- The objective of this study was to evaluate the association between a moderate to high risk patients of OSAS and postoperative cognitive dysfunction after volatile anesthesia.. - Patients were screened using the STOP-BANG test with score of 3 or higher indicating moderate to high risk of OSAS. - Results: Twenty-three of the 46 analyzed patients were identified with a moderate to high risk of OSAS. - While the moderate to high risk group scores increased postoperative in the DemTect test, they decreased in the low risk group ( p <. - When comparing the changes between groups, the moderate to high risk patients showed significant better test result for DemTect testing after anaesthesia. - Conclusion: Compared to low risk, a moderate to high risk of OSAS based on the STOP-BANG score was associated with improved postoperative cognitive function measured by the DemTect test.. - The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. - If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. - Though studies tried to define key factors in the development of POCD, its precise pathogenesis and the underlying mechanisms are still unclear [4].. - In the light of basically unchanged study setting under the permis- sion of a “general anesthesia” setting a new ethical vote of the local Ethics committee was dispensable.. - More patients were screened than were ultimately included in the study, as not every pa- tient screened wanted to take part in the study. - to the OSAS pathogenesis of one study arm patients have been enrolled in the otorhinolaryngology clinic.. - Thus, if the resulting composite score (range 0 to 8) in our study was 3 or higher, the patient was included into the moderate to high risk group, otherwise the. - If the pa- tients fit the specific study criteria prior surgery, they were asked to participate in the study. - Additional oxygen was supplied in the recovery room if necessary to raise oxygen saturation and patients were completely weaned of oxygen support before discharge and transfer to a regular ward. - Focusing on the postoperative phase, low risk patients were monitored in the recovery room continuously for at least 2 h. - However, patients in the moderate to high risk group were monitored overnight according to our hospital’s clinical security guidelines on an intermediate care station by telemetry.. - The time which is needed in the test setting is age ad- justed for interpretation. - The sub scores of “digit-span for- ward”, “digit-span backward” and of the subgroups defined in the SKT were included in the analysis as a dependent value. - Outliers were identified using the Grubbs test and were not included in the further data analysis. - The patients allocated to the moderate to high risk group had a higher score in the STOP-BANG test and therefore a higher risk for OSAS as compared with the pa- tients in the low risk group. - The average age was some- what higher in the moderate to high risk group, while the percentage of males and the BMI was significantly higher in the moderate to high risk group than in the low risk group. - Obesity and male sex are risk factors for sleep apnea, both parameters are used to identify patients with a high susceptibility to suffering from OSAS in the STOP- BANG questionnaire. - The body mass index (BMI) was significantly higher in the moderate to high risk group.. - Analyzing further questionnaire items, the moderate to high risk group showed a significantly higher proportion of arterial hypertension, DM and medication with beta- blocker (p = 0.047) or ACE/AT1 inhibitors (p = 0.047), with higher ASA physical status. - Nicotine use was found in the moderate to high risk group significantly more fre- quent than in the low risk group (p = 0.041). - The main type of surgery was otorhinolaryngologic surgery and no significant differences regarding dosage and anesthesia procedure between the moderate to high risk and the low risk group were noticed (Table 1).. - How- ever, a clearly more pronounced desaturation in the moderate to high risk subjects after transfer to the re- covery room was found (Table 2). - Within the same period of time moderate to high risk pa- tients decreased more pronounced in comparison to the low risk group while approaching to the recover- ing room ( p = 0.073). - Serious hyp- oxic episodes with a duration of ≥ 1 min and decrease to values lower than 90% were detected in 6 low risk patients and in 4 moderate to high risk patients. - In both groups we found postoperative hypoxic episodes in 17 low risk patients and in 22 moderate to high risk patients. - The overall decrease of oxygen satur- ation was more accentuated in the moderate to high risk than in the low risk group.. - Low risk (n . - Moderate to high risk (n lt. - While the DemTect result decreased in the low risk group, the result in the moderate to high risk group was unchanged.. - The preoperative test values between both groups did not differ significantly, whereas, postoperatively, signifi- cant differences between both groups were found for the DemTect, where the patients in the low risk group showed significantly worse results in comparison to the moderate to high risk group (p = 0.013). - In contrast, the patients in the moderate to high risk group showed a significant de- crease in the SKT test system only (p = 0.001) as well as a tendency increase in the DemTect test (n.s. - The aim of this study was to test for possible beneficial associations from intrinsic hypoxemic episodes in pa- tients with a moderate to high risk for OSAS on early postoperative cognitive deficits after non-cardiac