Virtual consultations for patients with Obstructive Sleep Apnoea:systematic review and meta-analysis

Background: The COVID-19 pandemic has accelerated the adoption of virtual care strategies for the management of patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome. Research question: What is the effectiveness of virtual consultations compared to in-person consultations for the management of Continuous Positive Airway Pressure therapy in adult patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome? Methods: A systematic review and meta-analysis (PROSPERO; CRD42022297532) based on six electronic databases plus manually selected journals was conducted in January 2022. Two researchers independently selected, quality appraised, and extracted data. The co-primary outcomes were patient-reported sleepiness, assessed by the Epworth Sleepiness Scale, and reported cost-effectiveness. Findings: 12 studies (n=1823 adults) were included in the review. Seven studies (n=1089) were included in the meta-analysis which showed no difference in the magnitude of improvement in patient-reported sleepiness scores between virtual and in-person consultations (MD [95%CI], -0.39 [-1.38 to 0.60]; p=0.4), though Epworth Sleepiness Scale scores improved in both groups. Virtual care strategies modestly increased Continuous Positive Airway Pressure therapy adherence and were found to be less costly than in-person care strategies in the three Spanish trials that reported cost-effectiveness. Conclusion: The findings of this review suggest that virtual care delivered by telephone or video consultations is as effective as in-person consultations for improving subjective sleepiness in patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome treated with Continuous Positive Airway Pressure. This clinical management strategy may also improve Continuous Positive Airway Pressure adherence without increasing the costs, supporting its potential as a follow-up management strategy, where patients prefer this approach

Sleep Quality, Insomnia, Anxiety, Fatigue, Stress, Memory and Active Coping during the COVID-19 Pandemic

Background: The current study aimed to evaluate the impact of the coronavirus (COVID-19) pandemic on sleep quality, insomnia, anxiety, stress, fatigue and active coping in the United States. Methods: This was a cross-sectional study using a publicly available database taken from the Boston College COVID-19 Sleep and Well-Being Dataset. We have selected the most recent data that included information about sleep quality and other measures, including insomnia, anxiety, stress, fatigue and coping, collected between 22 February–8 March 2021. Results: A total of 476 subjects were included in the analysis. The mean (SD) age of the study population was 38.8 (17.8) years, and there were more females (85%) than males. The population had a mean (SD) score of the Pittsburgh Sleep Quality Index (PSQI) of 6 (3.2), with 65% having the prevalence of poor sleep quality (defined as PSQ ≥ 5; n = 311). The mean (SD) score for Insomnia Severity Index (ISI) was 6.9 (5.2), with 55 subjects (11.5%) having clinical insomnia (defined as ISI ≥ 15); of whom 9% had severe clinical insomnia. There were positive correlations between PSQI and ISI (r = 0.76, p < 0.001), PROMIS fatigue scale (r = 0.53, p < 0.001), Generalized Anxiety Disorder-7 (GAD-7) (r = 0.46, p < 0.001), and Perceived Stress Scale (PSS) (r = 0.44, p < 0.001). The PSQI was inversely correlated with the John Henryism Active Coping Scale (JHACS) and memory scale. In the multivariate regression model, JHACS, ISI, fatigue, PSS and GAD-7 were significant predictors of PSQI, and these variables accounted for 62% of the variance of PSQI, adjusted for age and gender. Conclusion: An important contribution to the literature is made by this research, which demonstrates the significant prevalence of poor sleep quality and its association with insomnia and other mental and physical well-being. It also underlines the need to prioritise policy and public health efforts to address sleep issues that have substantial health and economic effects for both individuals and the population at large

Predictors and impact of in-hospital recurrent myocardial infarction in acute coronary syndrome patients: Findings from Gulf RACE-2

