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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 we should be little cautions 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 "fechaRecibido" => "2013-12-03" "fechaAceptado" => "2013-12-06" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pereira H, Xará D, Mendonça J, Santos A, Abelha F. Resposta a “Prevalência de apneia obstrutiva do sono e eventos respiratórios adversos em pacientes cirúrgicos”. Rev Port Pneumol 2013. http://dx.doi.org/10.1016/j.rppnen.2013.08.001,.</p>" ] ] "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. 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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. Gaber-Baylis" 6 => "Mazumdar M:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3182009abf" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2011" "volumen" => "112" "paginaInicial" => "113" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21081775" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000002000000001/v1_201401230023/S2173511514000177/v1_201401230023/en/main.assets" "Apartado" => array:4 [ "identificador" => "20584" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002000000001/v1_201401230023/S2173511514000177/v1_201401230023/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511514000177?idApp=UINPBA00004E" ]
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| 2023 August | 15 | 16 | 31 |
| 2023 July | 15 | 31 | 46 |
| 2023 June | 16 | 11 | 27 |
| 2023 May | 23 | 18 | 41 |
| 2023 April | 8 | 7 | 15 |
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