Las relaciones entre la especialización deportiva, el sueño y la calidad de vida en atletas juveniles de voleibol femenino

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

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.

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.

Información / Information

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

Información / 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

Safe Anaesthesia Worldwide

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vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

viernes, 2 de febrero de 2018

Apnea obstructiva del sueño / OSA

Febrero 2, 2018. No. 2982

Apnea obstructiva del sueño y el paciente bariátrico

OSA and the bariatric patient.

De Silva S1.

Abstract

J Perioper Pract. 2017 Jul;27(7-8):167-168.

Mrs NH is a 49-year-old lady who presented for assessment prior to weight reduction surgery.

KEYWORDS: Bariatric surgery; OSA; Obstructive sleep apnoea; Pre-assessment

Identificación de la apnea obstructiva del sueño significativa en el paciente obeso: desarrollo de la nueva puntuación "DX-AOS".

Identification of significant obstructive sleep apnoea in the obese patient: development of the novel DX-OSA score.

Godoroja DD1, Cioc DA2.

Rom J Anaesth Intensive Care. 2016 Oct;23(2):111-121. doi: 10.21454/rjaic.7518/232.dxo.

Abstract

BACKGROUND AND OBJECTIVES: There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in obese surgical patients. We investigated the extent to which anthropometric measurements can be used to identify the presence of significant OSA (Apnoea/Hypopnoea Index (AHI) ≥ 20) in adult patients. MATERIALS AND METHODS: We prospectively studied 1357 adult patients scheduled for elective laparoscopic bariatric surgery. Prior to surgery, body mass index (BMI), gender, neck circumference, STOP-Bang score, SpO2, neck and trunk fat (by dual X-ray absorptiometry) were recorded. All patients with a STOP-Bang score ≥ 5 underwent polysomnography. Auto-titrated Positive Airway Pressure (APAP) therapy was instituted when AHI ≥ 20/h. Predictors of OSA were identified and their cut-off values determined. RESULTS: In total, 1357 patients were screened; 345 patients underwent preoperative polysomnography; 190 had AHI ≥ 20/h and received APAP treatment. The novel Dual X-Ray-Obstructive Sleep Apnoea (DX-OSA) score was derived from the data. The score included 6 items: the STOP-Bang score, BMI, neck fat, trunk fat, baseline SpO2, and Expiratory Reserve Volume (ERV), and its sensitivity, specificity, positive-predictive values, negative-predictive values, likelihood ratios, and post-test probabilities determined. At a cut-off of 3, the DX-OSA score had the same sensitivity as the STOP-bang score, but better specificity. The lowest likelihood ratio was found for STOP-Bang and the highest for the DX-OSA score (OSA probability > 83%). CONCLUSION: The DX-OSA score may be useful for identifying obese patients with significant OSA who require CPAP (continuous positive airway pressure) treatment, and CPAP could be commenced without the need for polysomnography, therefore, without delaying surgery.

KEYWORDS: continuous positive airway pressure; obesity; obstructive sleep apnoea

La mejoría temprana en la apnea obstructiva del sueño y el aumento en los niveles de orexina después de la cirugía bariátrica en adolescentes y adultos jóvenes.

Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults.

Amin R1, Simakajornboon N2, Szczesniak R3, Inge T4.

Surg Obes Relat Dis. 2017 Jan;13(1):95-100. doi: 10.1016/j.soard.2016.05.023. Epub 2016 May 30.

Abstract

BACKGROUND: Obstructive sleep apnea (OSA) associated with obesity is known to improve after bariatric surgery, but little is known about early changes in this condition after surgery. OBJECTIVES: To study the clinical course of OSA after bariatric surgery SETTING: Children's hospital in the United States METHODS: Adolescents and young adults with obstructive sleep apnea undergoing vertical sleeve gastrectomy (n = 6) or gastric bypass (n = 1) were enrolled in this prospective study. Participants underwent formal polysomnography before and at 3 and 5 weeks after bariatric surgery. Anthropometric measurements and assay for orexin and leptin were also performed at study visits. Thirty-one adolescents who underwent 2 polysomnography studies that were 4 weeks apart served as control patients. RESULTS: Baseline mean (range) age of participants was 17.8 (15.4-20.7) years, 71% were male, with body mass index of 55.2 (41.3-61.6) kg/m2 and had a median apnea hypopnea index (AHI) of 15.8 (7.1-23.8) events/hour. Differences in least-square means from longitudinal analysis did not show significant differences in AHI in the control group but showed significant postoperative decline in AHI relative to baseline. AHI declined postoperatively from baseline by 9.2 events/hour (95% confidence interval: 3.8 to 14.5) at 3 weeks (P = .002) and 9.1 events/hour (95% confidence interval: 3.8 to 14.5) at 5 weeks (P = .002); there was no significant change from 3 to 5 weeks in AHI. Leptin decreased and orexin levels increased significantly by 3 weeks postoperatively. CONCLUSIONS: These observations suggest that OSA responds early and out of proportion to weight loss after metabolic and or bariatric surgery, thus weight independent factors may at least in part be responsible for early improvement in OSA postoperatively.

KEYWORDS: Leptin; Orexin; Polysomnography; Sleep apnea; Sleeve gastrectomy

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

World Congress on Regional Anesthesia & Pain Medicine

April 19-21, 2018, New York City, USA