American Association for Respiratory Care
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AARC Sleep Section

April 2013

Support RT Legislation

The AARC PACT made its annual trip up Capitol Hill in March to support issues important to you and your patients, but the work is far from over. The AARC is urging all its members to take a moment to write or email their members of Congress in support of the Medicare Respiratory Therapist Access Act. So visit our Advocacy page to learn more about it and then use one of our letter templates to let your elected officials know you support the legislation.

CPAP Improves Inflammatory Markers

Researchers publishing ahead of print in the Journal of Inflammation on Mar. 22 find CPAP treatment improves levels of inflammatory markers in people with OSA. The study reviewed 3835 full text English studies that addressed values of at least one inflammatory marker in adults with OSA. Twenty-three were pooled for analysis, 14 involving 771 patients pooled for C-reactive protein, 9 with 209 patients pooled for tumor necrosis factor-alpha, and 8 with 165 patients pooled for interleukin-6. Results showed:

  • C-reactive protein: Study level means ranged from 0.18 to 0.85 mg/dl before CPAP treatment to 0.10 to 0.72 mg/dl after CPAP treatment. Mean differences, at a study level, ranged from -0.05 to 0.50. The pooled mean difference was 0.14.
  • Tumor necrosis factor-alpha: Study level means ranged from 1.40 to 50.24 pg/ml before CPAP treatment to 1.80 to 28.63 pg/ml after CPAP treatment. Mean differences, at a study level, ranged from -1.23 to 21.61. The pooled mean difference was 1.14.
  • Interleukin-6: Study level means ranged from 1.2 to 131.66 pg/ml before CPAP treatment to 0.45 to 66.04 pg/ml after CPAP treatment. Mean differences, at a study level, ranged from -0.40 to 65.62. The pooled mean difference was 1.01.

READ ABSTRACT

Disrupted Sleep Linked to Preclinical Alzheimer’s

Could sleep disruption be an early warning sign for Alzheimer’s disease? Yes, report Washington University School of Medicine researchers who followed 145 volunteers from the university’s Alzheimer’s research center. The subjects were between the ages of 45 and 75 at enrollment and cognitively normal. Previous analysis of their spinal fluid for markers of Alzheimer’s disease revealed preclinical Alzheimer’s in 32. All of the subjects kept daily sleep diaries for two weeks, and activity levels were tracked using wrist sensors. Those with preclinical Alzheimer’s had poorer sleep efficiency (80.4%) than those without markers of Alzheimer’s (83.7%). While both groups spent about the same amount of time in bed, the preclinical Alzheimer’s subjects spent less time asleep. They also took more naps during the day. Subjects with a sleep efficiency lower than 75% were five times more likely to have preclinical Alzheimer’s than those with a higher percentage. The research appeared in the Mar. 11 edition of JAMA Neurology. READ PRESS RELEASE

Physical Exam Staging May Predict Resolution of OSA Symptoms after TA

A new study out of Johns Hopkins finds physical exam findings can be useful in determining which children who undergo tonsillectomy and adenoidectomy (TA) for the treatment of OSA will see a resolution of their symptoms. The research involved a retrospective analysis of 35 children with a mean age of 6.8 and OSA severity ranging from mild to severe who were staged using characteristics predictive of adult palatoplasty success. Similar to findings in adults, staging by tonsil size, modified Mallampati position score, and body mass index z score corresponded to response following surgery. Specifically, in stage 1 to 2, 64.7% of the children had a postoperative respiratory distress index <1.5, compared to 55.5% in stages 3 to 4. Although these findings were not considered statistically significant, the authors conclude, “A trend toward a dose-response relationship was seen between physical exam staging and persistent OSA after TA. Further data collection and analysis with a larger sample size are warranted.” The study was published ahead of print in Laryngoscope on Mar. 27. READ ABSTRACT

Brief CPAP Withdrawal Leads to Problems

Even patients who are compliant with their CPAP therapy will occasionally discontinue its use. That’s a bad idea, report NYU School of Medicine researchers publishing in the Mar. 1 edition of Sleep. They evaluated 42 patients with obstructive sleep apnea/hypopnea syndrome on the second night of CPAP withdrawal. All had been compliant with the therapy for the previous four months. The researchers found:

  • Overall, and for mild/moderate subjects, SDB indices returned to pretreatment values on CPAP withdrawal but with fewer apneas and more hypopneas/RERAs.
  • For severe SDB, the event frequency (AI, AHI4%, and RDI) was lower and oxygen desaturation was improved on CPAP withdrawal.
  • Across SDB severity, sleep architecture showed lower %REM (15.6% vs. 12.9%, P = 0.009) on CPAP withdrawal compared to pretreatment.
  • Stanford Sleepiness Score, MSLT, and PVT measures were not significantly different between pretreatment and CPAP withdrawal.

The authors conclude, “Our data suggest detrimental effects of even brief withdrawal of CPAP in subjects with both mild and severe OSAHS.” READ ABSTRACT

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