Obstructive sleep apnoea represents a sizable public health and economic burden. Owing to rising obesity rates, the prevalence of obstructive sleep apnoea is increasing, and it is a condition that is significantly underdiagnosed. Exacerbated by the COVID-19 pandemic, the backlog of elective surgeries is also sizable and growing. A combination of these factors means that many patients due to have surgery will have obstructive sleep apnoea, either diagnosed or otherwise. Patients with obstructive sleep apnoea have a significantly increased risk of operative complications, but the evidence base for optimum perioperative management of these patients is limited. This article reviews sleep apnoea, its prevalence and its impact on operative management and perioperative outcomes for patients. The evidence base for screening and treating undiagnosed obstructive sleep apnoea is also comprehensively assessed. Finally, a pathway to manage patients with possible undiagnosed obstructive sleep apnoea is proposed, and areas for further research identified.
We describe a family in which four subjects in two generations have a disorder of phenylalanine metabolism. Two first cousins had different biochemical presentations in the neonatal period. The older child was thought to have a more severe fonn of phenylketonuria (PKU), and the younger child a milder form. While carrying out family studies we discovered that their mutual grandfather and his older unmarried brother, both of normal intelligence, had a marked and previously undiagnosed hyperphenylalaninaemia.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and is significantly underdiagnosed in the community. Respiratory impairment is a key risk factor for perioperative morbidity and mortality.The National Institute for Health and Care Excellence (NICE) does not recommend routine spirometry before major surgery. However, in this article, we present the potential benefits of targeted spirometry in high-risk patient groups.Of 183 patients who underwent targeted preoperative spirometry, 25/70 (35.7%) of those with airflow obstruction had no previously known respiratory diagnosis. Of patients with known COPD, 20/46 (43.5%) were not prescribed optimum inhaled therapies for their degree of lung function deficit.Knowledge of lung function in respiratory disease helps to optimise patients perioperatively and facilitate shared decision making regarding the benefits and risk of surgeries. We propose that targeted spirometry should be used as part of the perioperative multidisciplinary team assessment of selected patients.
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