Bi-level noninvasive ventilation (NIV) in patients with obesity hypoventilation syndrome (OHS) can help reverse left ventricular hypertrophy, according to a study from Spain. Patients with OHS treated with continuous positive airway pressure (CPAP) did not experience the same benefits. Bi-level NIV (commonly referred to by its most popular trade name, BiPAP) is known to improve pulmonary [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “Upward, not northward.” -E. A. Abbott A pressure chamber within a pressure chamber; the heart within the thorax. These are two pumps beating in-and-out of time, varying in physiology and pathophysiology between patients and within any one patient during the arc of an illness. As such, when we inspect the [… read more]
The US Food and Drug Administration (FDA) approved an implanted phrenic nerve-stimulator device as a new treatment for moderate-to-severe central sleep apnea (CSA). The remedē System (Respicardia) consists of a pacemaker-like battery pack that’s surgically implanted in the upper chest beneath the skin. Wires electrically stimulate the phrenic nerve as it travels from the neck [… read more]
Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD Pilots of high-performance, tactical fighter jets each have continuous positive airway pressure [i.e. CPAP] masks as a part of their flight suit. Strikingly, beyond the clinically-commonplace airway pressure of 5-15 cm of H2O, a fighter pilot may endure a mask-applied pressure of 90 [… read more]
After an extensive review, the U.S. Preventive Services Task Force (USPSTF) concluded that there is insufficient evidence to recommend for or against screening adults for obstructive sleep apnea (OSA). In a statement posted to the website of the Journal of the American Medical Association the USPSTF panel said that in adults who are not actively complaining of symptoms of [… read more]
Nightly use of continuous positive airway pressure (CPAP) did not prevent cardiovascular events in high risk patients with obstructive sleep apnea, according to a large randomized trial. The SAVE study suggests that CPAP has no cardiovascular benefits for the millions of people using it less than 4 hours a night. However, those using CPAP for more [… read more]
Jon-Emile S. Kenny [@heart_lung] A recent study of applied respiratory physiology in the mechanically-ventilated, obese patient was published. The ubiquitous focus on lung protective ventilation with “low” [physiological] lung volumes, and low plateau pressure may leave the obese patient susceptible to untoward respiratory embarrassment. Excess abdominal and chest wall weight affect each of the following: [… read more]
The American College of Chest Physicians (unaffiliated with PulmCCM) published its new consensus guidelines in August 2014 for the drug treatment of pulmonary arterial hypertension (PAH). They’re free to view on the Chest website, and well worth a look. Remember that pulmonary arterial hypertension (PAH) is but one small subset (“Group 1”) of the much larger [… read more]
About half of people diagnosed with obstructive sleep apnea (OSA) can’t or won’t use the most effective therapy, overnight continuous positive airway pressure (CPAP). Most people with untreated OSA experience multiple episodes of hypoxemia — sometimes hundreds per night. For many patients declining CPAP treatment, their doctors provide overnight oxygen, in the hope that it might [… read more]
Image: Inspire Med Systems Hypoglossal Nerve Stimulation for Sleep Apnea Wins FDA Approval The U.S. Food and Drug Administration approved Inspire Medical Systems’ pacemaker-like hypoglossal nerve stimulator for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP). The Inspire device stimulates key airway muscles controlled by the hypoglossal [… read more]
Source: Inspire Med Systems Update: Inspire’s hypoglossal nerve stimulator was approved by the FDA in April 2014. Hypoglossal Nerve Stimulation Markedly Improves OSA An estimated 15% of men and 6% of women in the U.S. have clinically significant obstructive sleep apnea, meaning it worsens their daytime cognitive functioning, cardiovascular risk, or both. In obstructive sleep [… read more]
The American College of Physicians released a new clinical practice guideline for the management of obstructive sleep apnea, published in Annals of Internal Medicine. ACP advises people with obstructive sleep apnea should use CPAP therapy or other airway opening devices such as mandibular advancement devices, and should be encouraged and assisted in losing weight. The guideline was [… read more]
Most people with obstructive sleep apnea (OSA) have high blood pressure (hypertension), but treating OSA with continuous positive airway pressure (CPAP) has been shown to reduce blood pressure only minimally (by about 2.5 mm Hg). A randomized trial in the November 2013 Chest suggests that in people with severe drug-resistant hypertension with OSA, CPAP can [… read more]
In early 2012, PulmCCM breathlessly reported the results of a New England Journal of Medicine (NEJM) paper by Surenda K. Sharma et al, claiming to show that continuous positive airway pressure (CPAP) can reverse metabolic syndrome (obesity, dyslipidemia, and insulin resistance). Whoops. The authors retracted the article after keen-eyed academics smelled something fishy and asked [… read more]
Home Sleep Apnea Testing: New Standard is Bad Deal for Sleep Docs Sleep doctors in the U.S. have been doubling up on their Prilosec and putting their accountants on speed-dial since the federal government and insurers began signaling they plan to eventually run the $2,000-per-sleep-study gravy train off its rails. With an estimated 18 million people [… read more]
Obstructive Sleep Apnea and Perioperative Complications: A Review Obstructive sleep apnea and other sleep disorders may affect as many as 70 million U.S. adults — 1 in 4 men and 1 in 10 women. People with obstructive sleep apnea are usually obese, have other medical conditions, and are more likely to undergo surgery than people [… read more]
Acetazolamide Improved Obstructive Sleep Apnea at High Altitudes by Blair Westerly, MD Obstructive sleep apnea (OSA) is common, and so is travel to the mountains for work and play, therefore encounters with patients with OSA who travel to mountain destinations is not infrequent. We all learn early in training that altitude affects oxygenation, and patients [… read more]
Visual learners can see continuous positive airway pressure (CPAP) work for obstructive sleep apnea in realtime in this NEJM video. But how on earth does someone sleep inside an MRI machine? See the Sleep Apnea Video
CPAP Improves Metabolic Syndrome in Obstructive Sleep Apnea This paper has been RETRACTED! Continuous positive airway pressure (CPAP) therapy reversed elements of the high cardiovascular risk profile known as metabolic syndrome in a substantial minority of Indians with treatment-naive obstructive sleep apnea, according to this article in the New England Journal of Medicine. More than [… read more]
Obstructive sleep apnea (OSA) might be the perfect disease to describe the American health care system. The condition is overwhelmingly due to our over-indulgence and under-activity; its expensive diagnosis (polysomnography) and best treatment (CPAP) help physicians and device manufacturers prosper while consternating those who pay (the government and insurance companies), who then threaten to cut off [… read more]
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