EC Emergency Medicine and Critical Care

Introduction: In Obstructive sleep apnea, the upper airway is compromised during sleep leading to episodes of apnea and hypopnea. The condition is more pronounced while sleeping supine and is more common among middle-aged obese males. A sedentary lifestyle, smoking and consumption of alcohol can predispose to OSA. Moreover, chronic sleep apnea also predisposes to several metabolic and cardiovascular disorders. In this review, we shall discuss the various modalities of managing OSA and their prognosis.

Aim of Work: The aim of this study is to discuss the management and prognosis of OSA.

Materials and Methods: Comprehensive research of obstructive sleep apnea. PUBMED search engine were the mainly used database for search process, articles collected from the year 1991 to 2020 relating to obstructive sleep apnea. The term used in search were: obstructive sleep apnea - sleep apnea - hypopnea.

Conclusion: Sleep apnea is prevalent due to anatomical obstruction of the airway of many affected individuals during sleep. It can predispose to many cardiovascular and metabolic disorders. Several methodologies of management, ranging from simple aerobic exercises to complex surgical procedures, have been incorporated into practice. A detailed history of OSA, a thorough investigation and a proper treatment plan can successfully manage most cases.

Keywords: Obstructive Sleep Apnea; Sleep Apnea; Hypopnea

Introduction: Actually, endotheliitis is considered to be prominent in hypoxemic COVID-19 patients. Sulodexide (glycosaminoglycan with endothelial protective, vascular anti-inflammatory and antithrombotic activities) was identified to be helpful in this cases. The aim of this study was to evaluate the effect of sulodexide supplementation in severe SARS-CoV-2 pneumonia and to determine its impact on prognosis.

Methods: A two-arm interventional clinical study in the Intensive Care Unit (ICU) from April 2021 to December 2021, approved by the Ethics Committee. Consenting COVID-19 patients over the age of 18 are included. Two groups were identified: Group 1 (G1) the intervention group and group 2 (G2) the control group. Consenting COVID- 19 patients over 18 years were included. Two groups were identified: Group 1 (G1) interventional group and group 2 (G2) control. Sulodexide (500 LSU) was given for 21 days from the first day of ICU admission to discharge. There are no conflicts of interest to declare. Epidemiological and evolving data were analyzed. The study was conducted anonymously. No conflict of interest to be declared.

Results: A total of 149 patients with severe SARS-CoV-2 pneumonia were included during the study period. Seventy patients agreed to participate in the clinical study (G1). The rest were defined as the control group. On admission, the two groups were comparable in terms of demographic characteristics, clinical presentation, and initial severity. Comparison of outcome parameters showed that group 1 patients had fewer thromboembolic complications (23.1% vs. 39.6%, p = 0.016), required invasive mechanical ventilation (16.8% vs. 36%), with lower mortality (19% vs 36%, p = 0.047). In G2, cardiovascular complications were found in hospital (37% vs 12%). Multivariate analysis showed that sulodexide use was an independent protective factor against thromboembolic events. There were no significant differences in terms of bleeding complications’ occurrence, hemodynamic instability, incidence of healthcare-associated infections, barotrauma complications and length of ICU stay. Multivariate analysis showed that sulodexide use was an independent protective factor against thromboembolic events (OR=0,57; IC a` 95% [0.6-0.8]; p = 0,04). Follow-up of patients after three months of discharge, showed no differences in terms of cardiovascular complications, or post-COVID effects.

Conclusion: In this study, sulodexide appeared to reduce the risk of thromboembolism and cardiovascular complications in severely ill COVID-19 patients without affecting the bottom line. This benefit, if identified, could improve clinical outcomes and reduce the need for hospital care to assess for COVID19. Further prospective, multicentre studies with endothelial function studies are needed to confirm this contribution.

Keywords: COVID-19; Sulodexide; Acute Respiratory Distress; Intensive Care Unit; Outcome

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