Sleep Section eNews

September 2009

Notes from the Section

National Respiratory Care Week is just around the corner—Oct. 25–31—and the section encourages everyone to get involved in the celebrations. You can find everything you need to plan your events HERE.
The 2009 AARC International Respiratory Congress in San Antonio, Dec. 5–8, will feature a wealth of information for sleep therapists. Discounts on registration are available until Oct. 31, so VISIT THE WEB PAGE and take advantage of the savings today.
Kudos to Section Member Valerie O. Cornelius, RRT-SDS, RPSGT. Valerie took the NBRC’s new sleep exam in May, and the BRPT exam in July, and passed both with flying colors! (If you’d like to receive recognition for a sleep-related accomplishment, E-MAIL it to section chair Sheri Tooley-Peters.)

Mayo Clinic Experience with UPPP for OSA
Mayo Clinic investigators are publishing their experience with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA) in this month’s Mayo Clinic Proceedings. The study involved 63 patients who underwent polysomnography within six months before and after surgery. Results show:

Fifteen patients (24%) achieved a surgical cure.
Twenty-one patients (33%) had a postoperative AHI of 10 or less, whereas 32 (51%) achieved a 50% or greater reduction in AHI and/or an AHI of 20 or less.
No significant changes were noted in body mass index (BMI) before and six months after UPPP.
Patients who attained an AHI of 5 or less were younger, had lower BMIs, and had less severe OSA.
Of the 48 patients (76%) with a post-UPPP AHI greater than 5, 35 (56%) received continuous positive airway pressure, with a mean reduction in pressure of 1.4 cm H2O.

READ ABSTRACT

PAP Therapy: Why Patients Don’t Comply, and What Providers Can Do About It
A new review from Arizona researchers is helping to explain why patients fail to adhere to PAP therapy for OSA and what health care providers can do to improve compliance. Their study identifies several factors consistently associated with poor PAP compliance, including asymptomatic individuals, nasal obstruction, low self-efficacy, lack of risk perception, and lower socioeconomic status. Research shows good results for interventions such as cognitive-behavioral therapy, intensive education and support, and reduction of nasal obstruction. However, the benefits of device or interface modifications are not as clear. Care by certified specialists and accredited centers has shown positive results, but the findings need to be replicated. The report appeared in the Aug. 26 Epub edition of Current Opinion in Pulmonary Medicine. READ ABSTRACT

CPAP Results in Better Sleep for Alzheimer’s Patients with OSA
CPAP therapy can help Alzheimer’s patients with OSA get a better night’s sleep. That’s the take home message from University of California San Diego researchers who conducted a randomized placebo-controlled trial consisting of three weeks of therapeutic CPAP (tCPAP) vs. three weeks placebo CPAP (pCPAP) followed by three weeks tCPAP. The study involved 52 patients. After the first night of treatment, the tCPAP group had a significantly lower percentage of Stage 1 sleep and a significantly higher percentage of Stage 2 sleep than the pCPAP group. Three weeks of tCPAP resulted in significant decreases in wake time after sleep onset, percentage of Stage 1 sleep, and arousals, and an increase in the percentage of Stage 3 sleep. The research was published in the Aug. 19 edition of Sleep Medicine. READ ABSTRACT

Dexmedetomidine vs. Propofol for MRI Sleep Studies in Children
Dexmedetomidine may have significant advantages over propofol when conducting magnetic resonance imaging (MRI) sleep studies in children with OSA refractory to conservative therapy. According to researchers from Cincinnati Children’s Hospital Medical Center who reviewed the records of 52 children receiving dexmedetomidine and 30 children receiving propofol for anesthesia during MRI sleep studies:

An interpretable MRI sleep study was obtained for 98% of children in the dexmedetomidine group and 100% in the propofol group.
The studies were successfully completed without the use of artificial airways in 46 children (88.5%) in the dexmedetomidine group versus 21 children (70%) in the propofol group.
An artificial airway was required to complete the study in five children (12%) in the dexmedetomidine group vs. nine children (35%) in the propofol group.
Additional airway maneuvers (chin lift and shoulder roll) were required to complete the study in one child (2%) in the dexmedetomidine group and three children (10%) in the propofol group.
Children in the dexmedetomidine group experienced reductions in heart rate, whereas those in the propofol group experienced reductions in arterial blood pressure; these reductions were statistically, but not clinically, significant.

The investigators conclude, “Dexmedetomidine may be the preferred drug for anesthesia during MRI sleep studies in children with a history of severe OSA and may offer benefits to children with sleep-disordered breathing requiring anesthesia or anesthesia for other diagnostic imaging studies.” The study appears in this month’s Anesthesia and Analgesia. READ ABSTRACT