Karin G. Johnson

Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis.

Objective.— We aimed to identify clinical features in patients with severe headaches that predicted obstructive sleep apnea (OSA) and determine clinical and sleep study characteristics that predicted headache improvement with continuous positive airway pressure (CPAP).

Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia.

BACKGROUNDnOSA is associated with increased risks of respiratory complications following surgery. However, its relationship to the outcomes of hospitalized medical patients is unknown.nnnMETHODSnWe carried out a retrospective cohort study of patients with pneumonia at 347 US hospitals. We compared the characteristics, treatment, and risk of complications and mortality among patients with and without a diagnosis of OSA while adjusting for other patient and hospital factors.nnnRESULTSnOf the 250,907 patients studied, 15,569 (6.2%) had a diagnosis of OSA. Patients with OSA were younger (63 years vs 72 years), more likely to be men (53% vs 46%), more likely to be married (46% vs 38%), and had a higher prevalence of obesity (38% vs 6%), chronic pulmonary disease (68% vs 47%), and heart failure (28% vs 19%). Patients with OSA were more likely to receive invasive (18.1% vs 9.3%) and noninvasive (28.8% vs 6.8%) forms of ventilation upon hospital admission. After multivariable adjustment, OSA was associated with an increased risk of transfer to intensive care (OR, 1.54; 95% CI, 1.42-1.68) and intubation (OR, 1.68; 95% CI, 1.55-1.81) on or after the third hospital day, longer hospital stays (risk ratio [RR], 1.14; 95% CI, 1.13-1.15), and higher costs (RR, 1.22; 95% CI, 1.21-1.23) among survivors, but lower mortality (OR, 0.90; 95% CI, 0.84-0.98).nnnCONCLUSIONnAmong patients hospitalized for pneumonia, OSA is associated with higher initial rates of mechanical ventilation, increased risk of clinical deterioration, and higher resource use, yet a modestly lower risk of inpatient mortality.

Treatment of sleep-disordered breathing with positive airway pressure devices: technology update

Many types of positive airway pressure (PAP) devices are used to treat sleep-disordered breathing including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. These include continuous PAP, autoadjusting CPAP, bilevel PAP, adaptive servoventilation, and volume-assured pressure support. Noninvasive PAP has significant leak by design, which these devices adjust for in different manners. Algorithms to provide pressure, detect events, and respond to events vary greatly between the types of devices, and vary among the same category between companies and different models by the same company. Many devices include features designed to improve effectiveness and patient comfort. Data collection systems can track compliance, pressure, leak, and efficacy. Understanding how each device works allows the clinician to better select the best device and settings for a given patient. This paper reviews PAP devices, including their algorithms, settings, and features.

Obstructive Sleep Apnea Is a Risk Factor for Stroke and Atrial Fibrillation

1helps with the assessment of risk for stroke and thromboembolism in patients with atrial fibrillation (AF). Unfortunately, the Euro Heart Survey did not evaluate patients for obstructive sleep apnea (OSA), which we believe is a signifi cant risk factor. OSA is believed to increase the risk of stroke through endothelial damage and hypercoagulability as well as to increase the risk of AF. OSA with an apnea-hypopnea index (AHI) . 5 is an independent risk factor for stroke, with a hazard ratio of 1.97 when adjusted for race, sex, smoking, alcohol use, BMI, diabetes, AF, hypertension, and lipids. 2 In a metaanalysis of studies on stroke and sleep apnea, we found that 72% of patients with stroke and transient ischemic attack (TIA) have OSA with an AHI . 5, and 38% have OSA with an AHI . 20. 3 Further, we cite studies fi nding that treatment with continuous positive airway pressure (CPAP) reduces the rate of recurrent stroke and mortality in patients with OSA. Among the Sleep Heart Health Study cohort, 4.8% of patients with OSA (AHI . 5) have AF compared with only 0.9% of patients without OSA. 4 OSA increases the 12-month recurrence of AF after cardioversion from 53% of patients without OSA to 82% of patients with untreated OSA vs 42% of those treated with CPAP.

Obstructive Sleep Apnea and Prolonged Mechanical Ventilation

Patients with prolonged mechanical ventilation have a high one year mortality, with recognized contributing factors including COPD, cardiac failure, renal failure, and respiratory muscle weakness.[1][1] The study by Diaz-Abad et al[2][2] shows that obstructive sleep apnea (OSA) is very common among