Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

Lyons, M. Melanie; Bhatt, Nitin; Kneeland-Szanto, Elizabeth; Keenan, Brendan T.; Pechar, J; Stearns, Branden; Elkassabany, Nabil; Memtsoudis, Stavros G.; Pack, Allan I.; Gurubhagavatula, Indira

doi:10.2217/bmm.16.1

Cited by 9 publications

(5 citation statements)

References 163 publications

(311 reference statements)

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“…The identification of biomarkers associated with perioperative complications in OSA patients could aid in risk stratification and individualized treatment decisions. Additionally, the development of predictive models incorporating patient-specific factors could help estimate the likelihood of adverse events and guide perioperative management choices [33] .…”

Section:  Biomarkers and Predictive Modelsmentioning

confidence: 99%

Sleep-Related Breathing Disorder and its Relation to Anesthetic Practice

Ibrahim,

Abelgheit,

Hassan

2023

Benha Journal of Applied Sciences

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Background: Sleep-related breathing disorders, particularly obstructive sleep apnea (OSA), pose significant challenges in anesthesia practice. Understanding the relationship between OSA and anesthesia is crucial for ensuring safe perioperative management. Objectives: review the latest updates about obstructive sleep apnea, and how it affects the field of anesthesia as a crucial coexisting disease. furthermore, how to establish peri-operative strategies to manage OSA cases. Conclusions: Effective perioperative management of OSA patients requires a multidisciplinary approach, including collaboration between anesthesia providers, sleep specialists, and other healthcare professionals. Preoperative screening and evaluation, careful selection of anesthetic techniques and agents, and the implementation of non-pharmacological interventions such as continuous positive airway pressure (CPAP) therapy are essential. Future research should focus on precision medicine approaches, biomarkers, predictive models, novel monitoring technologies, and standardized protocols to further optimize perioperative care for OSA patients. By addressing these challenges and advancing knowledge, anesthesia practice can enhance the safety and outcomes of OSA patients undergoing surgery.

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Section:  Biomarkers and Predictive Modelsmentioning

confidence: 99%

Sleep-Related Breathing Disorder and its Relation to Anesthetic Practice

Ibrahim,

Abelgheit,

Hassan

2023

Benha Journal of Applied Sciences

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Section: Postoperative Managementmentioning

confidence: 99%

“…95 As such, the identification of accurate metrics of risk with stronger predictive value than the AHI (eg, Spo 2 or blood CO 2 levels, high-resolution pulse oximetry, cardiac biomarkers, indicators of arousal thresholds) is long needed to facilitate increased patient safety in OSA. 17,[97][98][99][100] Moreover, new methods and technologies should be investigated because early patterns of clinical instability and evolving death may be too complex for early detection by any unifying numeric threshold. 17 In conclusion, the diversity and vulnerability of OSA demand a systematic clinical approach for the implementation of aligned and effective measures that provide increased perioperative safety for this This manuscript was handled by: Toby N. Weingarten, MD.…”

Section: Challenges and Future Researchmentioning

confidence: 99%

Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review

Cozowicz

Memtsoudis

2021

Anesthesia &Amp; Analgesia

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The prevalence of obstructive sleep apnea (OSA) has reached 1 billion people worldwide, implying significant risk for the perioperative setting as patients are vulnerable to cardiopulmonary complications, critical care requirement, and unexpected death. This review summarizes main aspects and considerations for the perioperative management of OSA, a condition of public health concern. Critical determinants of perioperative risk include OSA-related changes in upper airway anatomy with augmented collapsibility, diminished capability of upper airway dilator muscles to respond to airway obstruction, disparities in hypoxemia and hypercarbia arousal thresholds, and instability of ventilatory control. Preoperative OSA screening to identify patients at increased risk has therefore been implemented in many institutions. Experts recommend that in the absence of severe symptoms or additional compounding health risks, patients may nevertheless proceed to surgery, while heightened awareness and the adjustment of postoperative care is required. Perioperative caregivers should anticipate difficult airway management in OSA and be prepared for airway complications. Anesthetic and sedative drug agents worsen upper airway collapsibility and depress central respiratory activity, while the risk for postoperative respiratory compromise is further increased with the utilization of neuromuscular blockade. Consistently, opioid analgesia has proven to be complex in OSA, as patients are particularly prone to opioid-induced respiratory depression. Moreover, basic features of OSA, including intermittent hypoxemia and repetitive sleep fragmentation, gradually precipitate a higher sensitivity to opioid analgesic potency along with an increased perception of pain. Hence, regional anesthesia by blockade of neural pathways directly at the site of surgical trauma as well as multimodal analgesia by facilitating additive and synergistic analgesic effects are both strongly supported in the literature as interventions that may reduce perioperative complication risk. Health care institutions are increasingly allocating resources, including those of postoperative enhanced monitoring, in an effort to increase patient safety. The implementation of evidence-based perioperative management strategies is however burdened by the rising prevalence of OSA, the large heterogeneity in disease severity, and the lack of evidence on the efficacy of costly perioperative measures. Screening and monitoring algorithms, as well as reliable risk predictors, are urgently needed to identify OSA patients that are truly in need of extended postoperative surveillance and care. The perioperative community is therefore challenged to develop feasible pathways and measures that can confer increased patient safety and prevent complications in patients with OSA.

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“…82,83 In elderly patients without a history of dementia who elect to undergo elective TJA, there is an association between preexisting OSA and postoperative dementia, which can lead to longer lengths of hospital stay and perioperative complications. 84…”

Section: Review Articlementioning

confidence: 99%

Roth’s Spots, a clinical diagnostic clue for Infective Endocarditis

Arora

Dhibar

Bashyal³

et al. 2020

TPJ

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An improved understanding of the implications of race on body satisfaction might optimize the weight loss process and quality of life in women with obesity. The findings of this study increased understanding of body satisfaction in women with obesity and have implications for addressing psychosocial factors within weight loss treatments across racial and at-risk groups. 24 Physicians' Views on a Wellbeing Course Gifted to Them: A Qualitative Study. Patricia Lynn Dobkin; Camila Velez Given concerns about staff burnout and distress, the Chief of the Department of Medicine sponsored the Physician Wellbeing program making it cost-free for doctors at a large academic medical setting. Ninety doctors registered within the one-year pilot project time frame. Following a Mind-Body Medicine online and Mindful Medical Practice workshop a qualitative study was conducted to identify physicians' views about the initiative.Physicians who agreed to take part following the workshops were the participants in the study. Physicians supported the integration of wellness programs into medical settings where stress is an inherent aspect of the work environment. They were grateful for the "gift" of being valued and supported by the administration.

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Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

Cited by 9 publications

References 163 publications

Sleep-Related Breathing Disorder and its Relation to Anesthetic Practice

Sleep-Related Breathing Disorder and its Relation to Anesthetic Practice

Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review

Roth’s Spots, a clinical diagnostic clue for Infective Endocarditis

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