Study: Treated sleep apnea reduces hospital readmission rate in cardiac patients

A study claims that the hospital readmission rate for hospitalized cardiac patients is lower if their sleep apnea is treated.

A study of hospitalized cardiac patients is the first to show that effective treatment with positive airway pressure therapy reduces 30-day hospital readmission rates and emergency department visits in patients with both heart disease and sleep apnea. The results underscore the importance of the "Stop the Snore" campaign of the National Healthy Sleep Awareness Project, a collaboration between the Centers for Disease Control and Prevention, American Academy of Sleep Medicine, Sleep Research Society and other partners.

Results show that none of the cardiac patients with sleep apnea who had adequate adherence to PAP therapy were readmitted to the hospital or visited the emergency department for a heart problem within 30 days from discharge. In contrast, hospital readmission or emergency department visits occurred in 30 percent of cardiac patients with sleep apnea who had partial PAP use and 29 percent who did not use PAP therapy.

"Finding a reduced 30-day cardiac readmission rate in PAP-adherent patients is important for improving both patient care and hospital finances," said principal investigator and senior author Dr. Richard J. Schwab, Professor in the Department of Medicine and co-director of the Penn Sleep Center at the University of Pennsylvania Medical Center in Philadelphia.

The study results are published in the Oct. 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.

"Severe sleep apnea is solidly associated with serious cardiovascular outcomes, such as heart failure, heart attacks, and heart-related deaths," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. "This study is a clarion call to detect, diagnose, and especially to treat sleep apnea in patients who are hospitalized for heart problems. Doing so is a win-win-win move; it improves the patient's quality of life, improves health outcomes, and reduces the resources used to manage heart diseases."

The "Stop the Snore" campaign was launched recently to encourage people to talk to a doctor about the warning signs for obstructive sleep apnea, which afflicts at least 25 million adults in the U.S. Sleep apnea warning signs include snoring and choking, gasping or silent breathing pauses during sleep. Pledge to stop the snore athttp://www.stopsnoringpledge.org.

The study involved 104 consecutive patients who reported symptoms of sleep apnea while being hospitalized for a cardiac condition such as heart failure, arrhythmias or myocardial infarction. They were evaluated for sleep apnea using an in-hospital, portable sleep study. Results show that 78 percent of the cardiac patients had sleep apnea (81/104). Eighty percent of sleep apnea cases were predominantly obstructive sleep apnea (65/81), and 20 percent were predominantly central sleep apnea (16/81).

Participants who were diagnosed with sleep apnea were started on PAP therapy, and compliance data were collected via modem or data card. Adequate treatment adherence was defined as using PAP therapy four or more hours per night on at least 70 percent of nights. Thirty-day hospital readmission was defined as a hospitalization or visit to the emergency department for a cardiac cause more than 48 hours after discharge.

According to the authors, reducing hospital readmission rates for cardiac patients is essential for the provision of cost-effective care. They noted that the average total cost per heart failure hospitalization ranges from $13,000 to $18,000. Furthermore, the Centers for Medicare and Medicaid Services (CMS) withholds hospital reimbursement for the care of patients readmitted within 30 days after hospital discharge.

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Sleep apnea screening before surgery

Research claims that people going in for surgery should be checked for sleep apnea due to negative outcomes associated with untreated sleep apnea and serious heart issues.

Scheduled for surgery? New research suggests that you may want to get screened and treated for obstructive sleep apnea (OSA) before going under the knife. According to a first-of-its-kind study in the October issue of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®), patients with OSA who are diagnosed and treated for the condition prior to surgery are less likely to develop serious cardiovascular complications such as cardiac arrest or shock.

"OSA is a common disorder that affects millions and is associated with an increased risk of surgical complications, but the condition often goes unrecognized," said Thomas Mutter, M.D., lead author, department of anesthesia and perioperative medicine, University of Manitoba, Winnipeg, Canada. "As many as 25 percent of surgical patients may have OSA, but the vast majority of these patients aren't treated or don't know they have the disorder."

