Obstructive sleep apnea and acute respiratory failure: An analysis of mortality risk in patients with pneumonia requiring invasive mechanical ventilation

Jean, Raymonde; Gibson, Charlisa D.; Jean, Raymond; Ochieng, Pius

doi:10.1016/j.jcrc.2015.03.016

Cited by 18 publications

(9 citation statements)

References 35 publications

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“…Jean et al carried out a retrospective study in 74,032 patients with pneumonia and invasive mechanical ventilation, showing that OSA patients had a significantly shorter hospital stay and a reduced risk of mortality. However [ 19 ], the lack of individual data and the potential confounding factors not assessed in these studies limits the interpretation of their results. Furthermore, these retrospective studies only analyze the outcomes in patients with a prior diagnosis of OSA, but unlike our study did not assess which patients with pneumonia may have OSA undiagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…Four recent studies, one involving children <5 years of age [ 16 ] and three national surveys among adults [ 17 – 19 ], have suggested that OSA could increase the incidence of pneumonia. To address this question, we designed a case-control study to compare the prevalence of OSA among patients with community-acquired pneumonia (CAP) with respect to patients with other non-respiratory infections.…”

Section: Introductionmentioning

confidence: 99%

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Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

et al. 2016

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BackgroundWe hypothesized that obstructive sleep apnea (OSA) can predispose individuals to lower airway infections and community-acquired pneumonia (CAP) due to upper airway microaspiration. This study evaluated the association between OSA and CAP.MethodsWe performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group). The controls were matched according to age, sex and body mass index (BMI). A respiratory polygraph (RP) was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI). The associations between CAP and the Epworth Sleepiness Scale (ESS), OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests.FindingsNo significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI) ≥10, showed an increased risk of CAP (OR = 2·86, 95%CI 1·29–6·44, p = 0·01). Patients with severe OSA (AHI≥30) also had a higher risk of CAP (OR = 3·18, 95%CI 1·11–11·56, p = 0·047). In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0·007). Furthermore, OSA was significantly associated with CAP severity (p = 0·0002), and OSA severity was also associated with CAP severity (p = 0·0006).ConclusionsOSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk should be explored to investigate the relationships among gastroesophageal reflux, silent aspiration, laryngeal sensory dysfunction and CAP.Trial RegistrationClinicalTrials.gov NCT01071421

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

et al. 2016

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“…However, artificial airway was always associated with longer ICU and hospital stays, including a higher incidence of ventilator-associated pneumonia and hospital expenditure. [ 39 ] Therefore, effective treatment strategies were needed. NIV was validated as an intervention in the treatment of acute exacerbations of COPD, cardiogenic pulmonary edema, and hypoxemic respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of noninvasive ventilation in patients after cardiothoracic surgery

Zhu

Huang²,

Dong³

et al. 2016

Medicine

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Background:Noninvasive ventilation (NIV) is a promising therapeutic strategy after cardiothoracic surgery. This study aimed to meta-analyze the efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery.Methods:PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing NIV with conventional management after cardiothoracic surgery. Relative risk (RR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used to measure the efficacy and safety of NIV using random-effects model. Heterogeneity was evaluated using the Q statistic.Results:This study included 14 RCTs (1740 patients) for the evaluation of efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery. Overall, NIV had minimal effect on the risk of mortality (RR: 0.64; 95% CI: 0.36–1.14; P = 0.127), endotracheal intubation (RR: 0.52; 95% CI: 0.24–1.11; P = 0.090), respiratory (RR: 0.70; 95% CI: 0.47–1.30; P = 0.340), cardiovascular (RR: 0.81; 95% CI: 0.54–1.22; P = 0.306), renal (RR: 0.70; 95% CI: 0.26–1.92; P = 0.491), and other complications (RR: 0.72; 95% CI: 0.38–1.36; P = 0.305), respiratory rate (SMD: −0.10; 95% CI: −1.21–1.01; P = 0.862), heart rate (SMD: −0.27; 95% CI: −0.76–0.22; P = 0.288), PaO2/FiO2 ratio (SMD: 0.34; 95% CI: −0.17−0.85; P = 0.194), PaCO2 (SMD: 0.83; 95% CI: −0.12–1.77; P = 0.087), systolic pressure (SMD: −0.04; 95% CI: −0.25–0.17; P = 0.700), pH (SMD: −0.01; 95% CI: −0.44–0.43; P = 0.974), length of ICU stay (SMD: −0.19; 95% CI: −0.47–0.08; P = 0.171), and hospital stay (SMD: −0.31; 95% CI: −1.00–0.38; P = 0.373). Sensitivity analysis showed that NIV was associated with higher levels of PaO2/FiO2 ratio (SMD: 0.52; 95% CI: 0.00–1.05; P = 0.048) and lower risk of endotracheal intubation (RR: 0.38; 95% CI: 0.22–0.66; P = 0.001).Conclusion:As compared to conventional management, the use of NIV after cardiothoracic surgery improved patient's oxygenation and decreased the need for endotracheal intubation, without significant complications.

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“…Bezüglich des Outcomes der CAP bei Patienten mit OSA liegen bisher nicht einheitliche Ergebnisse vor. In einer Untersuchung von Jean und Mitarbeitern [47], die den Einfluss obstruktiver Apnoephasen auf die Prognose einer beatmungspflichtigen Pneumonie untersuchten, zeigten die Pneumonie-Patienten mit OSA im Vergleich zu denen ohne OSA eine reduzierte Mortalität. Eine Kausalität lässt sich hieraus aber nicht ableiten.…”

Section: Intraoperatives Managementunclassified

Schlafbezogene Atmungsstörungen bei beatmungspflichtigen Patienten – Relevanz für das perioperative und das intensivmedizinische Management

2017

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There is a high prevalence of sleep related breathing disorders in critical ill patients and in perioperative settings. Nevertheless, less is known about their impact on clinical course and therapeutic strategies in this context. Intensive care physicians should be aware of difficult airway, weaning- and post-extubation failure and negative impact of SRBD on hemodynamics. Sedatives and analgetics might worsen SRBD and their use should be restricted as far as possible, furthermore the use of NIV might be beneficial. However, there is a lack of evidence with regard to this strategies.

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Obstructive sleep apnea and acute respiratory failure: An analysis of mortality risk in patients with pneumonia requiring invasive mechanical ventilation

Cited by 18 publications

References 35 publications

Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

Efficacy and safety of noninvasive ventilation in patients after cardiothoracic surgery

Schlafbezogene Atmungsstörungen bei beatmungspflichtigen Patienten – Relevanz für das perioperative und das intensivmedizinische Management

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