April 2011

New Features Bring Respiratory Care into the Digital Age
Your Section eNews keeps you up-to-date with studies from the medical literature, but when it comes to respiratory care, the Journal is the first place any therapist should turn for the most relevant information. Thanks to some spiffy new features, Respiratory Care is now easier to read than ever before. Take a look at what they’ve added:

  • A podcast with summaries of the papers
  • A DigiMag version you can read on your computer screen or tablet device
  • Papers in HTML format with cross linking to references
  • New papers published ahead of print

Read more about these new features HERE.

EDS, SDB, and Mortality
Researchers publishing in the April 1 issue of Sleep help to explain how excessive daytime sleepiness (EDS) and sleep disordered breathing (SDB) combine to raise the mortality rate among older adults. Noting that EDS, but not SDB, has been linked to increased mortality in this age group, they followed 289 people over the age of 65 for an average of 13.8 years. About half were diagnosed with EDS and half were not. All were free from dementia or depression at enrollment. Results showed those with EDS and SDB (defined at an apnea-hypopnea index ≥ 20 events/hour) had a higher risk of all cause mortality. However, no increased risk was seen in those with EDS alone or SDB alone. “The presence of SDB is an important risk factor for mortality from excessive daytime sleepiness in older adults,” conclude the authors. READ ABSTRACT

EPAP Proves Effective in Treating OSA
A new study conducted among 150 patients at 19 academic and private sleep disorders centers finds good results for a nasal expiratory positive airway pressure (EPAP) device in the treatment of obstructive sleep apnea (OSA). Researchers randomly assigned the patients to either EPAP or a sham device for three months. All the participants underwent polysomnography on two non-consecutive nights, one with the device on and one with the device off, at one week and three months. The median apnea/hyponea index (AHI) value at one week was significantly lower with EPAP, 5.0 events/hour with the device on versus 13.8 events/hour with the device off. No significant difference in AHI was seen during device on and off nights in patients assigned to the sham treatment, 11.6 vs. 11.1 events/hour, respectively. By the three month follow up, the AHI had decreased by 42.7% in the EPAP group and 10.1% in the sham group. Scores on the Epworth Sleepiness Scale decreased with EPAP treatment as well, and participants reported using the device on a median of 88.2% of nights. The study appeared in the April 1 edition of Sleep. READ ABSTRACT

Electrical Stimulation Treatment Produces Good Results
Could transcutaneous electrical stimulation of the genioglossus muscle treat OSA? British researchers asked that question in a study conducted among 11 healthy subjects and 11 patients. Among the results:

  • Ultrasound measurements showed a significant increase in tongue diameter during stimulation; the measurements were reproducible and repeatable.
  • In patients with OSA, snoring decreased during stimulation and oxygenation improved; the respiratory disturbance index fell from 28.1(26.3)/hour to 10.2(10.2)/hour during stimulation, returning to 26.6(26.0)/hour after stimulation was stopped.
  • The transdiaphragmatic pressure swing decreased from 24.1(13.5) cmH2O to 19.7(7.1) cmH2O during stimulation, increasing to 24.2 (10.8) cmH2O afterwards; EMGdi fell from 23.8(12.6)%max to 15.7(6.4)%max, rising to 22.6(10.4)%max post stimulation.

The authors conclude, “Continuous transcutaneous electrical stimulation of the genioglossus contracts the genioglossus muscle and reduces ventilatory load and neural respiratory drive in patients with obstructive sleep apnea.” The study was published ahead of print in CHEST on Mar. 31. READ ABSTRACT

SDB, OSA, Common in Kids with Cleft Palate, Pierre Robin Syndrome
Researchers from the Children’s Hospital of Pittsburgh find a high rate of SDB in children with cleft palate and Pierre Robin syndrome. The study was conducted among 459 cleft palate patients and 48 Pierre Robin patients. Among the cleft palate patients, 37.5% had symptoms of SDB and 8.5% were diagnosed with OSA by polysomnography (PSG). Forty-six of the patients had a total of 59 polysomnograpic studies, and 49 of the studies, or 83.1%, were positive for OSA. Eighty-nine patients had surgery, most commonly combined tonsillectomy and adenoidectomy, to address their SDB and/or OSA. Among patients with Pierre Robin syndrome, 35, or 72.9% had symptoms of SDB and/or OSA. The authors conclude that definitive diagnosis of OSA by PSG is underused in this patient population and that surgical management of SDB and/or OSA should be followed by PSG to demonstrate resolution or persistence of symptoms. The study appeared in the March issue of the Archives of Otolaryngology-Head & Neck Surgery. READ ABSTRACT


 

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