February 2014
Winter Bulletin Online Now
Our latest edition features two informative articles. The first looks at ways to increase your hospital-based sleep center’s revenue, while the second delves into patient screening for OSA. READ ISSUE
Orthopedic Surgery Patients with Sleep Apnea Have More Complications
U.S. researchers who analyzed data on 530,089 patients undergoing total hip and knee arthroplasty find those with a diagnosis of sleep apnea had increased risk for complications. Overall, 8.4% of the patients were identified as having sleep apnea, and these patients were 1.86 times more likely to have pulmonary complications and 1.59 times more likely to have cardiac complications. They were also more likely to require ventilator support; use more intensive care, stepdown, and telemetry services; and have longer hospital lengths of stay. They consumed more economic resources as well. The researchers call for more research to identify sleep apnea patients at risk for complications and would also like to see the development of evidence-based practices designed to help allocate the clinical and economic resources these patients require. The study appears in this month’s Anesthesia and Analgesia. READ ABSTRACT
CPAP Reduces Death Risk for Hypercapnic Overlap Syndrome Patients
A new study out of the VA Western New York Healthcare System suggests hypercapnic (PaCO2 ≥ 45 mmHg) COPD patients with obstructive sleep apnea (OSA) can mitigate their increased risk of dying with the use of CPAP therapy. However, the same is not true for normocapnic patients with both conditions. The investigators reached those conclusions after looking at 271 patients with overlap syndrome, defined as both COPD and OSA. Comparable apnea/hypopnea indexes were seen in the normocapnic vs. hypercapnic patients, and adherence to CPAP was also similar. Hypercapnic patients who were adherent to CPAP were less likely to die than those who were nonadherent. In the normocapnic group, the risk of death was about the same despite CPAP adherence. The study was published ahead of print in Lung on Jan. 23. READ ABSTRACT
OSA Patients with Parkinson’s Benefit from CPAP Therapy
Parkinson’s patients with obstructive sleep apnea benefit significantly from CPAP treatment, report California researchers publishing in the January edition of Sleep. In a randomized, placebo-controlled, crossover study conducted among 38 patients they found patients demonstrated a significant decrease in the apnea/hypopnea index, percent time with SaO2 <90%, and percent time spent in N2 sleep, along with a significant increase in percent time spent in N3 sleep, when they were using CPAP. Overall, three weeks of therapeutic treatment with CPAP also decreased the arousal index and decreased daytime sleepiness. All of the improvements seen at three weeks were maintained through six weeks of treatment. “These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease,” write the investigators. READ ABSTRACT
Smartphone Diagnosis of OSA?
Could a smartphone be used to assess for snoring and OSA? Japanese investigators asked that question in a laboratory-based study using the built-in microphone on a smartphone that was attached to the anterior chest wall over the sternum to acquire ambient sound during overnight polysomnography (PSG). Results showed:
- Snoring time measured by the smartphone highly correlated with snoring time measured by PSG.
- The top 1 percentile value of sound pressure level (L1) determined by the smartphone correlated with the ambient sound L1 during sleep determined by PSG.
- The respiratory disturbance index estimated by the smartphone (smart-RDI) highly correlated with the apnea/hypopnea index (AHI) obtained by PSG.
- The diagnostic sensitivity and specificity of the smart-RDI for diagnosing OSA (AHI ≥15) were 0.70 and 0.94, respectively.
While these findings were positive for the use of a smartphone in this setting, the authors are quick to point out that the use of this technology in a noisy home environment remains unproven. The research was published in the Jan. 15 edition of the Journal of Clinical Sleep Medicine.
