July 2013
AARC Congress to Convene in Anaheim
The AARC Congress will head to Anaheim, CA, this Nov. 16-19, and the preliminary program is expected out soon. We guarantee it will be packed with the cutting edge presentations you want to hear, including lots of updates on provisions in the Affordable Care Act likely to impact our practice. In the meantime, though, you can find out much more about the venue on our new microsite. So check it out and then make your plans to attend this premier educational event of the year. VISIT SITE
ATS Updates Guidelines on Sleep Apnea and Driving
The American Thoracic Society (ATS) has updated its 1994 clinical practice guidelines on sleep apnea, sleepiness, and driving risk on non-commercial drivers. The recommendations state that all patients undergoing initial evaluation for suspected or confirmed OSA should be asked about daytime sleepiness and recent unintended motor vehicle crashes or near-misses attributable to sleepiness, fatigue, or inattention. Clinicians are also urged to warn these patients about the danger of continuing to drive until effective therapy is initiated. The guidelines go on to include detailed recommendations regarding testing and treatment in these patients and cover opportunities to improve clinical practice, including the development of a practice-based plan to inform patients and their families about drowsy driving and behavioral methods that may reduce those risks. The guidelines were published in the June 1 edition of the American Journal of Respiratory and Critical Care Medicine. READ PRESS RELEASE
Sleep Oxygen Desaturation May Predict IPF Survival
A new study out of Greece suggests sleep oxygen desaturation is linked to survival in patients with idiopathic pulmonary fibrosis (IPF). The research was conducted among 31 treatment-naïve, newly diagnosed IPF patients who were assessed for sleep disordered breathing parameters. Results showed sleep oxygen desaturation was significantly higher than maximal exercise desaturation, with the maximal difference in oxygen saturation between wakefulness and sleep inversely related to survival, DLCO%, and SpO2 after the six minute walk test, and directly related to dyspnea, the apnea-hypopnea index (AHI), and right ventricular systolic pressure (RVSP). The lowest SpO2 was directly related to survival, as well as to functional, submaximal, and maximal exercise variables. An inverse association was seen between the lowest SpO2 and the dyspnea score, AHI, and RVSP. The study appeared in the June 15 edition of the Journal of Clinical Sleep Medicine. READ ABSTRACT
OSA Ups Risk of Sudden Cardiac Death
Mayo Clinic investigators publishing ahead of print in the Journal of the American College of Cardiology in June find obstructive sleep apnea (OSA) significantly increases the risk for sudden cardiac death. The study, which was funded by the National Heart, Lung and Blood Institute, followed 10,701 people enrolled in other sleep studies for an average of 5.3 years. During that time period, 142 died of sudden cardiac death — a twofold increase compared with the general population. An age of 60 or older, 20 or more apnea episodes per hour of sleep, and an oxygen saturation below 78% during sleep were the most common predictors of sudden cardiac death. READ PRESS RELEASE
FENO Levels Higher in OSA Patients; CPAP Brings Them Down
Fraction of exhaled nitric oxide (FENO) levels are higher in patients with OSA, report researchers from the Cleveland Clinic, suggesting that upper airway inflammation plays a role in the pathogenesis of the condition. The investigators arrived at that conclusion after measuring FENO levels both before and after sleep in 75 patients with OSA and 29 healthy controls. FENO levels were higher at both time points in the OSA patients, and OSA patients also had higher levels after sleep than before sleep. The rise in FENO correlated with the AHI as well, and was also associated with nadir oxygen saturation and the arousal index. Among the 37 patients who were treated with CPAP, successful titration led to a drop in overnight FENO increases and an overall decline in FENO levels following 1-3 months of treatment. “This study supports the role of upper airway inflammation in OSA pathogenesis and a possible role for FENO in monitoring CPAP therapy,” conclude the investigators. The study was published in the June 15 edition of the Journal of Clinical Sleep Medicine. READ ABSTRACT
