Sleep
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Randomized Controlled Trial Comparative Study
Flexible positive airway pressure improves treatment adherence compared with auto-adjusting PAP.
There are no clinical data comparing adherence and quality of life between auto-adjusting positive airway pressure (APAP) and two different flex positive airway pressure (PAP) devices (A-Flex, C-Flex) in patients with obstructive sleep apnea (OSA). ⋯ URL: http://www.clinicaltrials.gov. Unique identifier: NCT00873977.
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Randomized Controlled Trial Multicenter Study
Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy.
Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals. ⋯ Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).
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Randomized Controlled Trial
Acetazolamide attenuates the ventilatory response to arousal in patients with obstructive sleep apnea.
The magnitude of the post-apnea/hypopnea ventilatory overshoot following arousal may perpetuate subsequent respiratory events in obstructive sleep apnea (OSA) patients, potentially contributing to the disorder's severity. As acetazolamide can reduce apnea severity in some patients, we examined the effect of acetazolamide on the ventilatory response to spontaneous arousals in CPAP-treated OSA patients. ⋯ Acetazolamide substantially attenuates the increase in ventilation following spontaneous arousal from sleep in OSA patients. This study suggests an additional mechanism by which acetazolamide may contribute to the improvement in ventilatory instability and OSA severity. The data also provide support for reinforcing the importance of ventilatory control in OSA pathogenesis.
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Randomized Controlled Trial
Is the relationship between race and continuous positive airway pressure adherence mediated by sleep duration?
Black race has been associated with decreased continuous positive airway pressure (CPAP) adherence. Short sleep duration, long sleep latency, and insomnia complaints may affect CPAP adherence as they affect sleep and opportunity to use CPAP. We assessed whether self-reported sleep measures were associated with CPAP adherence and if racial variations in these sleep characteristics may explain racial differences in CPAP adherence. ⋯ PORTABLE MONITORING FOR DIAGNOSIS AND MANAGEMENT OF SLEEP APNEA (HOMEPAP) URL: http://clinicaltrials.gov/show/NCT00642486. NIH clinical trials registry number: NCT00642486.
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To determine whether adaptations to comply with Accreditation Council for Graduate Medical Education (ACGME) duty hour requirements are associated with changes in total cost and length of stay. ⋯ A trainee staffing model that included shorter shifts as consistent with current ACGME duty hour requirements was associated with reduced length of stay and total costs for patients not in the intensive care unit.