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.

Tongue fat and sleep apnea

Apparently your tongue is fat. I mean that there is a normal amount of fat within your tongue muscle. And if you have obstructive sleep apnea (OSA), you may have too much tongue fat. At least according to this recent study. Researchers used sophisticated MRI scans to compare the overall volume and amount of fat in the tongues of overweight men with and without OSA. The results showed that the more obese the subject, the larger the tongue and the higher amount of fat in the tongue. There was also a significant association between belly fat and tongue fat. Patients with OSA had more tongue fat than in the control patients. They also had higher tongue volumes and a higher percentage of tongue fat. There was also an association between the sleep apnea severity and the tongue volume as well as amount of tongue fat.

The amount of fat was greatest in the back of the tongue rather than the front of the tongue in the patients with OSA. This makes sense anatomically because the back of the tongue is involved in blocking off the upper airway during sleep apnea. Another interesting finding was that the researchers examined the chewing muscle and it did not have a higher percentage of fat. This means that when patient's have extra weight, it's not deposited uniformly in the neck and head, but only in certain areas.

Finally, the researchers suggest that the increased amount of fat in the tongue in those with OSA can inhibit the way the tongue normally moves out of the way to allow air to flow.

Salt water infusion and sleep apnea

Sleep researchers have not worked out exactly how we develop obstructive sleep apnea (OSA). There are several risk factors and anatomical reasons involved. Some researchers have postulated that OSA may be worsened by fluid shifting from the legs to the neck area overnight. In other words, because the legs are generally at the level of the heart while in bed, fluid from the legs moves into the neck area, causing swelling in the upper airway. This narrows the upper airway enough to restrict airflow.

In this article in the Journal Sleep, researchers studied older and younger men to see if giving them IV salt water impacted the level of sleep apnea. The study was limited to men who were not obese and had either no or non-severe OSA. They did sleep studies after giving them the IV salt water. The results showed that the IV salt water worsened OSA significantly in older men, but not younger men. The reason for this was not clear from the study. However, the results have important implications for older men undergoing surgery, since IV fluids are commonly given during and right after surgery.

Hibernation to reduce the cost of manned space flights

Here is a fascinating article about space travel. Apparently, a trip to Mars will take about 6 months. A team at NASA has shown that putting astronauts in a form of hibernation can significantly reduce the cost of a trip, as much less food will need to be brought if the crew is hibernating.

The way it works is that the crew members will be cooled down to 89°F – 93°F by fluid pumped through their noses! The crew will be fed intravenously while they hibernate. The article does not mention how urination is dealt with - catheter maybe? When the crew arrives at Mars, they will be warmed up again and woken up. The article mentions that during hibernation, the crew will be in a "spinning habitat...to offset bone and muscle loss." Sounds like something out of a science fiction movie, only apparently it's very possible to do this now.

Rising prevalence of obstructive sleep apnea

Obstructive sleep apnea (OSA) is becoming more common in the U.S. When I was a sleep disorders fellow, it was thought that OSA occurred in 2% of women and 4% of men. This article highlights how the rates of OSA have increased in the past two decades. Apparently, OSA now is present in at least 25 million adults in the U.S. and in 26% of adults between the ages of 30 and 70 years old.

The article discusses the complications of untreated OSA too. It does not discuss why the prevalence rates have risen. I suspect more public awareness of the symptoms, more acceptable treatment options, rising obesity rates, and aging population contribute to the increase in OSA rates.

Deep sleep circuit in the brain

There are 4 different sleep stages that humans cycle through at night. Deep sleep is one of those stages, and is typically seen in the first half of the night, at least in adults. Sleep researchers do not know exactly how deep sleep is produced, but it's thought to involve the neurotransmitter GABA, which stands for gamma-aminobutyric acid.

Here is a report of a study involving stimulation of a deep part of the brain (the brainstem) that turns on deep sleep. The technique used to stimulate this area of the brain is different than other methods involving electrical stimulation of the cells in the brainstem felt to be responsible for deep sleep. With electrical stimulation, the problem is that the electrode stimulates everything it touches, including surrounding areas it did not come into contact with. As stated in the article, electrically stimulating cells was like using a sledgehammer, when what was needed was a scalpel. In this study, researchers inserted a harmless virus that incorporated itself precisely into the very cells the researchers were trying to study. The cells were then remotely "turned on" and the animals went right into deep sleep.

This is exciting research as it points to the possibility of developing therapies that enhance deep sleep by targeting only certain brain areas. Hopefully this will lead to treatments with more specific modes of action and less side effects.