OSA causes the soft tissue in the rear of the throat to narrow and repeatedly close during sleep. The brain responds to each of these "apnea events" by waking the person in order to resume breathing. Since apnea events can happen hundreds of times per night, sleep becomes broken and ineffective and can lead to serious health problems if undetected. Those who are overweight or have high blood pressure are predisposed to developing OSA. It tends to occur in men but women can also develop OSA. Symptoms of apnea may include: heavy snoring, pauses in breathing during sleep and excessive sleepiness during the day.

The study compared postoperative outcomes in 4,211 patients with OSA, who were diagnosed by sleep study either before or after surgery, with a matched control group of patients who did not have the condition. Those who were diagnosed with OSA prior to surgery were prescribed treatment with continuous positive airway pressure (CPAP) therapy. CPAP keeps a patient's airway open by gently delivering pressurized air through a face mask.

The study found that although patients with untreated OSA were at an increased risk of developing cardiovascular complications, patients who were diagnosed and treated with CPAP therapy before surgery were less than half as likely to experience cardiovascular complications such as cardiac arrest or shock.

Additionally, researchers found that respiratory complications were twice as likely to occur in patients with OSA, compared to patients without the condition, regardless of when patients were diagnosed or if CPAP therapy was prescribed.

-MORE- For both cardiovascular and respiratory complications, increasing severity of OSA was associated with increased risk. Age, type of surgery and other diseases were also important risk factors.

The authors acknowledge limitations related to their retrospective study, as well as the potential resources needed to implement widespread screening. Nonetheless, this study adds to the knowledge base of how to care for this increasingly large segment of the population.

An estimated 18 million Americans are thought to have clinically significant OSA and, even more alarming, about 16 million of those people remain undiagnosed.

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How caffeine disrupts your sleep

New research looks into the specifics of how late-in-the-day caffeine can disrupt your sleep at night.

You hear it all the time when it comes to sleep: Don't drink caffeine too late in the day. It's among the most common sleep tips -- and it's a good one. Caffeine, with its stimulant effects, is disruptive to good sleep. And these days, with the popularity of energy drinks and other caffeine-laden beverages and snacks, it's not difficult to wind up consuming caffeine throughout the day, even if you've set your coffee cup aside. The negative health consequences of too much caffeine also extend beyond sleep problems. Research shows that caffeine may contribute to cardiovascular problems. A recent large-scale study also suggeststhat heavy caffeine consumption -- more than four 8-ounce cups of coffee per day on a daily basis -- is linked to higher mortality rates in men and women.

But how late in the day is too late in the day to be consuming caffeine? Despite consensus about caffeine's sleep-disrupting effects, recommendations about the timing of caffeine consumption -- and when it's best to stop for the day -- can vary widely. Though an abundance of research has been conducted to establish caffeine's negative effects on sleep, very little attention has been paid to the specific timing of caffeine consumption relative to bedtime.

A new study attempts to fill in some of these important specifics about the effects of late-afternoon and early-evening caffeine consumption on nightly sleep. Researchers at Michigan's Henry Ford Hospital's Sleep Disorders & Research Center and Wayne State College of Medicine analyzed the sleep-disruptive effects of caffeine consumption at different lengths of time before bedtime. They found that caffeine consumed even six hours before bedtime resulted in significantly diminished sleep quality and sleep quantity. This is believed to be the first study to investigate directly the effects of caffeine at specific times before nightly sleep.

The study included 12 adult men and women, all of whom were healthy and were normal sleepers who in their regular lives were moderate consumers of caffeine. During the study period volunteers kept up their normal sleep routines, which included bedtimes between 9 p.m. and 1 a.m. and wake times between 6 a.m. and 9 a.m. Participants' total nightly sleep duration fell somewhere in the range of 6.5 to 9 hours per night, with no regular habit of napping during the day. Throughout the study researchers tracked sleep by having participants keep sleep diaries and by using at-home sleep monitors. Participants were given doses of caffeine in pill form as well as placebo pills, on a schedule that enabled researchers to measure the sleep-disruptive effects of caffeine taken at three different points: at bedtime, three hours before bedtime, and six hours before bed. They found significant disruptions to sleep as a result of caffeine taken at all three points:

