Symptoms of Disturbed Sleep Predict Major Adverse Cardiac Events After Percutaneous Coronary Intervention

Fernandes, Nisha M.; Nield, Lynne E.; Popel, Najla; Cantor, Warren J.; Planté, Sylvain; Goldman, Lorne; Prabhakar, Manu; Manlhiot, Cedric; McCrindle, Brian W.; Miner, Steven E.S.

doi:10.1016/j.cjca.2013.07.009

Cited by 34 publications

(19 citation statements)

References 29 publications

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“…Moreover, Cassar et al 30 did not perform multivariate regression analysis to adjust for important confounders. More recently, Fernandes et al 25 reported that symptoms of sleep disturbances were independently associated with a higher rate of MACE (primarily due to repeat revascularization) in patients undergoing PCI. By design, this study was limited by sleep disturbances not being objectively measured by sleep studies.…”

Section: Discussionmentioning

confidence: 99%

“…20,21 A study found that moderate-severe OSA was present in 422 of 662 patients (63.7%) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft . 22 Furthermore, moderate-severe OSA is an independent predictor of worse clinical and angiographic outcomes aft er PCI [23][24][25] or myocardial infarction. 26,27 Although drug-eluting stents and intensive secondary prevention have led to improved outcomes aft er PCI, repeat revascularization remains relatively common, raising the possibility that treatment of OSA may be an eff ective secondary prevention in patients undergoing coronary revascularization procedures.…”

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confidence: 99%

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Treatment of OSA Reduces the Risk of Repeat Revascularization After Percutaneous Coronary Intervention

Liu

et al. 2015

Chest

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Treatment of OSA Reduces the Risk of Repeat Revascularization After Percutaneous Coronary Intervention

Liu

et al. 2015

Chest

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“…It is a common clinical problem for major surgery patients to experience severe postoperative sleep disturbance including sleep deprivation, disruption, and abnormal architecture, which could be caused by different factors such as anxiety, pain, or maladaptation to the ward environment. [1][2][3][4][5][6][7][8][9][10] Postoperative sleep disturbance may worsen a patients' physical condition by increasing the risk of postoperative delirium or cognitive dysfunction, and delaying recovery. 3,4,[10][11][12] Numerous attempts have been made to relieve severe sleep disturbances after surgery through eliminating noise and light in surgical wards with blinders or earplugs, the consolidation of patient care interactions.…”

Section: Introductionmentioning

confidence: 99%

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

Duan¹,

Wang²,

Peng³

et al. 2020

NSS

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The study aimed to investigate the effects of intraoperative dexmedetomidine on postoperative sleep disturbance for different surgical patients and compare such effects between different dose of dexmedetomidine. Methods: A total of 7418 patients undergoing nine types of non-cardiac major surgeries were retrospectively studied. Patients were separated into DEX (dexmedetomidine) or Non-DEX (Non-dexmedetomidine) groups based on the use of dexmedetomidine during surgery. The patients who reported they could not fall asleep during the night or woke up repeatedly during the most of the night at the day of the surgery and whose NRS were >6 were defined as cases with severe sleep disturbance. Propensity score matched analysis based on all preoperative baseline data was performed along with logistic regression analysis including different surgery types and dosage of dexmedetomidine use. Results: In both of the unmatched cohort (OR, 0.49 [95% CI: 0.43-0.56]) and matched cohort (0.49 [95% CI: 0.42-0.58]), the DEX group had a significantly lower incidence of severe sleep disturbance than the Non-DEX group. In the subgroup analysis, for gynecological and urological surgery population, the ORs for DEX-group reached 0.21 (95% CI, 0.13-0.33; P<0.0001) and 0.30 (95% CI,0.19-0.47; P<0.0001), respectively. In addition, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) showed the greatest effect with an odds ratio of 0.38 (95% CI: 0.31-0.44; P<0.0001), and the incidence of severe sleep disturbance in the low-dose group was significantly lower (11.5% vs. 17.7% vs. 16.5%, P<0.0001) than that in the medium-(0.4-0.6 μg•kg −1 •h −1) and high-dose (0.6-0.8 μg•kg −1 •h −1) groups. Conclusion: Intraoperative dexmedetomidine use can significantly decrease the incidence of severe sleep disturbance on the day of surgery for patients undergoing non-cardiac major surgery, and the effects were most significant in patients receiving gynecological and urological surgery. Furthermore, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) is most effective for prevention of postoperative sleep disturbance.

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“…Sleep disturbances frequently occur in patients after surgery, and its occurrence is harmful for postoperative recovery [ 1 – 5 ]. Recent evidences show that multiple perioperative factors are related to the development of postoperative sleep disturbances; some of these factors can be properly managed to reduce the severity of sleep disturbances, and sleep promotion may improve postoperative recovery.…”

Section: Introductionmentioning

confidence: 99%

Improve postoperative sleep

Wang²

2018

Current Opinion in Anaesthesiology

145

105

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Purpose of reviewWe reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery.Recent findingsNormal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients after surgery. Factors associated with the development of postoperative sleep disturbances include old age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative pain, environment stress, as well as other factors leading to discomfort of patients. Development of sleep disturbances produces harmful effects on postoperative patients, that is, leading to higher risk of delirium, increased sensitivity to pain, more cardiovascular events, and poorer recovery. Both nonpharmacological and pharmacological measures (such as zolpidem, melatonin, and dexmedetomidine) can be used to improve postoperative sleep. Recent evidences show that sleep promotion may improve patients’ outcome, but requires further evidences.SummarySleep disturbances are common in patients after surgery and produce harmful effects on postoperative recovery. Sleep-promotion therapy may be helpful to improve postoperative recovery, but long-term effects deserve further study.

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Symptoms of Disturbed Sleep Predict Major Adverse Cardiac Events After Percutaneous Coronary Intervention

Cited by 34 publications

References 29 publications

Treatment of OSA Reduces the Risk of Repeat Revascularization After Percutaneous Coronary Intervention

Treatment of OSA Reduces the Risk of Repeat Revascularization After Percutaneous Coronary Intervention

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

Improve postoperative sleep

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