diversas aplicaciones prácticas del cuestionario STOP-Bang en anestesia, cirugía y medicina perioperatoria. An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine. Nagappa M1, Wong J, Singh M, Wong DT, Chung F. Curr Opin Anaesthesiol. 2017 Feb;30(1):118-125. doi: 10.1097/ACO.0000000000000426. Abstract PURPOSE OF REVIEW: The present review aims to provide an update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine. RECENT FINDINGS: The STOP-Bang questionnaire was originally validated as a screening tool to identify surgical patients who are at high-risk of obstructive sleep apnea (OSA).  SUMMARY: STOP-Bang at least 3 was recommended previously to identify the suspected or undiagnosed OSA. To reduce the false positive cases and to improve its specificity, a stepwise stratification is recommended to identify the patients at high risk of moderate-to-severe OSA. Because of its practical application, STOP-Bang is a useful screening tool for patients with suspected or undiagnosed OSA. PDF Vacante para Anestesiología Pediátrica El Hospital de Especialidades Pediátricas de León, Guanajuato México  ofrece un contrato laboral en el departamento de anestesiología  Informes con la Dra Angélica García Álvarez  angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org