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

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

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

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

Effect of oxidative stress on ABC transporters: contribution to epilepsy pharmacoresistance

Epilepsy is a neurological disorder affecting around 1%-2% of population worldwide and its treatment includes use of antiepileptic drugs to control seizures. Failure to respond to antiepileptic drug therapy is a major clinical problem and over expression of ATP-binding cassette transporters is considered one of the major reasons for pharmacoresistance. In this review, we have summarized the regulation of ABC transporters in response to oxidative stress due to disease and antiepileptic drugs. Further, ketogenic diet and antioxidants were examined for their role in pharmacoresistance. The understanding of signalling pathways and mechanism involved may help in identifying potential therapeutic targets and improving drug response

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

An Impulse-C Hardware Accelerator for Packet Classification Based on Fine/Coarse Grain Optimization

Current software-based packet classification algorithms exhibit relatively poor performance, prompting many researchers to concentrate on novel frameworks and architectures that employ both hardware and software components. The Packet Classification with Incremental Update (PCIU) algorithm, Ahmed et al. (2010), is a novel and efficient packet classification algorithm with a unique incremental update capability that demonstrated excellent results and was shown to be scalable for many different tasks and clients. While a pure software implementation can generate powerful results on a server machine, an embedded solution may be more desirable for some applications and clients. Embedded, specialized hardware accelerator based solutions are typically much more efficient in speed, cost, and size than solutions that are implemented on general-purpose processor systems. This paper seeks to explore the design space of translating the PCIU algorithm into hardware by utilizing several optimization techniques, ranging from fine grain to coarse grain and parallel coarse grain approaches. The paper presents a detailed implementation of a hardware accelerator of the PCIU based on an Electronic System Level (ESL) approach. Results obtained indicate that the hardware accelerator achieves on average 27x speedup over a state-of-the-art Xeon processor

The sales lead black hole: On sales reps' follow-up of marketing leads

The sales lead black hole-the 70% of leads generated by marketing departments that sales representatives do not pursue-may result from competing demands on sales reps' time. Using the motivation-opportunity-ability framework, the authors consider factors that influence sales reps' pursuit (or lack thereof) of marketing and selfgenerated leads. The proportion of time that sales reps devote to marketing leads depends on organizational lead prequalification and managerial tracking processes (extrinsic motivation), as well as marketing lead volume (opportunity), and sales rep experience and performance (ability). Consistent with a person-situation framework, individual sales rep factors should also moderate the influence of organizational processes on lead follow-up. Data from 461 sales reps employed by four firms confirm that as sales reps' experience increases, their responses to managerial tracking of lead follow-up and marketing lead volume decrease; responses to the quality of the lead prequalification process increase. As sales reps' performance improves, their response to the volume of marketing leads increases, but their response to managerial tracking decreases. The interplay of individual sales reps' abilities and organizational marketing and sales processes explains differences in sales reps' follow-up of marketing leads.' © 2013, American Marketing Association