January 2013

Join. Renew. Win.

The AARC has launched a new membership drive for 2013, so CLICK OVER NOW to see what it’s all about and then share the link with your colleagues who are not yet members of the Association. They’ll be eligible for some great prizes if they join – and you will be too when you renew your membership in your professional organization. There’s a little friendly competition going on between the states to see who can grow by the most members and largest percentage of members from now through Oct. 31 too.

Adding Acetazolamide to Auto-CPAP Reduces OSA Symptoms at Altitude

High altitudes can exacerbate obstructive sleep apnea (OSA) symptoms, but adding the respiratory stimulant acetazolamide to treatment with auto-CPAP can help. That’s the take home message from a new study conducted among 51 OSA patients in Switzerland who lived at an altitude below 800 meters but were tested a university hospital at 490 meters and resorts in Swiss mountain villages at 1630 meters and 2590 meters in the summer of 2009. Patients were randomized to receive either auto-CPAP plus acetazolamide or auto-CPAP plus placebo. Higher oxygen saturation and a lower apnea/hypopnea index were seen at both 1630 and 2590 meters for patients in the combination therapy group, with auto-CPAP/acetazolamide increasing the median nocturnal oxygen saturation by 1% at 1630 meters and 2% at 2590 meters. The median apnea/hypopnea index was 5.8 events per hour and 6.8 events per hour in the combination therapy group vs. 10.7 per hour and 19.3 per hour in the control group, respectively. Median time spent during the night with oxygen saturation less than 90% at 2590 meters was 13% vs. 57%. The study was published in the Dec. 12 edition of JAMA. READ PRESS RELEASE

SDB, Sleep Behavioral Problems Linked in Kids

Sleep disordered breathing (SDB) and sleep-related behavioral problems like waking up repeatedly at night often go hand in hand in children, report Yeshiva University researchers publishing in the Dec. 4 online edition of Behavioral Sleep Medicine. They reached that conclusion after analyzing data from the Avon Longitudinal Study of Patients and Children conducted among more than 11,000 children age 18 months to five years in the United Kingdom. Parents reported their child’s snoring and apnea at 18, 30, 42, and 57 months of age and were also asked whether their child refused to go to bed, regularly woke early, had difficulty sleeping, had nightmares, got up after being put to bed, woke in the night, or awakened after a few hours. Children with five or more of these behaviors simultaneously were considered to have a clinically significant behavioral sleep problem. The prevalence of behavioral sleep problems over the 18- to 57-month age reporting period ranged from 15-27%, with a peak at 30 months of age. Among children with behavioral sleep problems, 26-40% had habitual SDB, again peaking at 30 months. Among children who had habitual SDB, 25-37% also had a behavioral sleep problem, peaking once more at 30 months. The researchers don’t believe behavioral sleep problems cause SDB, however, it is likely that SDB can lead to behavioral sleep problems. “There’s ample evidence that anything that interrupts sleep can negatively affect a child’s emotional, cognitive, behavioral, and academic development,” study author Karen Bronuck, PhD, was quoted as saying. “Fortunately, snoring and apnea are highly treatable, and there are many effective interventions for behavioral sleep problems.” READ PRESS RELEASE

New Tool Measures Up to ESS

Researchers from Oakland University in Rochester, MI, report good results for the use of a 12 item, self-administered tool to assess wakefulness inability and fatigue. The Sleepiness-Wakefulness Inability and Fatigue Test (SWIFT) was administered to 256 adults age 18 or older along with the Epworth Sleepiness Scale (ESS), 44 of whom retook the tests a month later. The SWIFT and ESS were also given to consecutive patients with sleep disorders symptoms, including 286 with OSA, 49 evaluated for narcolepsy with PSG and the multiple sleep latency test, and 137 OSA patients treated with CPAP. Results showed:

• SWIFT had internal consistency 0.87 and retest intraclass coefficient 0.82.
• Factor analysis revealed two factors — general wakefulness inability and fatigue (GWIF) and driving wakefulness inability and fatigue (DWIF).
• Normal subjects differed from patients in ESS, SWIFT, GWIF, and DWIF. SWIFT and GWIF (but not DWIF) had higher area under ROC curve, Youden’s index, and better positive and negative likelihood ratios than ESS.
• ESS, SWIFT, GWIF, and DWIF improved with CPAP. Improvements in SWIFT, GWIF, and DWIF (but not ESS) were significantly correlated with CPAP compliance.

The authors conclude SWIFT is reliable and valid and may be superior to the ESS in assessing patients. The study was published in the Dec. 15 edition of the Journal of Clinical Sleep Medicine. READ ABSTRACT

Adenotonsillectomy Helps Some, but Not All, Children with Prader-Willi

Children with Prader-Willi syndrome are at increased risk for sleep disorders due to the fact that the growth hormone used to treat the condition can cause enlargement of the tonsils and adenoids. Researchers from Nationwide Children’s Hospital studied 13 children with Prader-Willi who underwent annual sleep testing at their facility and had their tonsils and adenoids removed to see if the surgery is effective in resolving sleep problems in this patient population, Among those children, 89% with mild-to-moderate OSA or obstructive hypoventilation normalized after receiving adenotonsillectomy. Of the four children with severe OSA, two normalized after surgery and two continued to have severe apneas. “These findings suggest that adenotonsillectomy is effective in most children with Prader-Willi syndrome who demonstrate mild to moderate obstructive sleep apnea, but may not be curative in children with severe forms of the condition,” study author Kris Jatana, MD, was quoted as saying. The study was published in the November edition of the Archives of Otolaryngology-Head and Neck Surgery. READ PRESS RELEASE