Clinical Adult Literature Updates from July 2012

A Multisite Randomized Trial of Portable Sleep Studies and Positive Airway Pressure Autotitration Versus Laboratory-Based Polysomnography for the Diagnosis and Treatment of Obstructive Sleep Apnea: The HomePAP Study

This study tests the utility of an integrated clinical pathway for obstructive sleep apnea (OSA) diagnosis and continuous positive airway pressure (CPAP) treatment using portable monitoring devices. A home-based strategy for diagnosis and treatment compared with in-laboratory PSG was not inferior in terms of acceptance, adherence, time to treatment, and functional improvements.

Association Between Treated and Untreated Obstructive Sleep Apnea and Risk of Hypertension

Compared with participants without OSA, the presence of OSA was associated with increased adjusted risk of incident hypertension; however, treatment with CPAP therapy was associated with a lower risk of hypertension.

Effect of Continuous Positive Airway Pressure on the Incidence of Hypertension and Cardiovascular Events in Nonsleepy Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial

In patients with OSA without daytime sleepiness, the prescription of CPAP compared with usual care did not result in a statistically significant reduction in the incidence of hypertension or cardiovascular events. However, the study may have had limited power to detect a significant difference.

Outpatient Anesthesia for Patients with Obstructive Sleep Apnea: Results of a National Survey

This survey shows that outpatient surgery for patients with sleep apnea is common practice in Germany. It is also performed when patients have moderate or severe OSAS and for respiratory tract surgery. This means that the management of OSA patients in Germany does not conform to the ASA OSA guidelines.

Clinical Manifestations of Obstructive Sleep Apnoea in Pregnancy: More Than Snoring and Witnessed Apnoeas

Sleep disordered breathing and its symptoms have been associated with a multitude of fetal and maternal complications including gestational hypertensive disorders, gestational diabetes and possibly pre-term labour and other markers of alterations in fetal wellbeing. The disease remains underdiagnosed in the general population but likely also in pregnancy, mostly because providers do not appropriately screen for the disorder. This case series describes patients with diagnoses such as chronic hypertension, pre-eclampsia, pulmonary hypertension, nocturnal asthma and panic attacks, who were diagnosed with sleep disordered breathing and offered treatment with CPAP during pregnancy.

Expiratory Upper Airway Obstruction Caused by the Soft Palate during Bag-Mask Ventilation

An audit of 90 anesthetized patients undergoing bag-mask ventilation revealed a 34% incidence of EXPIRATORY upper airway obstruction due to the soft palate forming a one-way valve that allowed gas to enter the lung through the nose but prevented exhalation via this route. Expiratory obstruction resulted in breath-stacking and was cured by removing the mask intermittently and allowing the mouth to open.