August 2011

Mike Runge Takes Over as Section Chair
The AARC Board of Directors has appointed Mike Runge, BS, RRT, FAARC, from St. Alexius Medical Center in Bismarck, ND, to serve out the remainder of Tony Stigall’s term as chair of our section. Tony resigned earlier this summer due to personal reasons. We welcome Mike to the chair position and look forward to his leadership over the coming months.

Summer Bulletin Online Now
The Summer issue of our quarterly Bulletin is ONLINE now, with two great articles: the first looks at health care information security in the sleep center and the second explains how clinical actigraphy studies can add value to your lab.

Acid Reflux Treatment Benefits Patients with Sleep Disorders
Gastroesophageal reflux is common in patients with sleep disordered breathing, and treatment with a proton pump inhibitor (PPI) can help, report Spanish researchers publishing ahead of print in the European Journal of Gastroenterology & Hepatology on July 30. They studied 199 patients who were assessed for abnormal reflux levels in the distal and proximal esophagus, then underwent standard polysomnography. Results showed 72% of the patients had evidence of reflux in the distal esophagus and 46% had evidence in the proximal esophagus. Seventy-eight percent of these patients showed clinical or polysomnographic signs of improvement after 3–6 months of treatment with pantoprazole. Pretreatment pHmetry was a significant predictor of success, with a positive response seen in 67% of those with pathological proximal pHmetry and 55% of those with a pathological distal pHmetry. READ ABSTRACT

Repeat MSLTs Useful in Diagnosing Narcolepsy
Are repeat multiple sleep latency tests (MSLT) useful in patients for whom an initial test is inconclusive for narcolepsy? Yes, find Canadian and Brazilian researchers who looked at 125 patients who had an MSLT between 2004 and 2009. Among that group, ten underwent repeat studies, and two of those patients met narcolepsy criteria during the second test. Nine met sleepiness criteria vs. just five during the initial MSLT. The authors conclude, “We demonstrate that a repeat MSLT confirmed the diagnosis of narcolepsy in 20% of patients whose results had been nonconfirmatory on a first MSLT. This study provides support for a repeat MSLT in cases where clinical suspicion for narcolepsy is high despite an ambiguous first test.” The research appears in this month’s Journal of Clinical Neurophysiology. READ ABSTRACT

OSA Linked to ADHD
U.S. investigators who reviewed the literature on the relationship between obstructive sleep apnea (OSA) and attention deficit/hyperactivity disorder (ADHD) find attentional deficits have been reported in up to 95% of OSA patients, and 20-30% of patients with full syndromal ADHD have OSA. Improvements in behavior, inattention, and overall ADHD were seen in patients who were treated for their OSA. The review involved six interventional studies conducted between January of 1966 and June of 2010. The study appears in this month’s Annals of Clinical Psychiatry. READ ABSTRACT

A-Flex vs. CPAP
A new randomized, double-blinded, 3-arm, multicenter trial looked at the impact of the therapy mode and titration process on efficacy, adherence, and outcomes in 140 patients with sleep apnea. Automatically adjusted positive airway pressure (APAP) with a comfort feature (A-Flex) was compared to both CPAP and APAP for 14 days followed by CPAP at a fixed pressure. Results showed:

• Apnea-hypopnea indices, average and minimum oxygen saturation, and time spent at <90% were significantly poorer for A-Flex vs. CPAP at the initiation of study treatment; with the exception of minimum oxygen saturation, these differences were absent at 180 days.
• A-Flex had lower average leak values at both three and six months.
• No significant differences were seen between the groups in major efficacy, adherence, and outcome measures (subjective sleepiness, objective vigilance, blood pressure, and quality of life).
• No differences were noted in attitudes toward use at three or six months; participant ratings for CPAP were significantly higher than those for A-Flex on treatment satisfaction, and benefit, but similar ratings were seen for sleep quality and mask comfort.