October 2007

Section Meeting Scheduled for Congress
Section members are encouraged to be on hand for our annual business meeting at the AARC Congress. We’ll be gathering on Sunday, December 2, at 11:20 a.m., with Section Chair Tom Smalling presiding. Bring your questions and concerns and plan to take part in the discussions.

MedCAC Hears From Industry on Home Sleep Testing
A Medicare Evidence Development & Coverage Advisory Committee (MedCAC) panel heard from industry leaders last month on the advisability of adopting home testing for the diagnosis of obstructive sleep apnea (OSA). The American Academy of Sleep Medicine spoke against such a policy, noting laboratory polysomnography is more widely available than believed and scientific evidence in support of portable monitoring for OSA is lacking. Others contended that home testing is needed and has proven sensitivity and specificity. The MedCAC panel is expected to make a recommendation on portable testing by December 14. READ ARTICLE

Lack of Sleep Leads to Hypertension in Women
Fewer hours of sleep was linked to a greater risk of hypertension in a new study published in the October issue of Hypertension. But the finding was only true for women. The research analyzed data on more than 20,000 people in the United Kingdom over a 20 year period. Women who reported sleeping five hours a night or less were significantly more likely to be diagnosed with hypertension than women who reported sleeping seven hours. READ ARTICLE READ ABSTRACT

Study Looks at CSA on Initiation of CPAP
Central sleep apnea (CSA) can occur in obstructive sleep apnea (OSA) patients upon initiation of CPAP. Now Australian researchers have identified risk factors for this condition. Their study of 99 consecutive patients who were referred for CPAP titration due to a primary diagnosis of OSA showed 13 had a CSA index of ≥5 per hour at or near the prescribed CPAP level. These patients were defined as the CSA-CPAP group. Forty-six of the patients had evidence of CSA on their baseline PSG compared to just 8 percent in the no CSA group. These patients also had a higher apnea-hypopnea index, higher arousal index, and higher mixed apnea index on their baseline PSGs. Therapeutic CPAP could not be determined in 2 CSA-CPAP patients due to a very high frequency of severe central apneas, and in the remaining 11, the CPAP prescription was higher than in the no CSA-CPAP group. Patients in the CSA-CPAP group were more likely to have a history of ischemic heart disease or heart failure as well. The study appeared in the August 15 issue of the Journal of Clinical Sleep Medicine. READ ABSTRACT

New Surgical Option for OSA
Researchers from Thomas Jefferson University in Philadelphia have developed a new surgical procedure that might be an option for some OSA patients who cannot tolerate CPAP. Known as genial bone advancement trephine (GBAT), the procedure involves the surgical advancement of a small portion of the lower jaw that attaches to the tongue. Using a small titanium plate to affix the bone, physicians can pull the tongue away from the back of the airway to facilitate breathing. Most patients recover in two weeks, and since the surgery is done inside the mouth, no outward scars are left. Because only a small part of the jaw is advanced, dental occlusion is not a problem. READ ABSTRACT