Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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Randomized Controlled Trial Comparative Study
Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure.
Despite widespread agreement that continuous positive airway pressure is effective therapy for obstructive sleep apnea, it is estimated that 50% of patients recommended for therapy are noncompliant 1 year later. Interventions to improve compliance in such patients have not been studied. We evaluated a 2 phase intervention program to improve compliance in sleep apnea patients previously noncompliant with continuous positive airway pressure. ⋯ A two phase intervention program, first employing standard interventions, followed by a change to flexible bilevel airway pressure, can achieve improved compliance in patients previously noncompliant with continuous positive airway pressure.
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Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. ⋯ Under the conditions specified above, PM may be used for unattended studies in the patient's home. Afollow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography.
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To assess the prevalence of treatment and diagnosis of snoring and sleep apnea in the population of New South Wales Australia. ⋯ The population of New South Wales has had the longest potential exposure to continuous positive airway pressure. However, few of those in even the middle-aged group reported ever being recommended continuous positive airway pressure treatment. It is more common to have a surgical intervention for snoring or sleep apnea. Surprisingly, most surgical patients do not report any associated sleep study to quantify their snoring or sleep apnea or measure the efficacy of surgery. Since a substantial proportion of patients who experience snoring and sleep apnea are not assessed via a sleep study, it is necessary to increase awareness of undergoing such clinical procedures.
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Comparative Study
Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome.
Obstructive sleep apnea (OSA) has been associated with increased perioperative morbidity and mortality. We initiated a protocol designed to screen patients preoperatively and monitor them postoperatively. The goal was to identify patients who were at risk for oxygen desaturation after discharge from the postanesthesia recovery room (PACU). ⋯ We have shown that combining preoperative screening is useful for identifying patients at risk for oxygen desaturation after PACU discharge.
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Comparative Study
Central sleep apnea on commencement of continuous positive airway pressure in patients with a primary diagnosis of obstructive sleep apnea-hypopnea.
Central sleep apnea (CSA) may occur in patients with snoring and obstructive sleep apnea-hypopnea (OSAH) during commencement of continuous positive airway pressure (CPAP) therapy. The presence of CSA may limit the effectiveness of CPAP therapy. The aims of this study were to assess the prevalence of CSA amongst patients starting CPAP for OSAH and to identify possible predictors of this condition. ⋯ A significant minority of patients with a primary diagnosis of OSAH have either emergence or persistence of CSA on CPAP. Risk factors include male sex, history of cardiac disease, and CSA on baseline PSG.