IntroductionLittle in the literature is known about the predictors and the adverse impact of recurrent ischemia and infarction in patients with acute coronary syndrome (ACS). Accordingly; our objectives were to determine the risk factors, and long term outcome of patients with recurrent ischemia.MethodsWe evaluated ACS patients who were enrolled in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2).ResultsOut of 7930 ACS patients, 172 (2.2%) developed recurrent myocardial infarction (Re-MI) during their hospitalization. Patients with Re-MI were more likely to be older (mean age 59.12±13.5 vs. 56.8±12.4; P=0.016), had higher rates of hyperlipidemia (41.3% vs. 32.6%; P=0.027) and previous angina (47.7% vs. 37.9%; P=0.006), presented more with STEMI (72.1% vs. 43.9%; P<0.001), and had more Killip class 4 upon admission (8.1% vs. 3.2%; P<0.001) than patients without Re-MI. Management-wise, Re-MI patients received less aspirin (94.8% vs. 98.5%; P=0.002), beta-blockers (59.3% vs. 74.7%; P<0.001), and statin (87.2% vs. 94.9%; P<0.001), and were less frequently assessed by coronary angiogram (30.8% vs. 32.5%; P=0.036). These patients had more in-hospital complications including congestive heart failure (44.2% vs. 12.4%) and cardiogenic shock (25.6% vs. 5.3%) as well as higher mortality rates; both during hospitalization (23.8% vs. 4.1%) and after a discharge period of 30days (27.3% vs. 6.87%) and 1year (29.1% vs. 9.3%). P<0.001 for all comparisons.ConclusionPatients with recurrent infarction have a bad prognosis in terms of in-hospital complications and high mortality rates. High risk patients need to be monitored and managed differently to prevent secondary attacks

Impact of in-hospital recurrent ischemia event: findings from GULF RACE-2

BackgroundLittle in the literature is known about the long term outcome of patients with acute coronary syndrome (ACS) and in-hospital recurrent ischemic event. Accordingly; our objectives were to determine the baseline characteristics of patients, the predictors, and the long term outcome of patients with recurrent ischemia.MethodsThe population compromised 7930 enrolled in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2).ResultsOut of the 7930 ACS patients, 172 (2.2%) had Re-MI during their hospital stay. Patients with Re-MI were more likely to be older (mean age 59.12±13.5 vs. 56.8±12.4, P=0.016), had significantly higher rate of prior history of angina (48% vs. 38.2%, P=0.006), and hyperlipidemia (45.2% vs. 37.3%, P=0.027) than patients without Re-MI. On admission patients with Re-MI had significantly higher HR, lower systolic BP, Killip class 4 and high GRACE risk score than those without Re-MI (27.3% vs. 17.6%), (11% vs. 4.8%), (8.1% vs. 3.2%), and (31.8% vs. 21.5%, P<0.05 for all comparisons), respectively. Patients with Re-MI had a higher rate of STEMI on admission than patients without Re-MI (72.1% vs. 43.9%; P<0.001). Re-MI patients were less likely to receive Aspirin (94.8% vs. 98.5%, P=0.002), beta blockers (95.3% vs. 74.7%, P<0.001), and Statin (87.2% vs. 94.9%, P<0.001) than patients without Re-MI. Coronary angiogram was less frequently performed on patients with Re-MI than patients without Re-MI (30.8% vs. 32.5%, P=0.036). In hospital adverse events including HF, cardiogenic shock, VT/VF were more frequent in the Re-MI group than patients without Re-MI (44.2% vs. 12.4%), (25.6% vs. 5.3%), (7.6% vs. 2.7%; P<0.001 for all comparisons) respectively. In ACS patients with Re-MI in-hospital, 30days and 1year were significantly higher that patients without Re-MI (23.8% vs. 4.1%), (28.1% vs. 7.7%), and (31.6% vs. 12.1%; P<0.001 for all comparisons), respectively.ConclusionRecognizing patients at high risk of Re-MI is important as modifying the risk factors, and managing the patient aggressively may reduce the incidence of such events and the associated morbidity and mortality

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population