False negative home sleep apnea testing - an important concept to prevent misdiagnosis in patients with underlying sleep apnea

Obstructive Sleep Apnea (OSA) syndrome is characterized by repetitive reduction or cessation of airflow due to partial or complete obstruction of the airway leading to hypoxemia, arousals from sleep and fragmented sleep. It affects 5% of adult men and 2% of women in western countries and is associated with comorbidities such as cardiovascular and cerebrovascular diseases and several neurobehavioral morbidities. The current gold standard for a definitive diagnosis of OSA is an overnight Polysomnography (PSG). The overnight polysomnogram performed in a sleep center will give the comprehensive report of that includes the number of apneas, hypopneas and respiratory effort related arousals (RERAs). The total number of apneas and hypopneas per hour of sleep is called Apnea Hypopnea Index (AHI) while the total number of apneas, hypopneas and RERAs per hour of sleep is called 'Respiratory Disturbance Index' -RDI. Sleep Apnea is diagnosed if the RDI is 5 or more per hour of sleep. Home Sleep Apnea Testing (HSAT) has become an important tool in identifying high risk population. As the name suggests, the study is done while the patients sleep in their homes. One of the limitations of the study is the lack of Electroencephalographic (EEG) data. This prevents the inclusion of RERAs in the diagnosis of Sleep Apnea. The results of this preliminary analysis serves as the foundation to elucidate whether subtle changes in breathing patterns recorded during a sleep study are reflected in changes in cortical activity.Anudeep Yelam (1); Ross Taylor (2); Pradeep C. Bollu, M.D. (1) ; (1) M2 - University of Missouri SOM, (2) Department of Neurology - University of Missouri Hospital and Clinic

Safety of Needle Electromyography in Critically Ill Patients

Introduction: To evaluate the safety of needle electromyography (EMG) in critically ill intensive care unit (ICU) patients who are on anticoagulants and have comorbidities that increase the risk of bleeding and infections. Methods: We conducted a retrospective chart review of critically ill patients who underwent needle EMG studies. The most common complications followed by needle EMG were reviewed and classified based upon common terminology criteria for adverse events (CTAC) criteria. Descriptive statistics were reported using the frequencies and percentages for categorical variables. The mean and interquartile range is used for continuous variables. All analyses were conducted using the Statistical Package for the Social Sciences (IBM SPSS Statistic Version 21, IMB Inc., Chicago, IL. Results: Twenty-nine patients were included. 17 (58.6%) were males with a mean age of 60.8 +/- 16.7 years.  The mean PT, PTT, and INR were 15.2 sec, 36.5 seconds, and 1.13, respectively. Fourteen (48.2%) patients in this cohort were treated with low molecular weight heparin (LMWH), and an additional 8 (27.5%) patients were administered subcutaneous (SC) heparin for deep vein thrombosis prophylaxis. Therapeutic heparin was being used in 3 (10.3%) patients and sequential compression devices (SCDs) in 4 (13.7%) patients. A total of 228 muscles were tested. Among them, 38 (16.6%) were deep muscles. There were no major bleeding complications at the time of the procedure and for the next seven days in any of the patients, including those with multiple medical comorbidities. All our patients met the grade 1 scale in the severity of adverse events criteria proposed by CTCAE. Conclusion: Needle EMG is safe in critically ill ICU patients on anticoagulants and multiple comorbidities including those that increase the risk of bleeding and infection