October 2013

Going to the Congress? Put the Section Meeting on Your Schedule!

If you’ll be heading to Anaheim for AARC Congress 2013 next month, be sure to put our section business meeting on your schedule. We’ll be gathering at from 12:15-12:45 p.m. on Monday, Nov. 18.

CPAP Adherence Equals Younger Look

Still having trouble convincing your sleep apnea patients to use their CPAP? A recent study out of the University of Michigan offers a new tactic for convincing people to adhere to the treatment. Using sensitive face mapping technology used by plastic surgeons, they found a significant difference in how people look after treatment with CPAP. The study was conducted among 20 middle-aged sleep apnea patients who had their faces mapped at baseline and then several months after beginning CPAP. Significant changes for the better were noted on the follow up mappings. The investigators also showed before and after photos of the patients to 22 independent raters and asked them to rate the photos on the basis of attractiveness, alertness, and youthfulness. Raters deemed the after photo to be the most attractive about two-thirds of the time. The study was published in a recent issue of the Journal of Clinical Sleep Medicine. READ PRESS RELEASE

OSA-18 Falls Short

The OSA-18 is no replacement for polysomnography when it comes to diagnosing children with obstructive sleep apnea, report Swedish researchers publishing ahead of print in the International Journal of Pediatric Otorhinolaryngology. Their study compared the diagnostic value of the quality of life instrument against objective data from polysomnography in 225 children with a median age of 4.5 years. When they compared the apnea-hypopnea index (AHI) with the total symptom score (TSS) and the subscale of sleep disturbance (SD) from the OSA-18 questionnaire they found the following results:

• With the TSS of the OSA-18 at ≥60, compared with AHI levels of >1 and ≥5, the sensitivity was 55.2% and 59.3% respectively, and the specificity 40.9% and 48.4%, respectively.
• With the TSS >80 and AHI levels of ≥5 and ≥10, the sensitivity was 24.6% and 32.1%, respectively.
• For the subscale of SD, the majority of the subjects showed poor correlation with the AHI values.
• The ROC area under the curve for different levels of the AHI (>1, ≥5, and ≥10) was 0.49, 0.57, and 0.56, respectively.

“The majority of the children with severe OSA would not be correctly diagnosed if the OSA-18 were used as a dominant diagnostic tool,” write the authors. READ ABSTRACT

Sleep Education for Parents Helps Autistic Kids

A one hour, one-on-one education session on sleep, or four hours of group sleep education, for parents of autistic children can significantly improve sleep in these children, report U.S. and Canadian researchers. They enrolled 80 children ages 2-10 years into the study. The instructional sessions covered daytime and evening habits that promote sleep, including the importance of increasing exercise, limiting caffeine during the day, and minimizing use of video games and computers close to bedtime. Sleep educators also helped parents put together a visual schedule for their children to help them establish a bedtime routine and discussed ways to help kids get back to sleep if they woke up during the night. Two brief telephone follow up calls were provided to the parents after the formal education as well. In addition to improving sleep for the children, the intervention resulted in improvements in anxiety, attention, repetitive behavior, and quality of life. The research was reported in a recent issue of the Journal of Autism and Developmental Disorders. READ PRESS RELEASE

Leptin Deficiency Plays Role in HR Patients with CSA

A new study published ahead of print in CHEST on Sept. 12 takes a look at the role leptin deficiency may play in heart failure (HF) patients with central sleep apnea (CSA). The investigators note that animals deficient in leptin hyperventilate, that leptin expression by adipocytes is attenuated by atrial natriuretic peptide (ANP), and that, when increased, natriuretic peptides (NP) are associated with increased risk of CSA. With that in mind, they measured leptin, NP, carbon dioxide (CO2) chemosensitivity (∆minute ventilation/∆end-tidal CO2), and ventilatory efficiency (V˙E/V˙ CO2) in 29 subjects with heart failure. Patients underwent polysomnography to confirm or rule out the presence of CSA. Among the findings:

• Subjects with CSA had higher ANP and BNP concentrations, ∆minute ventilation/∆end-tidal CO2, and V˙E/V˙ CO2. They had lower leptin concentrations.
• Logistic regression analysis demonstrated leptin and BNP to be independently associated with CSA.

The authors believe these findings suggest counter-regulatory interactions of leptin and NP may play a role in ventilatory control in HF. READ ABSTRACT