Adenotonsillectomy and asthma in children

Some research studies have demonstrated an association between obstructive sleep apnea (OSA) and asthma. It's not clear why they are linked - it could be that both involve inflammation. OSA is also associated with obesity, which is linked to asthma. The most common treatment for OSA in children is the surgical removal of adenoids and tonsils, referred to as an adenotonsillectomy (AT). This study looked at historical medical and pharmacy records of children with asthma who did and did not have AT. The data in this study was from quite a large database, and the children who had AT were matched with those without AT.

The results showed that asthma flare-ups were worse in children the year prior to AT. However, after AT, asthma flare-ups declined significantly, to levels similar to the kids with asthma who did not receive AT. A similar decrease was seen in asthma medication refills in those children who underwent AT.

The study authors conclude that the presence of OSA can worsen asthma control in children, and that treatment of the OSA with AT may reduce asthma flare-ups. The authors appropriately caution that prospective studies will be needed to establish a causal relationship.

Sleep apnea and sex

Studies have shown that obstructive sleep apnea (OSA) increases risk of erectile dysfunction (ED), and treating OSA with CPAP can improve ED. And some of my patients with untreated OSA are just too tired to engage in sex. Finally, some of my patients are hesitant to start CPAP therapy because they worry it will interfere with their sex life. This is usually in my younger patients and some of it is a misunderstanding about when CPAP is worn. Some think it's supposed to be worn whenever they are in their bed, as opposed to just sleeping.

This article discusses research presented at a recent meeting. Researchers asked participants about their sexual quality of life. The participants all has OSA and were prescribed CPAP therapy. The researchers divided the participants into two groups - those that used the CPAP regularly and those that did not. Results showed no difference in sexual quality of life between the two groups. The conclusion was that CPAP did not interfere with the participants sexual satisfaction.

Postoperative outcomes in obstructive sleep apnea

Patients with undiagnosed obstructive sleep apnea (OSA) are thought to be at higher risk after an operation than those who have already been diagnosed and are being treated with CPAP therapy. Current practice guidelines recommend screening for obstructive sleep apnea before an operation, and starting CPAP therapy prior to surgery if feasible. Routine monitoring of patients with OSA is recommended after many types of surgery.

This study looked at historical outcomes after surgery that occurred before the implementation of the current practice guidelines. The study included data on adults and compared them to controls at low risk of having sleep apnea. The control patients were matched for the type of surgery, indication for the surgery, and date of the surgery.

The results showed that the risk of cardiovascular complications, primarily cardiac arrest and shock, was increased in undiagnosed obstructive sleep apnea but not diagnosed obstructive sleep apnea. However the risk of respiratory complications, primarily Acute Respiratory Distress Syndrome (ARDS) and acute respiratory failure was increased in both groups without significant difference in risk between them. Also, the results showed that increasing severity of obstructive sleep apnea, age, comorbid disease, and the type of surgery were also important risk predictors for postoperative complications.

The study was not designed to determine whether reduction in cardiovascular complications in those patients diagnosed with OSA was due to CPAP use as usage of CPAP was not measured immediately after surgery.

Energy drinks and athletes

Energy drinks like Red Bull and Monster are all the rage right now. Apparently, athletes are using them to enhance performance. This study assessed responses to energy drinks compared to placebo in athletes. The results showed athletes increased their "sporting performance by between 3% and 7%." Athletes were also able to up their performance at high intensities. The results also showed that "Energy drinks increase jump height for basketball players, muscle force and power for climbers and trained individuals, swimming speed for sprinter swimmers, hit force and accuracy for volleyball players, and the number of points scored in tennis.”

However, the energy drinks increased the frequency of insomnia, nervousness, and the level of stimulation in the hours following the competition. The researchers attributed all of the positive and negative effects to the caffeine in these energy drinks. The other ingredients did not seem to produce any benefit above the caffeine.