An AI-supported diagnostic tool for obstructive sleep apnea patients based on delta-alpha connectivity at the sensorimotor cortex [Abstract]

Background: The modulation of delta-alpha phase-amplitude cross-frequency coupling (PACFC) may influence information processing throughout the human cerebral cortex. We investigated whether this frequency band-specific modulation is impaired in patients with obstructive sleep apnea (OSA). Patients & Methods: In this study, the C3- and C4- electroencephalographic recordings of 170 participants (86 in main dataset: age 27-84 years, 44 subjects had moderate or severe OSA with respiratory disturbance index RDI>15/h; 84 in validation dataset: age 35 -75 years, 42 subjects with RDI>15/h) who underwent full-night polysomnography (PSG) were evaluated. We tested if the delta-alpha PACFC modulation index (MI) at the sensorimotor cortex differs between OSA patients with RDI>15/h and those with RDI≤15/h in distinct sleep stages. Further, by making use of a Support Vector Machine (SVM) algorithm, we tested if the sleep stage – specific MIs could predict RDI values of OSA patients. Results: In both datasets, in OSA patients with RDI >15/h, the delta-alpha CFC-MI was significantly (p< 0.05) reduced at the sensorimotor cortex during REM and NREM1 stages, while increased during NREM2 compared to patients with RDI ≤15/h. In addition, the delta-alpha MI in REM sleep stage could provide with use of an SVM algorithm a quite reliable (82% accuracy) prediction of the RDI in OSA patients. Conclusions: This increase in disconnection at the cortical sensorimotor areas with increasing respiratory distress during sleep further supports the concept of a cortical sensorimotor dysfunction in OSA patients. Additionally, the delta – alpha MI during REM sleep may provide an objective neurophysiologic surrogate marker of respiratory distress in OSA patients

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research