SLEEP APNEA- Common among Acute Respiratory failure survivor

 

A recent examination was conducted among a small group of acute respiratory failure survivors to understand their problem of insomnia, including sleep apnea as insomnia is a frequent complaint among survivors of critical illness.

The study involved a small group of about 20 patients with acute respiratory failure. These patients an acute need for at least 48 hours of mechanical ventilation. The evaluation included the Insomnia Severity Index and in-home level II overnight polysomnography three months after hospital discharge. Sleep-disordered breathing was evaluated with the Apnea-Hypopnea Index (AHI) and the Respiratory Distress Index (RDI). The AHI is used to measure the average number of apneas (breathing cessations) and hypopneas (partial obstructions) per hour. The Respiratory Distress Index (RDI) is used to measure the average number of respiratory disturbances per hour. An RDI of 15 or greater is considered clinically relevant to sleep quality and daytime function and an AHI of 15 or greater can be a risk factor for cardiovascular morbidity.

Among the patients who underwent polysomnography, the majority met criteria for clinically-relevant sleep apnea, with 90% having an RDI of 15 or greater and 70% having an AHI of 15 or greater. The Oxygen desaturations were generally mild. So, Insomnia severity did not significantly correlate with the presence of sleep-disordered breathing.

It was observed that some patients had clinically significant sleep apnea despite their lack of sleep complaints. So, it was concluded that evaluating and treating sleep apnea may significantly impact the health and well-being of these patients. It was also concluded that the incidence and severity of sleep apnea observed among acute respiratory failure survivors are a cause for concern.

In the study, it was observed that trauma was the triggering event for acute respiratory failure in 58% of patients. In the provided report, 30% were actively taking an opiate pain medication at the time of testing. Opiate medication can worsen sleep apnea by reducing upper airway tone and central respiratory drive. Hence the results suggested that sleep apnea is common after acute respiratory failure, with central-acting medications serving as one of the potential contributors.