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Volume 3 Supplement 2

19th International Symposium on Intensive Care and Emergency Medicine

Obstructive sleep apnea in acute respiratory failure

Study objectives

Emergency medicine deals with the diagnosis and the prevention of potentially life-threatening events, as well as prevention, diagnosis and treatment of acute illnesses; one of this event is sleep apnea syndrome (SAS). The relationship between obstructive sleep apnea (OSA) and acute respiratory failure (ARF) is not well established.

The aim of the study was to evaluate the prevalence of OSA in hypercapnic ARF patients and its correlations with the severity and length of nocturnal arterial oxygen desaturation, diurnal arterial carbon dioxide (PaCO2) and oxygen (PaO2) tensions, diurnal oxygen saturation, sudden death and BMI.

Methods

46 patients with chronic obstructive pulmonary disorder (COPD) (31 men and 15 women; M = 68 years; range 36 to 83) with hypercapnic ARF underwent a full night of polysomnography.

The polysomnography consisted of continuous polygraphic recording (by Compumedic Sleep PTYLTD Abbotsford) from surface leads for electroencephalography, electrooculography, electromyography and ECG, and from noninvasive sensor for nasal airflow, tracheal sounds, body position, thoracic and abdominal respiratory efforts, and oxymyoglobin level. The number and duration of nocturnal sleep apneas and hypopneas and the consequential oxygen desaturation were evaluated; sleep apnea was defined as more than five episodes of apnea or hypopnea per hour of sleep (apnea/hypopnea index = AHI > 5 ). Furthermore BMI, basal diurnal PaCO2, PaO2 and arterial oxygen saturation were also recorded.

Results

Overnight polysomnography was successfully performed in 39 of the 46 studied patients; 4 patients were intolerant to the study and 3 patients were awake all the sleep time. OSA was found in 13 of the 39 ARF patients (33.3%) and the mean AHI was 19.3 events per hour. We found statistically significant correlations between OSA and BMI (P < 0.0l; M=38), PaO2 (P < 0.001; M =65 ), diurnal oxygen saturation (P < 0.001; M =86 ) and nocturnal oxygen desaturation (P < 0.001; M=80 ).

Conclusion

The overnight polysomnography detects the possible existence of OSA in hypercapnic ARF. We also found a statistical significance positive correlation between OSA and hypoxemia. Polysomnography may he indicated to exclude sleep-induced desaturation contributing to the actual ARF, but it may also -improve therapeutic and prevention strategy.

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Pivetti, S., Navone, F., Tartaglino, B. et al. Obstructive sleep apnea in acute respiratory failure. Crit Care 3, P20 (2000). https://doi.org/10.1186/cc395

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Keywords

  • Obstructive Sleep Apnea
  • Sleep Apnea
  • Acute Respiratory Failure
  • Oxygen Desaturation
  • Nocturnal Sleep