Undiagnosed OSA May Significantly Affect Outcomes in Adults Admitted for COPD in an Inner-City Hospital

Naranjo, Mario; Willes, Leslee; Prillaman, Barbara A.; Quan, Stuart F.; Sharma, Sunil

doi:10.1016/j.chest.2020.03.036

Cited by 38 publications

(23 citation statements)

References 26 publications

(28 reference statements)

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“…Another major limitation is that we used the STOP questionnaire to screen participants for high risk of OSA. Although the STOP questionnaire is a validated screening tool in the population with pulmonary diseases [35,36], it has not been validated to use in patients with COVID-19. It is possible that an inflammatory state such as COVID-19 may produce enough upper airway inflammation to provoke snoring.…”

Section: Limitationsmentioning

confidence: 99%

The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study

et al. 2021

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Purpose Obstructive sleep apnea (OSA) may increase the risk of severe COVID-19; however, the level of potential modulation has not yet been established. The objective of the study was to determine the association between high risk of OSA, comorbidities, and increased risk for COVID-19, hospitalization, and intensive care unit (ICU) treatment. Methods We conducted a cross-sectional population-based web survey in adults in 14 countries/regions. The survey included sociodemographic variables and comorbidities. Participants were asked questions about COVID-19, hospitalization, and ICU treatment. Standardized questionnaire (STOP questionnaire for high risk of OSA) was included. Multivariable logistic regression was conducted adjusting for various factors. Results Out of 26,539 respondents, 20,598 (35.4% male) completed the survey. Mean age and BMI of participants were 41.5 ± 16.0 years and 24.0 ± 5.0 kg/m 2 , respectively. The prevalence of physician-diagnosed OSA was 4.1% and high risk of OSA was 9.5%. We found that high risk of OSA (adjusted odds ratio (aOR) 1.72, 95% confidence interval (CI): 1.20, 2.47) and diabetes (aOR 2.07, 95% CI: 1.23, 3.48) were associated with reporting of a COVID-19 diagnosis. High risk for OSA (aOR 2.11, 95% CI: 1.10–4.01), being male (aOR: 2.82, 95% CI: 1.55–5.12), having diabetes (aOR: 3.93, 95% CI: 1.70–9.12), and having depression (aOR: 2.33, 95% CI: 1.15–4.77) were associated with increased risk of hospitalization or ICU treatment. Conclusions Participants at high risk of OSA had increased odds of having COVID-19 and were two times more likely to be hospitalized or treated in ICU. Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02373-5.

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Section: Limitationsmentioning

confidence: 99%

The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study

et al. 2021

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“…Various reports have highlighted that delirium is under-recognised, underdetected and undertreated [1][2][3]. However, a plethora of publications have asserted similar claims for other common mental disorders that include anxiety disorders [4,5], sleep disorders [6,7], eating disorders [8], Attention Deficit Hyperactivity Disorder (ADHD) [9], depression [10] and schizophrenia [11]. These reports emphasise that each condition is undetected, underdiagnosed and undertreated and highlight the need for research that focuses upon improving awareness and detection.…”

Section: Introductionmentioning

confidence: 99%

Towards understanding the nature and need of delirium guidelines across nations and cultures

et al. 2021

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Background Delirium is associated with a variety of adverse healthcare outcomes but is highly predictable, preventable and treatable. For this reason, numerous guidelines have been developed for delirium recognition, prevention and management across different countries and disciplines. Although research is adduced as evidence for these guidelines, a constant finding is the lack of implementation if they exist at all. Implementation is a human behaviour that can be influenced by various factors including culture at a micro-and macro-level. Hofstede's model proposes that national cultures vary along six consistent dimensions. Aim Using this model, we examined the nature of delirium guidelines across countries in relation to Hofstede's six cultural dimensions. Methods Data collected for each country on: the six dimensions of Hofstede's model, number of delirium guidelines approved by a National professional body of each country (through searching databases), the annual old-age dependency ratio for each country. Results Sixty-four countries had the completed six dimensions of Hofstede's model. Twenty of them (31%) had one or more delirium guidelines. The total number of different delirium guidelines was 45. Countries with formal delirium guidelines have significantly lower power distance among their members, are more individualistic societies, have lower levels of uncertainty avoidance and higher old-age dependency ratio compared to those without delirium guidelines. Discussion/conclusion The development and implementation of delirium guidelines vary across countries. Specific combinations of cultural dimensions influence the production of delirium guidelines. Understanding these important cultural differences can facilitate more widespread acceptance and implementation of guidelines.

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“…In contrast to their study, we classified patients based on OSA risk with STOP‐BANG scores and pre‐sedation assessments. Patients with undiagnosed or untreated OSA have been well studied, and they have increased hospitalization, atrial fibrillation, and postoperative cardiopulmonary complications 13,14 . We found that patients with suspected OSA had higher chances of developing respiratory complications during bronchoscopy, albeit minor.…”

Section: Discussionmentioning

confidence: 78%

“…In the 165 patients with suspected OSA, 33.9% (56) patients developed a respiratory complication compared to 12.1% (20) patients who were not suspected of having OSA ( P = 0.001). In patients with suspected OSA, 24.8% (41) patients developed hypercapnia compared to 8.5% 14 patients who were not suspected of having OSA ( P = 0.003).…”

Section: Resultsmentioning

confidence: 94%

Safety and incidence of complications associated with bronchoscopy in an obese population

Salahuddin

Salamó

Karanth

et al. 2021

Clinical Respiratory J

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Introduction The safety of bronchoscopy in obese patients and those with obstructive sleep apnea (OSA) is unclear. Our objective was to evaluate the incidence of complications during bronchoscopy under moderate sedation in obese patients and to assess the impact of OSA, body mass index (BMI), and duration of the procedure. Methods We performed a retrospective study in adult patients undergoing bronchoscopy from January 2010 to August 2019. All patients with BMI > 30 kg/m2 were included. Logistic regression analyses were used to identify the factors associated with all‐complications and respiratory complications. Results A total of 345 obese patients were identified. The average BMI in our cohort was 35.3 ± 5.1 kg/m2. During the pre‐procedure risk assessment, 165 (47.8%) patients were labelled as “suspected OSA.” The most common doses of sedation given during the bronchoscopies were fentanyl 50 mcg (34.5%) and midazolam 3 mg (33.6%). The incidence of major complications was 0.6% and minor complications were 41.2%. Minor respiratory (22.9%) and cardiac (26.4%) complications were common. No deaths occurred due to bronchoscopy. Factors that were associated with increased respiratory complications were female gender, suspected OSA, and bronchoscopy duration 20‐30 minutes and bronchoscopy duration greater than 1 hour. Conclusion Bronchoscopy under moderate sedation performed in obese patients is safe; however, increased risk may exist with females, increased procedure time, and suspected OSA.

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Undiagnosed OSA May Significantly Affect Outcomes in Adults Admitted for COPD in an Inner-City Hospital

Cited by 38 publications

References 26 publications

The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study

The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study

Towards understanding the nature and need of delirium guidelines across nations and cultures

Safety and incidence of complications associated with bronchoscopy in an obese population

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