American Association for Respiratory Care
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AARC Sleep Section

November-December 2012

Notes from the Section

  • Congratulations to Karla Smith for receiving our 2012 Specialty Practitioner of the Year Award at AARC Congress 2012 in New Orleans.
  • Read more about Karla in the FALL edition of our Section Bulletin. We also have an informative article on polysomnography education at Stony Brook University in New York.

How Sleep May Affect Weight

Researchers from St. Luke’s-Roosevelt Hospital and Columbia University help to explain the relationship between sleep and obesity in a study published online by the American Journal of Physiology — Regulatory, Integrative and Comparative Physiology in October. The research compared sleep duration and sleep stages to the metabolic rate, hunger, and calorie intake in 27 healthy adults. All the subjects underwent polysomnography during a night of habitual sleep and a night in which sleep was shortened to four hours. For four days following each sleep study their meals were calibrated to meet their energy requirements for weight maintenance; on the fourth day they were asked to rate their hunger. Resting metabolic rate (RMR) was measured in a fasted state on day five, and on days six and seven the participants were allowed to eat whatever they wanted. Compared to habitual sleep length, the short sleep condition resulted in reductions in the duration and percentage of stage 2 and REM sleep and increased the percentage of total sleep time spent in slow wave sleep (SWS). A positive association was seen between stage 2 sleep duration and RMR, and an inverse relation was noted between stage 2 sleep percentage and calories consumed. There was an inverse relationship between REM sleep duration and hunger, and an inverse relationship between the amount of stage 2 sleep and desire for sweet and salty food. Reduced percentage of time spent in REM sleep and SWS was also associated with greater fat and carbohydrate intake. READ PRESS RELEASE

A Cardioprotective Role for OSA?

Obstructive sleep apnea (OSA) has been linked to cardiovascular risk factors, but according to Montefiore Medical Center researchers, it can also protect the heart during the acute phase of a heart attack. The investigators reached that rather surprising conclusion after looking at 136 heart attack patients with adequate sleep data in their facility. Of those, 35% had OSA. Compared to heart attack patients without OSA, these patients had:

  • A lower median level of peak Troponin-T. Troponin-T is a marker in the blood for myocardial cell death that accurately predicts the severity of a heart attack.
  • Lower levels of the enzyme creatine phosphokinase (CPK), which is also found in the blood. High levels of CPK usually indicate injury or stress to muscle mass.

“While our data do not refute a widely accepted view that sleep apnea is a risk factor for the development of a coronary artery disease related event such as a myocardial infarction, our study suggests that obstructive sleep apnea can provide a degree of cardioprotection during the acute phase of a myocardial infarction,” study author Neomi Shah, MD, MPH, was quoted as saying. The study was published in Sleep and Breathing on Oct. 24. READ PRESS RELEASE

CPAP May Improve Sexual Functioning in Men

German investigators who looked at the effect of CPAP treatment on men with OSA and erectile dysfunction (ED) and/or poor overall sexual function find the therapy can improve both ED and overall sexual functioning in these men. The study was conducted among 401 men, 91 of whom returned a valid International Index of Erectile Function questionnaire. These men were similar in baseline characteristics to the group as a whole. All the men suffered from some level of ED or poor sexual function and 91.2% were diagnosed with OSA. Compared to men who did not use CPAP, those with moderate to severe ED, as well as those with poor overall sexual function, experienced an improvement in overall sexual function if they used CPAP. CPAP treatment led to improvements in erectile function in men with moderate to severe ED and low mean nocturnal oxygen saturation as well. The authors conclude, “These data indicate that long-term CPAP treatment of OSA and the related intermittent hypoxia can improve or preserve sexual function in men with OSA and moderate to severe erectile or sexual dysfunction, suggesting a certain reversibility of OSA-induced sexual dysfunctions.” The study was published ahead of print in the Journal of Sex Medicine on Oct. 22. READ ABSTRACT

Practice Parameters for Pediatric Testing

Johns Hopkins researchers share practice parameters for the indications of polysomnography (PSG) and the multiple sleep latency test (MSLT) in the assessment of non-respiratory sleep disorders in children in a report published in the Nov. 1 edition of Sleep. According to the authors:

  • PSG is indicated for children suspected of having periodic limb movement disorder (PLMD) for diagnosing PLMD. (STANDARD)
  • The MSLT, preceded by nocturnal PSG, is indicated in children as part of the evaluation for suspected narcolepsy. (STANDARD)
  • Children with frequent NREM parasomnias, epilepsy, or nocturnal enuresis should be clinically screened for the presence of comorbid sleep disorders and polysomnography should be performed if there is a suspicion for sleep-disordered breathing or PLMD. (GUIDELINE)
  • The MSLT, preceded by nocturnal PSG, is indicated in children suspected of having hypersomnia from causes other than narcolepsy to assess excessive sleepiness and to aid in differentiation from narcolepsy. (OPTION)
  • The polysomnogram using an expanded EEG montage is indicated in children to confirm the diagnosis of an atypical or potentially injurious parasomnia or differentiate a parasomnia from sleep-related epilepsy. (OPTION)
  • Polysomnography is indicated in children suspected of having restless legs syndrome (RLS) who require supportive data for diagnosing RLS. (OPTION)
  • Polysomnography is not routinely indicated for evaluation of children with sleep-related bruxism. (STANDARD)

The practice parameters were reviewed and approved by the American Academy of Sleep Medicine. READ ABSTRACT

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