Sleep
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
The initial approach is to consider conservative measures, focusing on weight reduction, and modification of alcohol and sedative use. Avoidance of sleeping in the supine posture may be helpful in patients with mild sleep apnea occurring predominantly when supine. Nasal Continuous Positive Airway Pressure (nasal CPAP), a system for pressurizing the upper airway and thereby preventing collapse, is the treatment of choice for patients with moderate to severe sleep apnea.45 Nasal CPAP is very effective and safe, but it is not curative. Tolerance and compliance are not always optimal, and therefore other alternatives need to be considered for some patients. Surgery to the nose or soft palate is a consideration, although evidence for the efficacy of these surgical procedures is conflicting. Dental appliances which result in mandibular advancement have been demonstrated to be an effective treatment in some patients, particularly with mild to moderate sleep apnea.45
The Metabolic Medicine Postoperative Bariatric Surgery Consultation
Michael M. Rothkopf, Jennifer C. Johnson in Optimizing Metabolic Status for the Hospitalized Patient, 2023
Many morbidly obese patients have sleep apnea and will come into the hospital on continuous positive airway pressure (CPAP). It is worth a few minutes of our time to review the settings and discuss them with the patient. The deposition of fat in accessory adipose sites around the airway is pathophysiologically linked to the development of obstructive sleep apnea (OSA) (Schwartz et al. 2008). Because of this, the rapid loss of fat mass in the early days to weeks after bariatric surgery can have a dramatic beneficial effect on the degree of airway obstruction (Priyadarshini et al. 2017). Patients often report better sleep and the ability to gain independence from their CPAP units. It is not uncommon for a patient to be able to forgo the device entirely after 1- or 2-month postop. I try to encourage them to contact their pulmonary physician so that they are aware of the surgery and the possible need to adjust settings.
Medication effects on sleep
S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer in Sleep and Psychosomatic Medicine, 2017
Excessive daytime sleepiness (EDS), which is varyingly defined, is present in 5%–15% of the population.4,12,31 Many patients with EDS, particularly those who also complain of snoring, will require overnight sleep evaluation (polysomnography) because of the potential diagnosis of OSA. OSA is usually treated with continuous positive airway pressure (CPAP; a system that utilizes positive nasal pressure to maintain airway patency during sleep). Other treatment approaches for OSA include ear, nose, and throat (ENT) surgery and dental mouthpieces. Symptoms of mood disorders (e.g., depression), which also common causes of daytime sleepiness, can be difficult to distinguish from the symptoms of OSA.23,33 Chronic sleep deprivation as a basis for daytime sleepiness is particularly common in the adolescent and young adult populations and in individuals involved in occupations requiring nocturnal shift work. Less common causes of EDS are neurological diseases inducing sleepiness: narcolepsy and idiopathic hypersomnolence. Daytime sleepiness is probably the most common side effect of CNS-active medications (Table 18.5). A major concern in such sleepy patients is the potential danger to self and others while working and/or driving motor vehicles.34,35
Novel Therapies for Sleep Apnea—The Implants Have Arrived!
Published in The Neurodiagnostic Journal, 2018
Edwin M. Valladares, Terese C. Hammond
Since the introduction of continuous positive airway pressure (CPAP) therapy in 1981, CPAP has represented the first-line intervention for treating patients with moderate to severe sleep apnea (Sullivan et al. 1981). With approximately 29–83% of adult patients unable to meet minimum CPAP therapy adherence criteria (4 hours or more per night for 70% of nights), alternatives to traditional pressure-mask-based therapies have long been sought (Campos-Rodriguez et al. 2016; Weaver and Grunstein 2008; Wolkove et al. 2008). With the Food and Drug Administration (FDA) approval of the Respicardia, Inc., remedē® System for the treatment of central sleep apnea (CSA) in late 2017, and the Inspire® upper airway stimulation (UAS) therapy’s FDA approval for the treatment of obstructive sleep apnea (OSA) in 2014, these implantable devices are now a feasible option for the treatment of a subset of patients with CSA and OSA, respectively (Inspire Medical Systems, Inc. 2014; Respicardia, Inc. 2017). While these devices will not be appropriate for the majority of PAP-intolerant patients, careful selection criteria for both therapies make them a viable option for a small but growing percentage of patients (e.g., approximately 1000 Inspire® implants have been performed by November 2016) (Inspire Medical Systems, Inc 2016). For the first time in decades, truly novel alternatives are available and provide hope for the patients most difficult to treat, who have been intolerant or do not qualify for traditional PAP therapies.
Use and outcomes of long-term noninvasive ventilation for infants
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2018
Prabhjot K. Bedi, Maria Castro-Codesal, Kristie DeHaan, Joanna E. MacLean
Although the most common type of NIV used in both groups was CPAP, more infants were using BPAP compared to older children. CPAP is commonly used in conditions where upper airway obstruction is present, while BPAP is beneficial for disorders resulting in abnormal central ventilatory drive or muscle weakness as it can help unload respiratory muscles and improve alveolar ventilation.39,40 Since upper airway disorders occurred most frequently for both age groups in our population, the higher rates of CPAP use seems appropriate. With the incidence of CNS and NMD being similar for both infants and older children, it is interesting that the rates of BPAP use were significantly higher in infants. Lack of infant-specific guidelines around the use of long-term NIV may be a factor for clinicians deciding whether to initiate an infant on CPAP or BPAP. More infants start NIV in an acute care setting without a prior PSG and, therefore, may be initiated and subsequently continued on BPAP therapy after being transferred home. Additionally, BPAP, but not CPAP, is funded by the provincial health system in Alberta, suggesting funding could be a factor influencing treatment decisions. Infant-specific guidelines around the use of long-term NIV would provide a standard for decision making.
The Impact of Physiological Factors on 30-day Unplanned Rehospitalization in Adults with Heart Failure
Published in Journal of Community Health Nursing, 2019
Omar Alzaghari, Debra C. Wallace
The initial analysis examined the impact of cardiovascular and non-cardiovascular conditions on 30-day HF unplanned rehospitalization. The proportion of patients with many chronic diseases were comparable to those reported by M. Hernandez et al. (2013). Also, the proportion of persons with a reduced ejection fraction equal to or less than 40% was similar to a previous report (Harjai et al., 1999). Multiple diagnoses were related to 30-day unplanned rehospitalization, with chronic kidney disease and use of CPAP as significant predictors. Korda et al. (2017) had reported previous renal disease as a predictor for 30-day HF readmission. Those findings could be explained by volume overload in patients with chronic kidney disease that increases the workload of the heart muscle requiring frequent readmission to remove fluid through diuresis. The use of CPAP will help support a patient’s airways, especially, at night. Patients with HF often sleep on several pillows to reach a comfortable position, which allows full expansion of the chest. Orthopnea was reported a predictor of HF readmission in a previous study (Davison et al., 2016). The use of CPAP can reduce labored breathing and can help HF patients rest. It was interesting to find that combined impact of physiological factors on 30-day HF rehospitalization showed non-cardiovascular indicators as predictors, but not cardiovascular conditions. This may reflect that most of the patients experienced multiple comorbidities and cardiac conditions.
Related Knowledge Centers
- Acute Decompensated Heart Failure
- Bronchopulmonary Dysplasia
- Infant Respiratory Distress Syndrome
- Obstructive Sleep Apnea
- Upper Airway Resistance Syndrome
- Work of Breathing
- Positive Airway Pressure
- Work of Breathing
- Covid-19
- Positive End-Expiratory Pressure
- Pulmonary Alveolus