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Reply to “Obstructive sleep apnea prevalence and adverse respiratory events in surgical patients”
Resposta a “Prevalência de apneia obstrutiva do sono e eventos respiratórios adversos em pacientes cirúrgicos”
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We choose STOP questionnaire because it has been considered a practical step forward in identifying patients with OSA and because of the known sensitivity and specificity in diagnosing OSA. We agree that we may have a lower incidence of OSA patients compared to the report incidence of High Risk of OSA patients. That is why we reported the results of our study considering a group of patients we have named specifically High Risk of OSA because we agree we could not confirm the OSA diagnosis in all patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Indeed HR-OSA was not a risk factor for Acute Respiratory Events considered as a unique group; in our study only mild/moderate hypoxia had a higher incidence in HR-OSA patients. We agree with you and that is stated in discussion section “there was a greater risk of postoperative hypoxemia in HR-OSA patients in comparison with those without the diagnosis. However, in our study…analysis of perioperative adverse events did not show significant respiratory morbidity in HR-OSA patients compared to the LR-OSA patients. In fact in our study we did not find that HR-OSA was a determinant for ARE.”</p><p id="par0015" class="elsevierStylePara elsevierViewall">We think that we should be little cautious concluding “previous papers have shown that OSA itself is associated with a statistically significant higher incidence of respiratory complications” or at least understand some limitations of these studies. In fact there are studies (by Liao Pu<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and Gupta RM<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>) that apparently have succeeded in demonstrating that patients with OSA have a higher incidence of postoperative complications compared with matched non-OSA surgical patients. In the study by Liao PU<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Oxygen desaturation with SpO<span class="elsevierStyleInf">2</span> < 90% was also the most common complication but this study has also a limitation with the sampling methodology for group selection that should be addressed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the study of Gupta RM<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the authors concluded that adverse outcomes were more common in OSA patients but the considered outcomes included other complications and even in what concerns respiratory complications they too failed to demonstrate that respiratory complications were more frequent in OSA group of patients. In their study even episodic hypoxia was not more frequent in OSA patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the study by Memtsoudis S<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> OSA was considered an independent risk factor for perioperative pulmonary complications although their considered outcomes were clearly different and the studied respiratory complications were pneumonia, ARDS and respiratory failure. We may think that it is fundamental to verify if these acute events occurring at PACU are related to respiratory failure occurring after discharge from the PACU and perhaps this could be a challenge to future investigation.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patients with a high risk for obstructive sleep apnea syndrome: Postoperative respiratory complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Pereira" 1 => "D. Xara" 2 => "J. Mendonca" 3 => "A. Santos" 4 => "Abelha FJ:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppneu.2013.01.003" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "144" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23731773" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High STOP-Bang score indicates a high probability of obstructive sleep apnoea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Chung" 1 => "R. Subramanyam" 2 => "P. Liao" 3 => "E. Sasaki" 4 => "C. Shapiro" 5 => "Sun Y:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aes022" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2012" "volumen" => "108" "paginaInicial" => "768" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22401881" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Liao" 