Problem: The risk of serious postoperative cardiovascular and respiratory complications (SPCRCs) in patients with obstructive sleep apnea (OSA) is poorly defined. Methods: In this cohort study (n = 21221), patients with clinically diagnosed OSA were matched to controls without OSA to compare the risk of postoperative death and SPCRCs in an administrative database. Results: Compared to non-OSA controls, OSA patients were at increased risk of postoperative respiratory failure both before and after diagnosis with OSA. Prior to diagnosis, OSA patients, particularly those with severe OSA, were also at increased risk of cardiac arrest and SPCRCs . After diagnosis with OSA, except for postoperative respiratory failure, the risk of SPCRC’s was not different from controls. Also, the risk of postoperative death among OSA patients after diagnosis was not different from controls. Other important predictors of SPCRCs and death included admission in an intensive care unit at the time of surgery, a history of congestive heart failure, a higher Charlson comorbidity index score and the type of surgery. Conclusions: OSA was associated with an increased risk of SPCRCs, especially prior to diagnosis and in severe disease. This suggests that screening for and treating OSA in preoperative patients would reduce the risk of SPCRCs. However, the significant influences of the type of surgery and the presence of medical comorbidities on the risks of SPCRCs and death, regardless of the presence of OSA, must be considered in planning efficient and equitable interventions to reduce these risks.

Problem: The risk of serious postoperative cardiovascular and respiratory complications (SPCRCs) in patients with obstructive sleep apnea (OSA) is poorly defined. Methods: In this cohort study (n = 21221), patients with clinically diagnosed OSA were matched to controls without OSA to compare the risk of postoperative death and SPCRCs in an administrative database. Results: Compared to non-OSA controls, OSA patients were at increased risk of postoperative respiratory failure both before and after diagnosis with OSA. Prior to diagnosis, OSA patients, particularly those with severe OSA, were also at increased risk of cardiac arrest and SPCRCs . After diagnosis with OSA, except for postoperative respiratory failure, the risk of SPCRC’s was not different from controls. Also, the risk of postoperative death among OSA patients after diagnosis was not different from controls. Other important predictors of SPCRCs and death included admission in an intensive care unit at the time of surgery, a history of congestive heart failure, a higher Charlson comorbidity index score and the type of surgery. Conclusions: OSA was associated with an increased risk of SPCRCs, especially prior to diagnosis and in severe disease. This suggests that screening for and treating OSA in preoperative patients would reduce the risk of SPCRCs. However, the significant influences of the type of surgery and the presence of medical comorbidities on the risks of SPCRCs and death, regardless of the presence of OSA, must be considered in planning efficient and equitable interventions to reduce these risks.

Zugl.: Regensburg, Universiẗat, Diss., 2005.

Thesis (M.S.)--West Virginia University, 2008. / Title from document title page. Document formatted into pages; contains vi, 79 p. Includes abstract. Includes bibliographical references.

Thesis (doctoral)--Friedrich-Alexander-Universität zu Erlangen.

Thesis (doctoral)--Universität Heidelberg, 1972. / Bibliography: p. 282-289.

Thesis (doctoral)--Universität Münster i. Westf., 1973. / Includes bibliographical references (p. vi-xi).

Univ., Diss.--Fribourg, 2001.

Background-Emergency 9-1-1 callers use a wide range of terms to describe abnormal breathing in persons with out-of-hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process. Methods and Results-We conducted an observational study of emergency call audio recordings linked to confirmed OHCAs in a statewide Utstein-style database. Breathing descriptors fell into 1 of 8 groups (eg, gasping, snoring). We divided the study population into groups with and without descriptors for abnormal breathing to investigate the impact of these descriptors on patient outcomes and telephone CPR process. Callers used descriptors in 459 of 2411 cases (19.0%) between October 1, 2010, and December 31, 2014. Survival outcome was better when the caller used a breathing descriptor (19.6% versus 8.8%, P<0.0001), with an odds ratio of 1.63 (95% confidence interval, 1.17-2.25). After exclusions, 379 of 459 cases were eligible for process analysis. When callers described abnormal breathing, the rates of telecommunicator OHCA recognition, CPR instruction, and telephone CPR were lower than when callers did not use a breathing descriptor (79.7% versus 93.0%, P<0.0001; 65.4% versus 72.5%, P=0.0078; and 60.2% versus 66.9%, P=0.0123, respectively). The time interval between call receipt and OHCA recognition was longer when the caller used a breathing descriptor (118.5 versus 73.5 seconds, P<0.0001). Conclusions-Descriptors of abnormal breathing are associated with improved outcomes but also with delays in the identification of OHCA. Familiarizing telecommunicators with these descriptors may improve the telephone CPR process including OHCA recognition for patients with increased probability of survival.

Information was collected in an eight and a half month prospective study about 358 recent cardiac disease-related cardiac arrest cases which were attended by personnel from the Provincial Ambulance Service in the Lower Mainland of British Columbia. When possible, advanced life support personnel (EMA Ills), regular ambulance attendants (EMA Ms) and Fire Department staff are dispatched to cardiac arrest calls. At the time of this study some areas in the region did not have advanced life support coverage, and some cardiac arrest calls occurred while the EMA Ills were already engaged with another case. Such calls, attended by EMA lis, but not by EMA Ills, served as the comparison group for paramedic performance in this study. Patient outcomes were compared at admission to hospital and at discharge from hospital for the group of patients treated by EMA Ms and the group of patients treated by EMA Ills, or by a combination of EMA Ills and EMA Ms. Strongly significant differences in initial outcome (hospital admission) were found between the two patient groups, with EMA IM patients faring better (p.=0.002). Marginally significant differences in final outcome (discharge alive) between the two patient groups were found, with the EMA III group again doing better (p.=0.10). Whether or not the receiving hospital had a coronary care unit was not associated with a difference in initial (p.=0.45) or final outcome (p.=1.0) for the entire group of patients in the study. Short time in arrest without CPR was associated with better initial outcome (p.=0.00), and with better final outcome (p.=0.01) for all patients. in the study, as was short time to definitive care (initial outcome p.=0.001; final outcome p.=0.03). EMA II patients had a better chance of survival when they arrested during attendance by EMA lis than they did when they were found in arrest. This study suggests that significantly more cardiac arrest victims reach hospital alive, and more survive to be discharged alive from hospital, when their prehospital treatment is provided by advanced life support personnel than when it is provided by regular ambulance personnel. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate