Monday, June 30, 2008

Friday, June 27, 2008

Running A Sleep Lab

A key part of running a sleep lab is keeping on top of the constantly changing regulatory environment, on both the federal and state levels. This link does a good job of describing the new federal regulations for independent diagnostic and testing facilites (IDTF's) that went into effect January 2008 (though for pre-existing IDTF's, many of the provisions do not apply until January 2009). Every February the AASM gives a course on sleep lab management that is very useful for anyone running a sleep lab.

Wednesday, June 18, 2008

Treating OSA improves cognitive dysfunction in Alzheimer's disease

Increases in total sleep time (TST) related to treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) are associated with improvements in cognition in patients with Alzheimer's disease, a new study shows.
The study is summarized on Medscape.

obstructive sleep apnea and diabetes

The International Diabetes Federation reports on the close relationship between type 2 Diabetes and Obstructive Sleep Apnea:

Obstructive Sleep Apnea (OSA) is the most common form of sleep-disordered breathing, accounting for over 80% of cases.
Estimates suggest that up to 40% of people with OSA will have diabetes, but the incidence of new diabetes in people with OSA is not known.[i]
In people who have diabetes, the prevalence of OSA may be up to 23%[ii], and the prevalence of some form of sleep disordered breathing may be as high as 58%.[iii]
Overweight and obesity may play a role, but some recent studies show an association between the two conditions that is independent of overweight/ obesity.
OSA may have effects on glycemic control in people with type 2 diabetes.
OSA is associated with a range of cardiovascular complications such as hypertension, stroke and heart failure.
IDF calls on health decision makers to encourage further research into the links between the two conditions and urges healthcare professionals to adopt new clinical practices to ensure that a person with one condition is considered for the other.

More information about the relationship between diabetes and osa is available on the IDF website.

Sunday, June 15, 2008

Memory dysfunction and obstructive sleep apnea

Obstuctive sleep apnea is associated with cognitive dysfunction, including memory problems.
A study reports that key brain structures involved in memory, the mammilary bodies, are shrunken in patients with Obstructive sleep apnea:
A study using high-resolution magnetic resolution imaging (MRI) scans reports that mammillary bodies — brain structures involved in memory — were 20% smaller in patients with sleep apnea than in controls.

Wednesday, June 11, 2008

More from Baltimore

Earlier this week preliminary data from the Sleep Heart Health Study was presented. It appears that in patients without significant preexisting cardiovascular disease, moderate to severe osa (apnea-hypopnea index of greater than 30 with events requiring a 4% desat) over a 10 year period led to only modest increases in the risk of incident coronary artery disease in men younger than 70 (about 1.35x risk), and no to minimal increased risk in older men and in women. The stroke risk however was significantly elevated in men, but not in women with an ahi of greater than 30. Sleepiness appeared to increase the risk of the development of coronary artery disease and stroke.

The implications of this large (over 6000 subjects) prospective cohort study is that osa may not increase the risk of developing cardiovascular disease (angina, coronary artery disease, congestive heart failure) as much as previously thought, though the risk of developing ischemic stroke is increased in younger men (about 2.7x).
Patients without significant cardiovascular disease should be treated if symptomatic (significant sleepiness). This study does not change the need to aggresively treat osa in patients with preexisting cardiovascular disease.

Tuesday, June 10, 2008

Greetings from Baltimore

Went to an interesting session today at SLEEP 2008 on portable home testing. Not much has changed over the last several months. Most Medicare carriers are still writing Local Coverage Determinations for home testing. It appears that the old code for home testing with a type 3 device (95806) is being replaced with a G code (G0399) with additional G codes for Type 2 and Type 4 devices. Trailblazer, the Medicare carrier for New Mexico and several neighboring states apparently won't cover home testing, though that decision is still under review.
Everyone is talking about home testing, but no one appears to be doing it yet to any great extent. It doesn't appear that home testing will be done to any great extent until 2009; it will take at least that long for the local Medicare carries to decide their policies regarding home testing, and more importantly, get the payment mechanisms/codes in place for home testing

Sunday, June 08, 2008

SLEEP 2008

I just arrived at the SLEEP annual meeting, in Baltimore. Hope to be inspired at this meeting and post about it this week.