1 => "B. Yegneswaran" 2 => "S. Vairavanathan" 3 => "P. Zilberman" 4 => "Chung F:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-009-9190-y" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth" "fecha" => "2009" "volumen" => "56" "paginaInicial" => "819" "paginaFinal" => "828" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19774431" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.M. Gupta" 1 => "J. Parvizi" 2 => "A.D. Hanssen" 3 => "Gay PC:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/76.9.897" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2001" "volumen" => "76" "paginaInicial" => "897" "paginaFinal" => "905" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11560300" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Memtsoudis" 1 => "S.S. Liu" 2 => "Y. Ma" 3 => "Y.L. Chiu" 4 => "J.M. Walz" 5 => "L.K. 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| 2022 October | 32 | 30 | 62 |
| 2022 September | 20 | 31 | 51 |
| 2022 August | 28 | 36 | 64 |
| 2022 July | 34 | 51 | 85 |
| 2022 June | 14 | 22 | 36 |
| 2022 May | 37 | 46 | 83 |
| 2022 April | 21 | 32 | 53 |
| 2022 March | 22 | 41 | 63 |
| 2022 February | 28 | 31 | 59 |
| 2022 January | 26 | 34 | 60 |
| 2021 December | 25 | 42 | 67 |
| 2021 November | 24 | 36 | 60 |
| 2021 October | 22 | 36 | 58 |
| 2021 September | 19 | 30 | 49 |
| 2021 August | 18 | 25 | 43 |
| 2021 July | 22 | 25 | 47 |
| 2021 June | 22 | 31 | 53 |
| 2021 May | 24 | 28 | 52 |
| 2021 April | 37 | 47 | 84 |
| 2021 March | 48 | 23 | 71 |
| 2021 February | 44 | 20 | 64 |
| 2021 January | 30 | 20 | 50 |
| 2020 December | 16 | 11 | 27 |
| 2020 November | 35 | 19 | 54 |
| 2020 October | 33 | 18 | 51 |
| 2020 September | 49 | 22 | 71 |
| 2020 August | 59 | 23 | 82 |
| 2020 July | 92 | 24 | 116 |
| 2020 June | 64 | 18 | 82 |
| 2020 May | 77 | 20 | 97 |
| 2020 April | 55 | 11 | 66 |
| 2020 March | 46 | 13 | 59 |
| 2020 February | 49 | 22 | 71 |
| 2020 January | 61 | 17 | 78 |
| 2019 December | 55 | 20 | 75 |
| 2019 November | 54 | 10 | 64 |
| 2019 October | 59 | 14 | 73 |
| 2019 September | 43 | 22 | 65 |
| 2019 August | 87 | 13 | 100 |
| 2019 July | 78 | 72 | 150 |
| 2019 June | 106 | 16 | 122 |
| 2019 May | 72 | 10 | 82 |
| 2019 April | 91 | 17 | 108 |
| 2019 March | 100 | 11 | 111 |
| 2019 February | 117 | 9 | 126 |
| 2019 January | 125 | 22 | 147 |
| 2018 December | 81 | 4 | 85 |
| 2018 November | 23 | 5 | 28 |
| 2018 October | 37 | 7 | 44 |
| 2018 September | 23 | 6 | 29 |
| 2018 August | 31 | 29 | 60 |
| 2018 July | 45 | 21 | 66 |
| 2018 June | 48 | 12 | 60 |
| 2018 May | 73 | 20 | 93 |
| 2018 April | 82 | 16 | 98 |
| 2018 March | 79 | 23 | 102 |
| 2018 February | 65 | 9 | 74 |
| 2018 January | 75 | 11 | 86 |
| 2017 December | 104 | 23 | 127 |
| 2017 November | 51 | 14 | 65 |
| 2017 October | 29 | 14 | 43 |
| 2017 September | 42 | 17 | 59 |
| 2017 August | 29 | 22 | 51 |
| 2017 July | 30 | 23 | 53 |
| 2017 June | 40 | 14 | 54 |
| 2017 May | 35 | 17 | 52 |
| 2017 April | 14 | 8 | 22 |
| 2017 March | 31 | 10 | 41 |
| 2017 February | 14 | 4 | 18 |
| 2017 January | 14 | 3 | 17 |
| 2016 December | 21 | 23 | 44 |
| 2016 November | 12 | 16 | 28 |
| 2016 October | 7 | 5 | 12 |
| 2016 September | 16 | 2 | 18 |
| 2016 August | 10 | 4 | 14 |
| 2016 July | 2 | 8 | 10 |
| 2016 June | 0 | 4 | 4 |
| 2016 May | 2 | 0 | 2 |
| 2016 April | 19 | 2 | 21 |
| 2016 March | 19 | 9 | 28 |
| 2016 February | 19 | 14 | 33 |
| 2016 January | 18 | 14 | 32 |
| 2015 December | 31 | 11 | 42 |
| 2015 November | 18 | 5 | 23 |
| 2015 October | 12 | 4 | 16 |
| 2015 September | 25 | 8 | 33 |
| 2015 August | 18 | 5 | 23 |
| 2015 July | 16 | 7 | 23 |
| 2015 June | 17 | 2 | 19 |
| 2015 May | 27 | 6 | 33 |
| 2015 April | 28 | 9 | 37 |
| 2015 March | 21 | 13 | 34 |
| 2015 February | 19 | 8 | 27 |
| 2015 January | 28 | 12 | 40 |
| 2014 December | 62 | 13 | 75 |
| 2014 November | 23 | 8 | 31 |
| 2014 October | 22 | 12 | 34 |
| 2014 September | 31 | 29 | 60 |
| 2014 August | 35 | 14 | 49 |
| 2014 July | 50 | 16 | 66 |
| 2014 June | 45 | 8 | 53 |
| 2014 May | 36 | 13 | 49 |
| 2014 April | 37 | 25 | 62 |
| 2014 March | 70 | 31 | 101 |
| 2014 February | 58 | 34 | 92 |
| 2014 January | 61 | 24 | 85 |
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