surgery using volatile anesthesia. - When comparing the two study groups, we discovered a significant difference between both groups in the DemTect test regarding the. - preoperative to postoperative testing phase in favor of the moderate to high risk of OSAS group.. - We found an isolated significant change between moderate to high risk and low risk group patients in respect to the pre- and postoperative period in the DemTect Test. - Sur- prisingly, the low risk group showed a significant de- crease of test performance, in the moderate to high risk group a tendency to increased values was observed. - Test values for digit span backwards testing in the low risk group demon- strated significant better results in the early post- operative testing phase.. - One possible explanation is the difference in the test construction. - Test Low risk group Moderate to high risk group. - It is commonly accepted that moderate to high risk patients exhibit limited cognitive ability and deficits in the quality of psychomotor speed and executive func- tion, while memory functions, motor control,. - However, other studies com- paring moderate to high vs. - There re- mains controversy about the cognitive performance of moderate to high risk patients and the grade of cognitive impairment. - Pre low risk Pre moderate to high risk. - Post low risk Post moderate to high risk. - Test Low risk Moderate to high risk P MWU P ANOVA. - This might be explained by the fact that the detected STOP-BANG Score for moderate to high risk suspect patients averaged 4 in comparison to a score of 5 in the cited study. - Taking these variations into account the present work reflects an overall high probability for the moderate to high risk group compared with low risk patients. - Following this concept, the moderate to high risk group might not show a decrease in cognitive performance even if the DemTect test reveals small changes in cogni- tive function. - Moreover, the mod- erate to high risk group gained statistically the same values as the low risk group. - While low risk patients elicited a significant decrease in test results the moderate to high risk patients demon- strated an increased in their test score. - Thus 79% of low risk patients and 96% of moderate to high risk patients presented a. - Although this phenomenon is unwanted, it appears regularly in the perioperative set- ting and is a well-known complication after the oper- ation process [38, 39]. - Bayer and colleagues report a significant improvement in DemTect test and Clock Drawing Test values in the treated group while the low risk group failed to improve their test results.. - Thus, we used the STOP- BANG questionnaire to identify patients with a moder- ate to high risk for OSAS in the current study. - Furthermore, we supposed that the patients in our moderate to high risk group were at least suspected of being affected to inter- mittent hypoxemic episodes while sleep.. - A two-way ANOVA with sex and group as fac- tors revealed that the observed differences in the change of the cognitive function could be attributed to the fac- tor group whereas sex did not show a significant effect.. - Therefore, we think that the chance for a type I error with regard to the isolated finding in the DemTect test is low.. - Short-term hypotension phases between the measurement intervals might remained undetected and even minor periods of hypotension are clearly associated with worse cognitive function in the postoperative phase. - In the present study, we aimed to evaluate the in- fluence of repeated hypoxic phases while asleep in pa- tients with a high probability for moderate to high risk group. - We used an assessment battery to evaluate cognitive func- tion and found that the scores in the moderate to high risk group were almost the same as in the low risk group. - With exception in the DemTect test which showed a significant better result for the mod- erate to high risk group in the postoperative testing phase in comparison to the low risk group. - The post- surgery scores in the moderate to high risk group were mainly the same as preoperatively regarding the. - Likewise, these results have been found in the low risk group. - Each patient read and signed a consent form before enrolment in the study.. - https://doi.org/10.1213/ANE.. - doi.org/10.3389/fnagi . - https://doi.org . - https://doi.org/10.1016/j.exger . - https://doi.org/10.1097/ACO . - https://doi.. - https://doi.org/10.1007/s . - https://doi.org/10.1017/S . - https://doi.org/10.1016/j.patbio . - https://doi.org/10.1016/S . - https://doi.org/10.1016/j.pneurobio . - A high risk of sleep apnea is associated with less postoperative cognitive dysfunction after intravenous anesthesia: results of an observational pilot study. - https://doi.org/1 0.1186/s . - https://doi.org/10.1016/j.nrl . - https://doi.org/10.1016/j.. - https://doi.org/10.1055/s . - https://doi.org/10.1076/. - https://doi.org/10.1016/j.smrv . - Ischemic preconditioning in the intensive care unit. - https://doi.org/10.1 016/j.advms . - Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. - Ventilatory pattern and associated episodic hypoxaemia in the late postoperative period in the general surgical ward. - https://doi.org/10.1046/j x.. - https://doi.org/10.1097/MD.. - https://doi.org/10.1093/bja/aes022.. - https://doi.org/10.1590/. - https://doi.org/10.1371/journal.. - The Hidden Epidemic of Cognitive Dysfunction in the Older Surgical Patient. - Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring. - https://doi.org/10.1016/j.jclinane
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