SESSION TITLE: Consequences of Sleep Disorders
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 28, 2014 at 02:45 PM - 04:15 PM
PURPOSE: To assess the prevalence of SRBDs in acutely ill patients admitted to respiratory ICU and identify patients' characteristics that aid in predicting SRBDs in such population
METHODS: 72 patients were subjected to clinical apnea score (CAS) and classified into 2 groups: group I (n=21) patients with low clinical probability for SRBDs and group II (n=51) patients with high probability. We then compared the 2 groups according to their demographic data, anthropometric measures, clinical diagnosis, daytime gasometry (ABGs), APACHE score, mortality rate, length of ICU stay, and mode of assisted ventilation. 39 patients from group II were subjected to overnight sleep study.
RESULTS: Mean age, hypertension, diabetes mellitus, BMI, neck circumference, waist/hip ratio, occurrence of type 2 respiratory failure and use of BiPAP were statistically significantly higher in patients with SRBDs than in patients without SRBDs. All patients with high clinical suspicion objectively demonstrated AHI>5/hour on polysomnography. They included 10.2% (n=4) with mild OSAHS, 25.6% (n=10) with moderate OSAHS and 64.1% (n=25) with severe OSAHS. Sleep efficiency was decreased, stage 1 was increased, and several types of arrhythmias were detected. 82% of patients with SRBDs suffered from sleep related hypoventilation (SHV) in addition to OSAHS. Serum bicarbonate was the sole parameter that was statistically significantly higher in patient with SRBDs and SHV compared to patients without SHV.
CONCLUSIONS: SRBDs is a very common medical condition but yet underrecognized in ICU setting. CAS has a high clinical predictive value for detection of OSAHS. ABGs cannot predict presence or absence of SRBDs in the ICU setting. Anthropometric data have significant importance in directing the awareness towards SRBDs. Patients with SRBDs are complicated with many co morbidities such as hypertension, diabetes mellitus, hyperuricemia, dyslipidemia and cardiac arrhythmia. Patients in ICU have decreased sleep efficiency. Treating patients with SRBDs with positive pressure will significantly decrease the frequency of readmission to ICU. Serum bicarbonate is the sole parameter of significantly high clinical predictive value for presence of concomitant SHV in patients with OSAHS. AHI has linear relationship with neck circumference thus considered a good predictor to the presenceof OSAHS.
CLINICAL IMPLICATIONS: SRBDs is highly prevalent among patients admitted with respiratory failure. Physicians need to be aware of this common prevalnce for proper management.
DISCLOSURE: The following authors have nothing to disclose: Mahmoud Mahmoud, Tamer Morsi, Heba Gharraf, Dina ElHady
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