Treatment of cardiomyopathy with PAP therapy in a patient with severe obstructive sleep apnea.

Obstructive sleep apnea is common in patients with heart failure. This case illustrates that treatment with PAP therapy can improve cardiac function in patients with both conditions. CPAP-emergent central apnea, as seen in this patient, has multiple etiologies. It is commonly seen in patients with severe sleep apnea, usually resolves over time, and does not need treatment with adaptive servoventilation

A quality improvement project to reduce the wait time for initial appointment in an urban outpatient sleep center

Project Aim: In this study we aimed to see if replacing one face to face follow up visit after sleep study with a phone call by a trained office staff will -decrease the total number of follow up office visits, thus decreasing health care cost -increase the number of new patients seen during the 6 month follow up period -Did not decrease patient compliance.https://jdc.jefferson.edu/patientsafetyposters/1048/thumbnail.jp

Sleep Strategies: Sleep in Women A Changing Perspective

As with many other specialties, sleep medicine has been shifting toward helping clinicians obtain a better understanding of gender-specific issues in disorders and disturbances. It is easier today to appreciate the complex dynamics of biological, psychosocial, and cultural factors that define sleep patterns and problems in women. Sleep in women changes across their life spans, with three major shifts likely due to hormonal differences: at the onset of the menstrual cycle, during pregnancy, and during the perimenopausal period

Severe Obesity Hypoventilation Syndrome Treated with Auto-CPAP

Summary Obesity hypoventilation syndrome (OHS) is a serious medical condition that remains undiagnosed in seriously ill hospitalized patients. Significant improvement of daytime hypercapnia can be achieved with positive airway pressure (PAP) therapy. Bi-level PAP is generally employed with the goal of improving ventilation. A 50-year-old woman with OHS and severe hypercapnia was successfully treated with an auto titrating continuous PAP (Auto-CPAP) device. The major role in the pathogenesis of daytime hypercapnia in patients with OHS, is the progressive accumulation of carbon dioxide (CO2) caused by repetitive obstructive events at night, which can be eliminated with the low cost approach of treating with Auto CPAP. Background OHS, an interaction between sleep disordered breathing and obesity-related respiratory impairment leading to chronic daytime hypercapnia, remains under recognized and definitive treatment is often delayed.[1] Treatment of sleep disordered breathing with PAP therapy results in significant improvement of daytime hypercapnia.[2] Auto-CPAP is generally not recommended to treat obesity hypoventilation syndrome.[3,4] We present a patient with OHS and severe daytime hypercapnia who was successfully treated with Auto CPAP. Case Presentation: A fifty-year-old morbidly obese (BMI 52) non-smoking female with a history of hypertension and untreated obstructive sleep apnea (OSA) was admitted to the hospital with severe dyspnoea on exertion in July 2012. She was hypoxemic at admission. Arterial blood gas (ABG) on 2 liters of supplemental oxygen revealed a pH of 7.34, pCO2 of 88 mm Hg and a pO2 of 79 mm Hg. Serum bicarbonate level was elevated at 44mEq/L. Cardiac enzymes were normal. Brain natriuretic peptide (BNP) was elevated at 2161 pg/ml. D-dimer was normal. Chest x-ray was notable for prominence of main pulmonary artery, suggestive of pulmonary artery hypertension. EKG had non-specific changes. Echocardiogram revealed normal left ventricular systolic and diastolic function with mild pulmonary hypertension. Nuclear medicine stress test was normal. Computed tomography angiogram was normal. Pulmonary/Sleep medicine was consulted, and a presumptive diagnosis of OHS was made given the patient\u27s morbid obesity, previous history of OSA and hypoventilation on ABG. She was placed on CPAP at 10 cm water pressure in the hospital and demonstrated significant clinical improvement with relief of shortness of breath. Supplemental oxygen requirements improved from as high as 4 liters per minute via nasal cannula to 2 liters per minutes

Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature.

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management

Does A Short, Thick Neck Predict Obstructive Sleep Apnea?: The Role of Physical Examination in OSA Screening

Purpose: The purpose of this study was to determine whether a short neck, alone or together with a thick neck, can predict obstructive sleep apnea (OSA). Methods: The laryngeal heights of 169 new adult patients presenting to a sleep medicine physician were measured over a period of 5 months. Neck circumference, Mallampati score, and body-mass index (BMI) were also determined, together with medical history, smoking status, and serum bicarbonate. Lastly, patients’ polysomnograms were obtained in order to ascertain the presence or absence of OSA as indicated by the apnea-hypopnea index, as well as other sleep study parameters. Results: No association was found between laryngeal height and presence of OSA, bicarbonate concentration or oxygen saturation. Of interest, neck circumference was also not significantly associated with any of the aforementioned parameters, although there was a trend towards significance in its association with OSA (p=0.055). Still, a combined short laryngeal height and large neck circumference was associated with lower nadir SaO2 (p=0.018). Of all clinical parameters we measured, only higher BMI, older age and male sex were positively associated with OSA (p\u3c0.05). Conclusion: This study challenges the popular notion that short necks predict OSA

Sleep Issues in Women

Overall Goals and Objectives: 1. Normal Sleep 2. Physiology of sleep in women 3. Sleep disorders in wome

Utility of the STOP-BANG Questionnaire for Identifying Obstructive Sleep Apnea in Patients Undergoing Bariatric Surgery

Introduction Patients undergoing bariatric surgery are at high risk for obstructive sleep apnea (OSA). OSA has been associated with an increased risk of perioperative complications, but is under-recognized and underdiagnosed in the bariatric population. It is currently recommended that all patients considering bariatric surgery for obesity should be evaluated for OSA. In the general pre-surgical population, the STOP-BANG questionnaire is a validated screening tool for identifying OSA. We hypothesize that in bariatric patients the STOP-BANG questionnaire plus other clinical variables can predict OSA