Caring for the Patient With Obstructive Sleep Apnea: Implications for Health Care Providers in Postanesthesia Care

Abstract Introduction Obstructive Sleep Apnea (OSA) is associated with neuro-cognitive, cardiovascular and metabolic morbidity in children. Adeno-tonsillectomy is the first line of treatment for OSA with PAP therapy and Oxygen supplementation being alternative therapeutic options in select cases. Severe Obstructive Sleep Apnea is a known risk factor for postoperative respiratory complications after adenotonsillectomy. Therefore, inpatient adenotonsillectomy with close monitoring is recommended for this group of children. Challenges to safe and timely care for this high risk group of children can be overcome with effective coordination of care between different locations and health care providers. Methods All children seeking treatment at Dayton Children’s Division of Sleep Medicine were managed through a pathway developed by a multi-disciplinary team involving sleep medicine, otolaryngology and clinical logistics. Severe OSA was defined as AHI ≥15 events/hr (children <2 year old), AHI ≥15 events/hr with three or more Oxygen desaturations <80% (children ≥2 to <6 years old), AHI ≥ 30 events/hr with three or more Oxygen desaturations <80% (Children ≥6 to 18 years old). Results A total of 78 children were diagnosed with severe OSA in 2019. All children were successfully triaged to appropriate therapeutic option (Adenonotonsillectomy, PAP, O2) within 24 hours of diagnosis. Urgent adenotonsillectomy was performed on the same day in 4 children and within 2 weeks on 12 children. There was no postoperative respiratory complication after urgent adenotonsillectomy. Thirteen children had adenotonsillectomy after 2 weeks. PAP therapy was started in 28 children (34%). Therapy was initiated on the same day in 10 children and the next day on one child. Oxygen supplementation was started in 21 children (27%). Conclusion A multidisciplinary collaborative approach can result in delivery of timely and safe care for severe OSA in children. Support NA

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Effect of Sleep Disturbances on Blood Pressure

Hypertension ◽

10.1161/hypertensionaha.120.14479 ◽

2021 ◽

Author(s):

Nour Makarem ◽

Carmela Alcántara ◽

Natasha Williams ◽

Natalie A. Bello ◽

Marwah Abdalla

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Shift Work ◽

Health Care Providers ◽

Sleep Disturbances ◽

Care Providers ◽

Short Sleep ◽

Hypertension Risk ◽

Obstructive Sleep

This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Observational studies demonstrate that subjectively assessed short sleep increases hypertension risk, though conflicting results are observed in studies of objectively assessed short sleep. Intervention studies demonstrate that mild and severe sleep restriction are associated with higher BP. Rotating and night shift work are associated with hypertension as shift work may exacerbate the detrimental impact of short sleep on BP. Further, studies demonstrate that shift work may increase nighttime BP and reduce BP control in patients with hypertension. Finally, moderate to severe obstructive sleep apnea is associated with hypertension, particularly resistant hypertension. Obstructive sleep apnea is also associated with abnormal 24-hour ambulatory BP profiles, including higher daytime and nighttime BP, nondipping BP, and a higher morning surge. Continuous positive airway pressure treatment may lower BP and improve BP dipping. In conclusion, efforts should be made to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.

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Impact Of Positive Airway Pressure On Health Care Utilization In Patients With Obstructive Sleep Apnea

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a5564 ◽

2010 ◽

Author(s):

Scott I. Hagedorn ◽

Robert J. Walter ◽

Christopher Lettieri

Keyword(s):

Health Care ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Health Care Utilization ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Care Utilization ◽

Obstructive Sleep

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Health Care Services Utilization in Children With Obstructive Sleep Apnea Syndrome

PEDIATRICS ◽

10.1542/peds.110.1.68 ◽

2002 ◽

Vol 110 (1) ◽

pp. 68-72 ◽

Cited By ~ 78

Author(s):

H. Reuveni ◽

T. Simon ◽

A. Tal ◽

A. Elhayany ◽

A. Tarasiuk

Keyword(s):

Health Care ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Health Care Services ◽

Sleep Apnea Syndrome ◽

Services Utilization ◽

Care Services ◽

Obstructive Sleep ◽

Health Care Services Utilization ◽

Apnea Syndrome

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0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.733 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A280-A281

Author(s):

S E Neill ◽

R Majid

Keyword(s):

Health Care ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

The United States ◽

Initial Study ◽

Diagnostic Value ◽

Obstructive Sleep ◽

Medicare Patients ◽

Care Costs

Abstract Introduction The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs. Methods A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented. Results 429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA. Conclusion Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP. Support N/A

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397 Health Insurance Status in Subjects at High Risk for Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsab072.396 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A158-A158

Author(s):

Adnan Abbasi ◽

Sameepya Thatipelli

Keyword(s):

Health Care ◽

Obstructive Sleep Apnea ◽

Health Insurance ◽

Sleep Apnea ◽

High Risk ◽

Low Risk ◽

Insurance Status ◽

Health Insurance Status ◽

Obstructive Sleep ◽

Increased Risk

Abstract Introduction Undiagnosed obstructive sleep apnea (OSA) is a major public health problem. Undiagnosed OSA can result in decreased productivity due to absenteeism, increased risk of comorbidities (cardiovascular disease, diabetes, and depression), and increased motor vehicle as well as workplace accidents. Lack of health insurance coverage can lead to undiagnosed and therefore untreated OSA. The objective of this study is to evaluate health insurance status in subjects at high-risk for OSA. Methods This is a cross-sectional, population-based study of adults 18 years and older who participated in the 2017–2018 National Health and Nutrition Examination Survey (NHANES). A modified STOP-Bang score was used to calculate OSA risk. This score included all the variables from the standard STOP-Bang questionnaire, except neck circumference, since it was not reported in the NHANES survey. Subjects were divided into two groups: those at low-risk for OSA with a modified STOP-Bang score of ≤ 3 and those at high-risk for OSA with a modified STOP-Bang score of >4. Results A total of 4,847 adult subjects were included, which represented 223,385,241 of the U.S. non-institutionalized population. Using the modified STOP-Bang score cutoff of >4, 20.9% of the sample were classified as high-risk for OSA, while 79.1% were classified as low-risk for OSA. 90% of the high-risk OSA group and 85.1% of the low-risk OSA group reported having health insurance. Sociodemographic data will also be analyzed and included. Conclusion Approximately 10% of subjects who are at high-risk for OSA reported not having health insurance. This represents over 4.6 million Americans in the non-institutionalized population. Health insurance can improve access to health care. Timely diagnosis and treatment of OSA not only can reduce morbidity and mortality, but can also reduce health care costs. Support (if any) CDC for NHANES Data.

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