Sleep Apnea's Implications for Surgery

On March 31, 2012, in Sleep Apnea, by admin

(dailyRx)

Feeling confused and losing consciousness after a surgery is no light matter – it can cause health problems later on. But if it’s related to a treatable condition, that’s good news.

A recently published small study has found a link between sleep apnea and delirium experienced by patients after a surgery. If the link is confirmed, better treatment of the apnea may reduce the likelihood of delirium.

Get screened for sleep apnea prior to a major surgery.

Lead author Benjamin Flink, a student in the Duke School of Medicine, and fellow researchers studied 106 patients over the age of 65 who underwent total knee replacement to see what underlying medical conditions might relate to the patient’s experiencing delirium immediately after the surgery.

Delirium occurs when a person experiences confusion and goes in and out of consciousness.

Previous research has found that patients who experience delirium after a surgery are at a higher risk for health issues and death immediately after surgery and even ten years down the road.

Patients with dementia, a nervous system or neurological disorder, alcoholism, depression or any serious psychiatric disorder were excluded from the study.

Of the 15 people undergoing the surgery who had sleep apnea, eight developed delirium within the first three days following the procedure – approximately 53 percent.

There were 19 others who developed delirium on the second or third day after surgery, but they were out of a total 91 patients who did not have sleep apnea, a rate of only 20 percent.

The researchers did not identify any other conditions that increased the likelihood that a patient would experience delirium after the surgery, and they adjusted their statistics to account for the patients’ age, gender, weight and education level.

Because the number of people who had sleep apnea in the study was small, the researchers recommended a larger study to confirm their results.

The researchers also recommended that patients be screened for sleep apnea prior to a surgery.

“If the association between pre-existing sleep apnea and postoperative delirium discovered in this study is confirmed by a larger study, we may be able to prevent postoperative delirium by treating sleep apnea before and immediately after surgery,” said senior author Madan Kwatra, Ph.D., an anesthesiology professor at Duke University Medical Center.

Although doctors are not sure what causes delirium after a surgery, one theory is that a patient is not getting enough oxygen before or just after a surgery. Another proposes that the cause is related to problems with a person’s immune system.

The study appears in the April issue of Anesthesiology. The research was funded by a National Institutes of Health grant and the Department of Anesthesia at the Duke University Medical Center. No competing interests of authors were noted.

Sleep Disorder

Over 50 million American adults have chronic sleep and wakefulness disorders. There are many different kinds of sleep disorders, but the most common ones deal with insomnia (not being able to fall asleep or stay asleep) and sleep apnea (poor sleep due to physical or neurological problems with breathing during sleep) and narcolepsy (excessive daytime sleepiness).

Restless leg syndrome (need to move while falling asleep), and sleepwalking are less common, but often cause considerable distress and disability. Treatments for sleep disorders generally can be grouped into four categories: behavioral treatments, rehabilitation management, medications and other somatic treatments.

Diagnosis is often made by the patient going to a sleep lab, where breathing, heart rate, and brain activity is measured while the patient sleeps. Medications include sleep aids for insomina (Ambien, Sonata, Lunesta), as well as over the counter remedies (Benadryl, Unisom, and melatonin).

Sleep Apnea

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

Narcolepsy

Narcolepsy (NAR-ko-lep-se) is a disorder that causes periods of extreme daytime sleepiness. It also may cause muscle weakness.

Rarely, people who have this disorder fall asleep suddenly, even if they’re in the middle of talking, eating, or another activity. Most people who have narcolepsy also have trouble sleeping at night.

Narcolepsy affects between 50,000 and 2.4 million people in the United States. Symptoms usually begin during the teen or young adult years. Due to extreme tiredness, people who have narcolepsy may find it hard to function at school, work, home, and in social situations.

Insomnia

Insomnia (in-SOM-ne-ah) is a common condition in which you have trouble falling or staying asleep. This condition can range from mild to severe, depending on how often it occurs and for how long.

Insomnia can be chronic (ongoing) or acute (short-term). Chronic insomnia means having symptoms at least 3 nights a week for more than a month. Acute insomnia lasts for less time.

Some people who have insomnia may have trouble falling asleep. Other people may fall asleep easily but wake up too soon. Others may have trouble with both falling asleep and staying asleep.

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