title: Effect of sedative-hypnotics, anesthetics and analgesics on sleep architecture in obstructive sleep apnea.
abstract: The perioperative care of obstructive sleep apnea (OSA) patients is currently receiving much attention due to an increased risk for complications. It is established that postoperative changes in sleep architecture occur and this may have pathophysiological implications for OSA patients. Upper airway muscle activity decreases during rapid eye movement sleep (REMS). Severe OSA patients exhibit exaggerated chemoreceptor-driven ventilation during non-rapid eye movement sleep (NREMS), which leads to central and obstructive apnea. This article critically reviewed the literature relevant to preoperative screening for OSA, prevalence of OSA in surgical populations and changes in postoperative sleep architecture relevant to OSA patients. In particular, we addressed three questions in regard to the effects of sedative-hypnotics, anesthetics and analgesics on sleep architecture, the underlying mechanisms and the relevance to OSA. Indeed, these classes of drugs alter sleep architecture, which likely significantly contributes to abnormal postoperative sleep architecture, exacerbation of OSA and postoperative complications.
authors.affiliation: Department of Anesthesiology and the Center for Clinical and Translational Science, Creighton University School of Medicine, 601 N. 30th Street, Suite 3222, Omaha, NE 68131, USA.
authors.forename: Dan M
authors.initials: DM
authors.lastname: McEntire
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kirkpatrick
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Kerfeld
authors.forename: Zakary J
authors.initials: ZJ
authors.lastname: Hambsch
authors.forename: Mark D
authors.initials: MD
authors.lastname: Reisbig
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Agrawal
authors.forename: Charles F
authors.initials: CF
authors.lastname: Youngblood
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects; D000818:Animals; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D012890:Sleep / Q000187:drug effects*; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology
chemical_list: D000700:Analgesics; D000777:Anesthetics; D006993:Hypnotics and Sedatives
keywords: analgesia; anesthesia; non-rapid eye movement sleep; obstructive sleep apnea; opioids; preoperative screening; rapid eye movement sleep; sedative–hypnotic; sleep architecture; surgical prevalence