October 2012
Section Meeting Scheduled for New Orleans
If you’ll be in New Orleans, Nov. 10–13, for AARC CONGRESS 2012, be sure to attend our section membership meeting. We’ll be gathering on Sunday from 4:30–5:00 p.m. Check your program onsite for the room number.
AAP Revises Pediatric OSAS Guideline
The American Academy of Pediatrics (AAP) has revised its clinical practice guideline for the diagnosis and treatment of uncomplicated obstructive sleep apnea syndrome (OSAS) in otherwise healthy children. Recommendations include:
- All children/adolescents should be screened for snoring.
- Polysomnography should be performed in children/adolescents with snoring and symptoms/signs of OSAS; if polysomnography is not available, then alternative diagnostic tests or referral to a specialist for more extensive evaluation may be considered.
- Adenotonsillectomy is recommended as the first-line treatment of patients with adenotonsillar hypertrophy.
- High-risk patients should be monitored as inpatients postoperatively.
- Patients should be reevaluated postoperatively to determine whether further treatment is required. Objective testing should be performed in patients who are high risk or have persistent symptoms/signs of OSAS after therapy.
- CPAP is recommended as treatment if adenotonsillectomy is not performed or if OSAS persists postoperatively.
- Weight loss is recommended in addition to other therapy in patients who are overweight or obese.
- Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated or for mild postoperative OSAS.
READ GUIDELINE
Insomnia Ups Risk for Resistant Hypertension
Italian researchers presenting at the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions report insomnia can have serious consequences for people with hypertension. They looked at the sleeping patterns of 234 hypertension patients, most of whom slept for six hours a night or less. Those who reported poor sleep quality were twice as likely as others to have resistant hypertension, and women were more likely to report poor sleep quality than men. READ PRESS RELEASE
Melatonin May Counteract Sleep Effects of Beta Blockers
A new study from Boston researchers finds repeated treatment with melatonin can help relieve insomnia among hypertensive patients being treated with beta blockers. The authors decided to study the use of melatonin in this patient population because previous studies have shown that beta blocker treatment can increase the risk for insomnia. In this study, 16 hypertensive patients on beta blockers underwent two, four-day in-laboratory admissions that included polysomnography. Patients were randomized to 2.5 mg. melatonin or placebo nightly for three weeks after the first admission. Sleep was reassessed during the second admission. Results showed significantly increased total sleep time for the patients who received melatonin during the three week treatment period. Sleep efficiency was increased as well, and sleep onset latency was decreased to Stage 2. Sleep onset latency remained shortened on the night after discontinuing melatonin, leading the researchers to conclude there was no rebound effect during withdrawal of the drug. The study appears in this month’s Sleep. READ ABSTRACT
CPAP Cuts Cardiovascular Deaths in Older People with Severe OSA
Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular death in middle-aged subjects. Now Spanish researchers find it is a risk factor in those age 65 or over as well. What’s more, treatment with CPAP can reduce the risk. The investigators arrived at those conclusions after conducting a prospective, observational study of 939 patients with suspected OSA who were followed for a median of 69 months. Patients who were diagnosed with mild-to-moderate or severe OSA and were compliant with their CPAP treatment were less likely to die of cardiovascular conditions than those who were noncompliant or not prescribed CPAP. The finding was strongest for those diagnosed with severe OSA. “Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk,” write the authors. The study was published ahead of print by the American Journal of Respiratory and Critical Care Medicine on Sept. 13. READ ABSTRACT
