Differences between Midazolam and Propofol Sedation on Upper Airway Collapsibility Using Dynamic Negative Airway Pressure

Norton, J. Russell; Ward, Denham S.; Karan, Suzanne; Voter, William A.; Palmer, Linda; Varlese, Anna; Rackovsky, Ori; Bailey, Peter L.

doi:10.1097/00000542-200606000-00009

Cited by 57 publications

(38 citation statements)

References 20 publications

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“…The tranquilizing effects of sleep medications and benzodiazepines may have direct effects on breathing during sleep which results in airway obstruction. [89][90][91][92][93] Atypical antipsychotics, a group of medications that are generally associated with fewer extrapyramidal side effects, have been associated with an increased AHI in a crosssection of psychiatric patients, even when compared to patients with similar BMI and neck circumference taking benzodiazepines, opioids, and sleeping agents. 86 This result points to an obesity independent effect of antipsychotics on OSA, possibly due to their extrapyramidal side effects.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Gupta

Simpson

2015

Journal of Clinical Sleep Medicine

249

156

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Study Objectives: Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations. Methods: A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups. Results: The search retrieved 48 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insuffi cient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD. Conclusions: OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes. 1 According to a major US study of OSA diagnosed by polysomnography (PSG), the prevalence of OSA, as defi ned by an apnea-hypopnea index (AHI) ≥ 5 and without inclusion of a daytime sleepiness criterion, was reported as 24% for men and 9% for women under the age of 65 years; addition of a daytime sleepiness criterion reduced these estimates to 4% for men and 2% for women. 1,2 OSA is commonly associated with metabolic syndrome including comorbid obesity, hypertension, and diabetes.1 Upper airway obstruction may present as apneas, hypopneas, or respiratory effort-related arousals (RERAs), resulting in oxygen desaturation, repeated arousals and sleep fragmentation. Recently, there has been an increase in reports of comorbidity of OSA with psychological/psychiatric symptoms. Psychiatric comorbidity in OSA has been reported to adversely affect the quality of life of OSA patients and adherence to CPAP therapy. 3-5Psychological symptoms such as depression and anxiety are commonly reported in adults with OSA; however, the relationship between OSA and full psychiatric syndromes is less clear. Global prevalence studies and reviews have suggested that there are elevated rates of psychological symptoms in individuals with OSA. [17][18][19] Studies that have evaluated the prevalence of OSA in the highly selected groups of psychiatric popu...

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Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Gupta

Simpson

2015

Journal of Clinical Sleep Medicine

249

156

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“…At higher doses, the BZDs affect ventilation in two different ways. They decrease the muscular tone in upper airways, which increases the risk of airway obstruction (Norton et al, 2006). BZDs are therefore not recommended and are considered contraindicated in patients suffering from obstructive sleep apnea.…”

Section: Gabaergic Inhibition In Anesthesiologymentioning

confidence: 99%

Enhancement of GABAergic Activity: Neuropharmacological Effects of Benzodiazepines and Therapeutic Use in Anesthesiology

et al. 2011

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“…During wakefulness, patients with OSA compensate for diminished airway anatomical features by increasing the cranio-cervical angulation that lifts the hyo-mandibular complex (tongue, soft tissues and mandible) away from the spine, thereby increasing the airway space [11]. This useful compensation is lost during anesthesia since most anesthetics diminish critical UA muscular tone, thereby promoting airway collapse [12][13][14][15][16].…”

Section: Difficult Airwaymentioning

confidence: 99%

Morbid Obesity and Obstructive Sleep Apnea: The Challenging Link

Ebert¹

2011

TOATJ

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Abstract:Obstructive sleep apnea (OSA) is a common medical condition that is increasing in prevalence and is associated with substantial morbidity and a 40% eight-year mortality rate if left untreated. Morbidly obese patients have a greater incidence of co-morbid disease, including OSA. OSA is characterized by repeated upper airway obstruction and arousal during sleep, sympathetic activation, hypertension and daytime somnolence. In morbidly obese OSA patients undergoing surgical procedures, the perioperative period is more challenging than in non obese OSA patients. Their airway anatomy is often abnormal with excess pharyngeal tissue and tongue size making it difficult to ventilate thru a facemask and to establish tracheal intubation. Several suggestions for optimizing the anesthetic induction, emergence, and early recovery periods in these patients are offered. Most important are positioning of the patient (both during and post surgery), pre-oxygenation prior to intubation, proper dosing of anesthetic maintenance drugs to ideal body weight, alveolar recruitment maneuvers, full reversal of paralysis at the end of surgery, and careful drug titration in recovery to improve pulmonary mechanics. With proper preparation and precautions it is possible to avoid the significant high frequency of respiratory and cardiac complications observed in these patients and to avoid or better manage length of hospital stay, unplanned ICU admission and/or reintubation.

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Differences between Midazolam and Propofol Sedation on Upper Airway Collapsibility Using Dynamic Negative Airway Pressure

Cited by 57 publications

References 20 publications

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Enhancement of GABAergic Activity: Neuropharmacological Effects of Benzodiazepines and Therapeutic Use in Anesthesiology

Morbid Obesity and Obstructive Sleep Apnea: The Challenging Link

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