Circadian distribution of sleep phases after major abdominal surgery
01 Jan 2008-BJA: British Journal of Anaesthesia (Oxford University Press)-Vol. 100, Iss: 1, pp 45-49
TL;DR: Patients have significantly increased REM sleep, LS, and reduced time awake during the daytime period after surgery compared with before surgery, suggesting disturbances in the circadian regulation of the sleep-wake cycle may be involved in the development of postoperative sleep disturbances.
Abstract: Background It is believed that the severely disturbed night-time sleep architecture after surgery is associated with increased cardiovascular morbidity with rebound of rapid eye movement (REM). The daytime sleep pattern of patients after major general surgery has not been investigated before. We decided to study the circadian distribution of sleep phases before and after surgery. Methods Eleven patients undergoing elective major abdominal surgery were included in the study. Continuous ambulatory polysomnographic monitoring was made 24 h before surgery and 36 h after surgery, thus including two nights after operation. Sleep was scored independently by two blinded observers and the recordings were reported as awake, light sleep (LS, stages I and II), slow wave sleep (SWS, stages III and IV), and REM sleep. Results There was significantly increased REM sleep ( P =0.046), LS ( P =0.020), and reduced time awake ( P =0.016) in the postoperative daytime period compared with the preoperative daytime period. Five patients had REM sleep during the daytime after surgery. Three of these patients did not have REM sleep during the preceding postoperative night. There was significantly reduced night-time REM sleep for two nights after surgery compared with before surgery ( P =0.001). Conclusions Patients have significantly increased REM sleep, LS, and reduced time awake during the daytime period after surgery compared with before surgery. Disturbances in the circadian regulation of the sleep–wake cycle may be involved in the development of postoperative sleep disturbances.
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TL;DR: It is reported that suspected OSA based on the PSAP score is independently associated with increased risk of early PRC, pointing to the potential for examining risk modification through these exposures in future studies.
Abstract: BACKGROUND:Obstructive sleep apnea (OSA) is a prevalent condition that is associated with early postoperative respiratory complications (PRCs). As the majority of patients with OSA are undiagnosed, preoperative screening remains the most efficient method to identify suspected OSA.METHODS:This retros
24 citations
Journal Article•
TL;DR: Postoperative measures improving respiratory function of patients suffering from obstructive sleep apnoea syndrome are presented, and the algorithm of the postoperative respiratory management of morbid obese patients used in this institution is provided.
Abstract: Morbid obesity results in a restrictive pulmonary syndrome including decreased functional residual capacity. General anaesthesia further decreases functional residual capacity, and consequently alters gas exchanges more profoundly in morbidly obese patients than in nonobese patients. Moreover, these changes persist longer during the postoperative period, rendering obese subjects vulnerable to postoperative respiratory complications. In this review, we present postoperative measures improving respiratory function of these patients. Whether these measures affect outcome remains however unknown. Patients suffering from obstructive sleep apnoea syndrome deserve special considerations that are briefly described. Finally, the algorithm of the postoperative respiratory management of morbid obese patients used in our institution is provided.
22 citations
TL;DR: The role of modulation of sleep during the perioperative period on postoperative pain is needed to understand the role of bidirectional interaction between sleep and pain.
Abstract: Background: Sleep macrostructure is commonly disturbed after surgery. Postoperative pain control remains challenging. Given the bidirectional interaction between sleep and pain, understanding the role of modulation of sleep during the perioperative period on postoperative pain is needed. Methods: This was a systematic review. Controlled trials examining the effects of perioperative sleep-promoting pharmacological agents on postoperative pain and analgesic consumption were identified through a systematic search strategy utilizing multiple electronic databases. Results: Fourteen studies (9 melatonin, 5 zolpidem) involving 921 patients (melatonin n = 586, zolpidem n = 335) were included. Compared to placebo, melatonin reduced postoperative pain scores by ≥30% and significantly decreased opioid consumption in 3 studies (postoperative day [POD] 1–2), whereas 4 studies reported no significant effect of melatonin on postoperative pain. Compared to placebo, zolpidem reduced postoperative pain scores during POD1–7/POD1–14 in 2 studies, but only 1 trial suggested clinically meaningful improvement (ie, relative reduction of pain score ≥ 30%). Whereas 3 zolpidem trials showed no significant differences regarding postoperative pain ratings, zolpidem treatment was associated with decreased analgesic consumption in 4 out of 5 trials. Several limitations of the included studies were identified; only 1 study out of 14 was deemed to be at low risk of bias, and heterogeneity of the study design and outcome assessment precluded meta-analysis. Conclusion: Perioperative addition of a sleep-promoting pharmacological agent may improve pain control, but underlying evidence is weak and results are inconsistent. Only 5 of the 14 studies objectively evaluated changes in sleep (polysomnography, 2 zolpidem studies; actigraphy, 3 melatonin studies), which complicates conclusions regarding links between perioperative sleep and pain. (Less)
21 citations
Cites background from "Circadian distribution of sleep pha..."
...of REM sleep can last far beyond the fourth postoperative night,(11) and major surgery may also result in altered circadian distribution of sleep.(18) Persistent preoperative sleep disturbance and/or disturbed sleep after surgery can contribute to postoperative morbidity,...
