Daily Archives: 27 May 2024

Winding down the window, consuming tea and coffee, increasing the radio volume, and singing while driving could indicate a hazardous snoring condition

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A study published in ERJ Open Research suggests that regularly using multiple methods to stay awake while driving might indicate severe sleepiness due to obstructive sleep apnea (OSA).

Individuals with OSA typically experience loud snoring, intermittent breathing during sleep, and frequent awakenings. Although it is estimated that one in five people suffers from OSA, most are unaware of their condition. Untreated, OSA leads to extreme drowsiness, significantly increasing the risk of vehicular accidents.

The research highlights the potential of using certain behaviours, such as opening car windows, consuming caffeinated beverages, or increasing radio volume, as indicators to identify drivers at heightened risk of incidents due to OSA.

This study, led by Dr Akshay Dwarakanath and his team at St James’s University Hospital in Leeds, UK, compared 119 untreated OSA patients with 105 individuals without the disorder. Participants were queried about their general and driving-specific sleepiness, strategies employed to combat drowsiness while driving, and any history of driving incidents.

The research findings are significant, revealing that those with OSA were more likely to adopt multiple alertness strategies while driving compared to their non-OSA counterparts. Notably, nearly a third of the OSA group reported frequently using over three techniques to stay awake, a practice nonexistent among the control group. Furthermore, OSA patients engaging in multiple strategies not only felt generally sleepier but also reported a higher incidence of crashes—22.8% versus 2.4% among those using fewer strategies.

Standard methods among OSA sufferers included adjusting the car environment by opening windows or using caffeinated drinks, as well as behavioural tactics like singing, adjusting seating positions, chewing gum, taking breaks for physical activity, and even stopping to refresh themselves with cold water.

Dr Dwarakanath emphasized the clinical challenge in assessing patients’ fitness to drive, mainly when it affects their employment, especially for professional drivers. Nonetheless, he stressed the responsibility of medical professionals to advise against driving when there is a substantial risk of accidents.

The study underscores the crucial role of healthcare providers in inquiring about these adaptive strategies during clinical assessments. They can serve as indirect indicators of sleepiness and aid in identifying patients who may be more susceptible to driving-related accidents. This approach could empower healthcare providers to better manage the risks associated with untreated OSA in drivers.

More information: Akshay Dwarakanath et al, An exploratory study evaluating the use of coping strategies while driving in obstructive sleep apnoea syndrome patients and controls, ERJ Open Research. DOI: 10.1183/23120541.00638-2023

Journal information: ERJ Open Research Provided by European Respiratory Society

The type of surgery and its associated risk level exert a considerable influence on the occurrence of complications and mortality rates among elderly patients

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Frailty stands as a well-established predictor concerning the likelihood of complications and mortality following surgery. Nonetheless, a recent study, as published in the Journal of the American College of Surgeons (JACS), reveals a significant escalation in postoperative complications and death among patients aged over 65 who undergo high-risk emergency surgeries compared to those evaluated solely based on frailty levels.

In the foreseeable future, the elderly demographic in the United States is expected to undergo a doubling, compelling surgeons to confront numerous considerations in decision-making processes, particularly concerning postoperative recuperation. Dr. Raul Coimbra, the study’s co-author and a prominent figure in the surgical field, underscores the deteriorating outcomes observed among elderly patients in emergency settings undergoing significant surgeries, urging for transparent communication with patients and their families regarding the associated risks and potential consequences.

The researchers postulated that, for the elderly cohort, the degree of procedural risk, whether high or low, holds greater significance in determining adverse outcomes when juxtaposed with frailty status alone. Utilising the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), the researchers scrutinised records of elderly patients over 65 who underwent emergency surgeries between 2018 and 2020. This program is a benchmark for nationally evaluating and enhancing surgical care quality across hospitals.

Patients were categorised based on frailty levels — non-frail, frail, and severely frail — and then further grouped according to procedural risk, distinguishing between low-risk and high-risk operations. High-risk procedures included open cholecystectomy, open colectomy, laparoscopic colectomy, small bowel resection, and perforated ulcer repair, while low-risk procedures encompassed appendectomies and cholecystectomies.

The evaluation encompassed five key outcomes: 30-day mortality, 30-day postoperative complications, failure to rescue, hospital readmission, and 30-day reoperation. The aim was to delineate the impact of surgical procedure types on outcomes among elderly patients.

Among the study’s sample of 59,633 elderly patients, 29.3% were classified as non-frail, 66.4% as frail, and 4.3% as severely frail. Within these groups, 25,157 underwent low-risk procedures, whereas 34,476 underwent high-risk procedures. Both frailty and procedural risk correlated with elevated risks of mortality, postoperative complications, failure to rescue, and readmissions. However, when comparing the impact of procedural risk against frailty alone, the former emerged as a more robust predictor of adverse outcomes.

For instance, non-frail patients subjected to high-risk emergency surgeries exhibited a mortality rate of 7.1%, contrasting with a mere 0.2% mortality rate associated with low-risk procedures. Conversely, frail and severely frail patients undergoing high-risk procedures demonstrated mortality rates of 11.5% and 25.8%, respectively, compared to 1.0% and 4.1% following low-risk procedures.

High-risk procedures were associated with a fourfold increase in surgical complications among non-frail patients and similarly among frail and severely frail patients. The disparity between high-risk and low-risk procedures was consistently at least four times greater across all outcome measures compared to frailty status alone, with high-risk procedures magnifying the risk of 30-day mortality by eightfold.

Dr Coimbra underscores the urgent nature of many surgeries among elderly patients, attributing it to the delayed seeking of surgical care and surgeons’ reluctance to address issues electively. Delaying minor surgeries could significantly compromise long-term health and quality of life in elderly patients. Consequently, the study authors advocate for a shift in approach, emphasising the importance of early surgical intervention to mitigate the need for emergency surgeries and their associated risks.

The findings underscore the imperative of timely surgical intervention for elderly patients, aiming to circumvent the heightened risks associated with emergency surgeries. Transparent communication and informed decision-making are pivotal in guiding treatment strategies and managing expectations regarding postoperative outcomes in this vulnerable demographic.

More information: Zakhary, Bishoy et al, Procedure Risk vs Frailty in Outcomes for Elderly Emergency General Surgery Patients: Results of a National Analysis, Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001079

Journal information: Journal of the American College of Surgeons Provided by American College of Surgeons