April 2010

Notes from the Section

• Each year our section honors a member who has gone above and beyond, either for the section or on the job, with a Specialty Practitioner of the Year award. Nominations are being accepted now through Aug. 31, so start brainstorming deserving members and then use our ONLINE nomination form to nominate them for this prestigious honor.
• Wondering how much your AARC membership is really worth? Now you can find out. Our new SAVINGS CALCULATOR is a quick and easy way to attach a dollar value to the benefits and services that mean the most to you.

Differences Between CPAP Adherers and Nonadherers
Why do some obstructive sleep apnea (OSA) patients adhere to CPAP treatment while others do not? Researchers publishing in the Mar. 30 Epub edition of Qualitative Health Research asked that question in a new study involving 30 OSA patients who were interviewed post-diagnosis and one week after beginning CPAP therapy. From there, the researchers classified 15 participants with severe OSA as adherent or nonadherent. Results revealed differences in the following beliefs and perceptions among the adherers and nonadherers: OSA risk perception, symptom recognition, self-efficacy, outcome expectations, treatment goals, and treatment facilitators/barriers. “Our findings suggest opportunities for developing and testing tailored interventions to promote CPAP use,” write the authors. READ ABSTRACT

SDB May Affect Children’s Hearts
A new study out of Penn State University has identified a link between sleep disordered breathing (SDB) and impaired cardiac autonomic modulation in children. Researchers looked at a population-based sample of 700 children and a clinically diagnosed sample of 43 children with SDB who underwent one night of polysomnography. About 73% had no SDB, 25.8% had mild SDB, and 1.2% had moderate SDB. Children with moderate SDB in both the population-based and clinically diagnosed sample had a significantly lower mean heart rate variability-high frequency power and a significantly higher low frequency power to high frequency power ratio compared to children without SDB. “SDB in healthy young children and in clinical patients is significantly associated with impaired cardiac autonomic modulation, i.e., sympathetic overflow and weaker parasympathetic modulation, which may contribute to increased risk of acute cardiac events in persons with SDB, even before reaching the ‘high risk age,’” conclude the investigators. The study appeared in the Mar. 31 Epub edition of Sleep Medicine. READ ABSTRACT

ICU Stay Not Necessary for Morbidly Obese LGB Surgery Patients with OSA
The standard practice of admitting morbidly obese patients with OSA to the ICU following laparoscopic gastric bypass (LGB) surgery may be unwarranted, report Wisconsin researchers. They compared the medical records for 585 LGB patients at their facility, which typically admits these patients to the surgical floor. Demographic data were similar between those diagnosed with OSA and those not diagnosed with OSA, and no differences were seen in length of postanesthesia care unit stay, length of hospital stay, or 30-day major complication rates among the two groups. No deaths or ICU admissions for pulmonary complications occurred in either group. The study was published in the March issue of Surgery for Obesity and Related Diseases. READ ABSTRACT

New Perioperative Sleep Apnea Prediction Score
Michigan investigators have developed a perioperative sleep apnea prediction (P-SAP) score they believe can help identify patients at risk for OSA-related surgical complications. The P-SAP score is based on findings from 43,576 adult cases undergoing anesthesia, 3884 of whom had a documented diagnosis of OSA. Independent predictors of an OSA diagnosis were categorized as follows:

• Three demographic variables: age >43 years, male gender, and obesity.
• Three history variables: history of snoring, diabetes mellitus Type 2, and hypertension.
• Three airway measures: thick neck, modified Mallampati class 3 or 4, and reduced thyromental distance.

Results showed excellent sensitivity but poor specificity for a diagnostic threshold P-SAP score > or = 2, and poor sensitivity and excellent specificity for a P-SAP score > or = 6. The P-SAP score was subsequently validated in 512 patients undergoing overnight polysomnography, with similar accuracy. The study appears in this month’s Anesthesia and Analgesia. READ ABSTRACT