Repetitive Nocturnal Arterial Oxygen Desaturation and Silent Myocardial Ischemia in Patients Presenting for Vascular Surgery

Goldman, Michael; Reeder, M.K.; Muir, A. D.; Loh, L.; Young, John; Gitlin, D. A.; Casey, Kenneth R.; Smart, Darren; Fry, June M.

doi:10.1111/j.1532-5415.1993.tb07457.x

Cited by 29 publications

(10 citation statements)

References 38 publications

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“…4,51 Cardiac complications are the leading cause of postoperative deaths, 7 and several postoperative factors (e.g., hypotension, tachycardia, bleeding, hypoxemia, and pain) are associated with such complications. 16,42,[52][53][54][55][56] Pr eoper ati v e Pr edic tion of C a r di ac Complic ations…”

mentioning

confidence: 99%

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

2015

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lthough major noncardiac surgery has the potential to improve the quality and prolong the duration of a patient's life, surgery may also precipitate complications such as death from cardiac causes, myocardial infarction or injury, cardiac arrest, or congestive heart failure. 1 In this article, we review what is known about the epidemiology and mechanisms of perioperative cardiac complications (i.e., from induction of anesthesia to within 30 days after surgery), preoperative methods of predicting these complications, perioperative cardiac interventions, and postoperative monitoring. Epidemiol ogy a nd Mech a nisms of Per ioper ati v e C a r di ac Complic ations

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confidence: 99%

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

2015

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“…In addition, sleep studies performed on the first postoperative night have shown that sleep is highly fragmented and thus this may also play a role in worsening underlying sleep apnea [34][35][36]. Interestingly, sleep deprivation for 36 hours in patients with mild sleep apnea will worsen oxygenation during sleep [37]. Complications related to OSA seen later in the postoperative course may be due to other factors, however, with increased REM sleep during recovery likely playing a major role.…”

Section: Osa and Perioperative Riskmentioning

confidence: 92%

“…The absence of REM sleep on these nights creates a "REM pressure" that is alleviated by increased density and the increased duration of REM sleep postoperatively on subsequent nights. During REM rebound sleep, REMassociated hypoxemic episodes can increase by three fold on the second and third nights compared with the night before surgery [35,37]. As apneas lengthen and are associated with worsened hypoxia during REM sleep [29], this increase in duration of REM sleep could contribute to aggravation of underlying OSA and nocturnal hypoxia.…”

Section: Osa and Perioperative Riskmentioning

confidence: 98%

Perioperative Considerations in Patients with Obstructive Sleep Apnea

Auckley¹,

Bolden²,

Smith³

2007

CRMR

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Patients with obstructive sleep apnea (OSA) are at increased risk to sustain adverse events during the perioperative period including difficulty with airway control, hypoxemia, airway obstruction requiring reintubation, arrhythmias, myocardial ischemia, and death. Numerous factors appear to be responsible for these consequences, including the effects of anesthetic agents, narcotics, postoperative supine positioning and, in some cases, the surgical intervention itself. The situation is complicated by the fact that most patients with OSA are undiagnosed and there is often insufficient time for adequate evaluation prior to surgery. Perioperative care providers need to maintain a high index of suspicion for OSA and should consider guidelines to help with the recognition and management of these patients. This review will discuss the available literature regarding the preoperative, intraoperative and postoperative evaluation and management of patients with known or suspected OSA undergoing surgery.

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“…While suppression of specific sleep stages may occur during administration of these medications, a rebound increase in REM or SWS can occur upon drug withdrawal. A rebound increase in REM sleep can be associated with exacerbation of sleep disordered breathing, along with autonomic instability, potentially leading to adverse hemodynamic effects, myocardial ischemia, and altered mentation [41].…”

Section: Effects Of Medications On Sleep In the Icumentioning

confidence: 99%

Sleep and the ICU

Wang

Greenberg²

2013

TOCCMJ

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Disturbed sleep is common in critical illness, not only during early phases of treatment in an intensive care unit (ICU) but also during later stages of recovery after ICU discharge. While sleep quality during critical illness is usually not a primary concern of intensivists, disrupted sleep can impede recovery and has been associated with immune system dysfunction, impaired wound healing, and adverse neurological and psychological outcomes [1]. The noise and lighting of the ICU environment, frequent patient-provider interactions, and critical care procedures all profoundly impact sleep quality and continuity in critically ill patients. Various sedative medications and various modes of mechanical ventilation can also affect sleep. This article will review (1) sleep disruption and its clinical manifestations in the ICU patient, (2) the effects of the ICU environment and routine critical care on sleep disturbances, (3) the biological consequences of critical illness on sleep and circadian rhythms, and how sleep deprivation (SD) affects the immune system, (4) iatrogenic disturbances of sleep in the ICU patient (e.g. commonly used sedatives, mechanical ventilation), and (5) sleep during recovery after critical illness.

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Repetitive Nocturnal Arterial Oxygen Desaturation and Silent Myocardial Ischemia in Patients Presenting for Vascular Surgery

Cited by 29 publications

References 38 publications

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

Perioperative Considerations in Patients with Obstructive Sleep Apnea

Sleep and the ICU

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