Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery
Standard
Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery. / Zaremba, Sebastian; Shin, Christina H; Hutter, Matthew M; Malviya, Sanjana A; Grabitz, Stephanie D; MacDonald, Teresa; Diaz-Gil, Daniel; Ramachandran, Satya Krishna; Hess, Dean; Malhotra, Atul; Eikermann, Matthias.
in: ANESTHESIOLOGY, Jahrgang 125, Nr. 1, 07.2016, S. 92-104.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery
AU - Zaremba, Sebastian
AU - Shin, Christina H
AU - Hutter, Matthew M
AU - Malviya, Sanjana A
AU - Grabitz, Stephanie D
AU - MacDonald, Teresa
AU - Diaz-Gil, Daniel
AU - Ramachandran, Satya Krishna
AU - Hess, Dean
AU - Malhotra, Atul
AU - Eikermann, Matthias
PY - 2016/7
Y1 - 2016/7
N2 - BACKGROUND: Bariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression.METHODS: In a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing.RESULTS: Sixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P < 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P < 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness-sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P < 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant.CONCLUSIONS: This pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects.
AB - BACKGROUND: Bariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression.METHODS: In a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing.RESULTS: Sixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P < 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P < 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness-sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P < 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant.CONCLUSIONS: This pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects.
KW - Adult
KW - Aged
KW - Analgesics, Opioid/adverse effects
KW - Arousal
KW - Bariatric Surgery
KW - Continuous Positive Airway Pressure/methods
KW - Cross-Over Studies
KW - Female
KW - Hemodynamics/drug effects
KW - Humans
KW - Male
KW - Middle Aged
KW - Oxygen/blood
KW - Polysomnography
KW - Postoperative Complications/chemically induced
KW - Prospective Studies
KW - Respiratory Insufficiency/chemically induced
KW - Respiratory Mechanics
KW - Sleep Apnea Syndromes/chemically induced
U2 - 10.1097/ALN.0000000000001160
DO - 10.1097/ALN.0000000000001160
M3 - SCORING: Journal article
C2 - 27171827
VL - 125
SP - 92
EP - 104
JO - ANESTHESIOLOGY
JF - ANESTHESIOLOGY
SN - 0003-3022
IS - 1
ER -