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TL;DR: The results show that wrist-level monitoring provides an adequate estimate of light exposure for in-hospital circadian studies and the eye-level monitor was found to underestimate light exposure at higher light levels.
Abstract: This clinical methods comparison study describes the difference between light levels measured at the wrist (Actiwatch-L) and at the eye (Daysimeter) in a postoperative in-patient population. The mean difference between the two devices was less than 10 lux at light levels less than 5000 lux. Agreement between the devices was found to decrease as eye-level light exposure increased. Measurements at eye level of 5000 lux or more corresponded to a difference between the devices of greater than 100 lux. Agreement between the eye- and wrist-level light measurements also appears to be influenced by time of day. During the day, the measurement differences were on average 50 lux higher at eye level, whereas at night they were on average 50 lux lower. Although the wrist-level monitor was found to underestimate light exposure at higher light levels, it was well tolerated by participants in the clinical setting. In contrast, the eye-level monitor was cumbersome and uncomfortable for the patients to wear. This study pr...
20 citations
Cites background from "Circadian distribution of sleep pha..."
...Ambient light levels in hospitals have been measured in a number of previous studies using stationary light meters (Bullough et al., 1996; Garcia-Gonzalez et al., 2008; Glotzbach et al., 1993; Gogenur et al., 2007, 2008; Wakamura et al., 2001)....
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TL;DR: It is reported that prolonged PACU oxygen therapy and nadir desaturation <89% in PACU as captured in a retrospective database are independently associated with early PRC.
Abstract: Introduction
The clinical importance of postoperative episodic hypoxemia is still unclear, and therefore largely under-studied As a result, there is limited understanding of its relationship with early postoperative respiratory complications (PRC, defined as intubation within three days of surgery) and hospital resource utilization
Materials and methods
This single center study was performed using a retrospective observational design We described population based definitions of desaturation from continuous SpO2 monitoring data captured in the post anesthesia care unit (PACU), namely median SpO2 in PACU, duration of desaturation below median, nadir desaturation, and length of oxygen therapy relative to PACU duration These measures were evaluated against the occurrence of early PRC in logistic regression models Measures that were independently associated with early PRC were accepted as the primary study exposures Stratified logistic regression models were planned if significant interaction occurred with high risk surgical procedures Models were adjusted by including several patient conditions, procedural, and anesthesia risk factors Propensity matching on desaturation occurrence was planned to evaluate the relationship with postoperative resource utilization
Results
Among 125,740 patients included in the univariate analyses, 351 patients (03%) developed early PRC Nadir desaturation 60 min) to 304 (>90 min); p<0001] were identified as independent predictors of early PRC occurrence A modest interaction was observed between desaturation and higher surgical risk Propensity matching for postoperative oxygen requirement was performed in 37,354 matched patients Matched analysis demonstrated significant increase in day of surgery charges, respiratory charges, total charges, hospital length of stay, reintubation and use of invasive or non-invasive ventilatory support
Conclusions
In summary, we report that prolonged PACU oxygen therapy and nadir desaturation <89% in PACU as captured in a retrospective database are independently associated with early PRC This study describes resource implications of PACU desaturation in a large academic medical center in North America
20 citations
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11,993 citations
TL;DR: Techniques of recording, scoring, and doubtful records are carefully considered, and Recommendations for abbreviations, types of pictorial representation, order of polygraphic tracings are suggested.
Abstract: With the vast research interest in sleep and dreams that has developed in the past 15 years, there is increasing evidence of noncomparibility of scoring of nocturnal electroencephalograph-electroculograph records from different laboratories. In 1967 a special session on scoring criteria was held at the seventh annual meeting of the Association for the Psychophysiological Study of Sleep. Under the auspices of the UCLA Brain Information, an ad hoc committee composed of some of the most active current researchers was formed in 1967 to develop a terminology and scoring system for universal use. It is the results of the labors of this group that is now published under the imprimatur of the National Institutes of Health. The presentation is beautifully clear. Techniques of recording, scoring, and doubtful records are carefully considered. Recommendations for abbreviations, types of pictorial representation, order of polygraphic tracings are suggested.
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3,002 citations
01 Jan 1968
2,439 citations
TL;DR: REM sleep is associated with profound sympathetic activation in normal subjects, possibly linked to changes in muscle tone and the hemodynamic and sympathetic changes during REM sleep could play a part in triggering ischemic events in patients with vascular disease.
Abstract: Background The early hours of the morning after awakening are associated with an increased frequency of events such as myocardial infarction and ischemic stroke. The triggering mechanisms for these events are not clear. We investigated whether autonomic changes occurring during sleep, particularly rapid-eye-movement (REM) sleep, contribute to the initiation of such events. Methods We measured blood pressure, heart rate, and sympathetic-nerve activity (using microneurography, which provides direct measurements of efferent sympathetic-nerve activity related to muscle blood vessels) in eight normal subjects while they were awake and while in the five stages of sleep. Results The mean (±SE) amplitude of bursts of sympathetic-nerve activity and levels of blood pressure and heart rate declined significantly (P<0.001), from 100 ±9 percent, 90 ±4 mm Hg, and 64 ±2 beats per minute, respectively, during wakefulness to 41 ±9 percent, 80 ±4 mm Hg, and 59 ±2 beats per minute, respectively, during stage 4 of non-REM sl...
1,378 citations