January 2014

Webcast Central: Your Ticket to CRCE

One of the best ways to earn the continuing education credits you need to maintain your license to practice is to attend the AARC Webcasts that take place every month throughout the year. These “virtual” sessions only last about an hour, making them a quick way to pick up credits one at a time. Sign up for the live versions and your CRCE is free, but you can also take advantage of archived sessions and earn CRCE for a new lower member price of just $7.50 each. LEARN MORE

Disaster Preparedness Strategies Needed

Japanese investigators shed some light on how nasal CPAP patients may fare during a large scale natural disaster in the December edition of Prehospital Disaster Medicine. The authors surveyed 1047 sleep disordered breathing (SDB) patients within 14 days of the Great East Japan Earthquake that struck the country in 2011 to find out what kinds of challenges they experienced with their CPAP therapy during the immediate aftermath. Among the group, 92.3% reported being unable to use their CPAP device in the days following the earthquake, with the most common reason being power failure. Anxiety about sleeping at night due to fear of aftershocks, involvement in disaster relief activities, loss of the CPAP device, and fear of being unable to wake up in case of an emergency were also top concerns. A relapse in symptoms was reported by 25.1% of the patients who were unable to use their devices, including excessive daytime sleepiness, insomnia, headache, irritability, and chest pain. The researchers believe these findings support the premise that developing “strategies for the continuation of nCPAP therapy during disasters is important for providing healthy sleeping environments for SDB patients in emergency situations.” READ ABSTRACT

CPAP Not Associated with Improvements in Vascular Injury Markers

A new study out of the UK finds one month of CPAP treatment does not decrease vascular injury marker levels. The investigators looked at 40 consecutive patients referred to a Sleep Disordered Breathing Unit. Blood samples were taken in the morning to test for serum amyloid A, C-reactive protein (CRP), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 levels. The patients then underwent a sleep study, with additional blood sampling the next morning and then again after the first night on CPAP and one month later for those diagnosed with obstructive sleep apnea hypopnea syndrome (OSAHS). Overall 20 patients were diagnosed with OSAHS and were started on CPAP. Vascular injury marker levels did not differ in the morning and afternoon samples between the two groups, but CRP and VCAM-1 did show significant diurnal variation within the OSAHS group, with morning levels lower than afternoon levels. No changes were seen in the levels following treatment with CPAP, despite good adherence to the therapy. The study was published ahead of print by Sleep & Breathing on Dec. 11. READ ABSTRACT

More Intense Care, but Lower Mortality

U.S. investigators who compared the characteristics, treatment, and risk of complications and mortality among 250,907 pneumonia patients at 347 hospitals find OSA is associated with the need for higher levels of care. After adjusting for other factors, the 6.2% of patients who were diagnosed with OSA were significantly more likely to be transferred to an ICU, and they were also more likely to be intubated on or after the third hospital day, have longer hospital stays, and incur higher costs. Interestingly, OSA patients had modestly lower inpatient mortality rates, despite the more intense care they required. The study was published ahead of print by CHEST on Dec. 26. READ ABSTRACT

Sleep and High Blood Pressure: The Association in Women

Another U.S. study gauged cross-sectional and longitudinal relationships between poor sleep as measured by in-home polysomnography (PSG) and blood pressure in 132 black, 164 white, and 59 Chinese subjects taking part in the Study of Women’s Health Across the Nation (SWAN) ancillary sleep study. All underwent in-home PSG and then were followed for a mean of 4.5 years. Results showed no link between sleep duration and efficiency and blood pressure either cross-sectionally or longitudinally in multivariate models. However, higher total beta power predicted hypertension at the time of the sleep study, and women with lower total delta power were more likely to exhibit increases in diastolic blood pressure over time and be at increased risk for incident hypertension. The authors conclude, “Low NREM delta power may be a risk factor for future hypertension. Quantitative EEG measures are worthy of future investigations of hypertension risk.” The study was published ahead of print by Sleep Medicine on Nov. 20. READ ABSTRACT