• Caffeine consumed zero, three, and six hours before bedtime significantly reduced total sleep time. Even caffeine consumed six hours before bed reduced total nightly sleep amounts by more than one hour.
• Caffeine consumed at all three points diminished sleep quality. Caffeine taken three and six hours before bedtime, as well as caffeine consumed at bedtime, significantly increased the amount of time spent awake during the night.
• Disruptions to sleep as a result of caffeine were perceived by volunteers (as recorded in sleep diaries) for caffeine consumed at bedtime and three hours before bed, but were not reported for caffeine taken six hours before bed. However, sleep monitors measuring total sleep time, and sleep efficiency (time spent sleeping relative to total time spent in bed) showed that caffeine consumed six hours before bedtime had significant detrimental effects to both.

This last finding is especially important, because it suggests that people can't -- and shouldn't -- rely entirely on their own perceptions of how much or little caffeine affects their sleep, especially caffeine consumed in the afternoon. Even if you don't feel that late-afternoon cup of coffee has a negative impact on your sleep, this study suggests that it is likely to be interfering nonetheless. This is one reason that I have long recommended a 2 p.m. cut off time for caffeine consumption.

Remember, limiting caffeine doesn't mean removing it entirely from your daily routine. A moderate amount of caffeine, consumed at the right times, can be useful and evenhealthful, stimulating alertness and energy. These new findings provide us with some really important specifics about just how significantly late-in-the-day caffeine can undermine a good night's sleep. Want to enjoy your coffee without wrecking your sleep? Follow these basic suggestions for consuming caffeine in a sleep-friendly way:

Stick to a 2 o'clock cut off. As this current study shows, late-afternoon caffeine can cause problems for your sleep, even if you aren't aware of it. To avoid sleep disruption, restrict your caffeine consumption primarily to the morning hours. If you do have a midday cup of coffee, make sure to drink it before 2 p.m.

Taper caffeine as the day progresses. Start your day with your most highly caffeinated beverage and ease up on the caffeine as the morning goes on. First thing in the morning is likely when you'll crave caffeine the most, and when it can do you the most good in terms of boosting energy and shaking off the effects of a night's sleep. Switch over to tea or decaffeinated coffee as the morning continues, to keep overall daily caffeine amounts moderate and be comfortably caffeine-free by mid-afternoon.

Avoid jumbo drinks. These days, everything seems to be "super-sized" -- and caffeinated drinks are no exception. From a 20-plus-ounce latte or soda to a caffeine-packed energy drink, a lot of caffeine products deliver way more of the stimulant than is healthful. Stick to something much closer to the old-fashioned 8-ounce cup, and savor it.

Don't ignore your sleep problems. Being tired makes us more likely to feel the need for caffeine, and that extra consumption can in turn make sleep problems worse. Avoid this sleep-disruptive cycle by making sleep a daily priority. Practice good sleep hygiene and talk to your doctor about how you are sleeping, particularly about any problems that arise.

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High amounts of exercise can decrease epilepsy risk

A new study indicates that high levels of exercise reduced the risk of developing epilepsy.

A new study conducted in Sweden has revealed that lower fitness rate in men aged 18 has a direct relationship to increased epilepsy risks, the study was a long one covering over 40 years. “During the 40 years, we know that certain people had TBI, we know people had cardiovascular events, and we know some had diabetes because we could follow these from the registers in Sweden,” said Dr. Ben-Menachem. “We also looked at the genetic part and even if we correct for all of those different aspects, we still get the people with high cardiovascular fitness having a lower risk compared to the lower cardiovascular group.”

The association of cardiovascular fitness with epilepsy was still quite significant even allowing for the other known factors responsible for epilepsy. Another interesting factor that came into light is that in a family if 1 brother has epilepsy then the risk becomes two times more for the other brother or brothers to develop epilepsy later in life.

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Sleep Apnea and Sudden Cardiac Death

Research shows that sleep apnea can increase the risk of sudden cardiac death.

Recent studies showed that sleep apnea may increase  the danger of sudden cardiac death.  This was recently revealed by a new research in the Journal of the American College of Cardiology.

During the extensive  research, 10,000 middle aged men and women were referred for sleep studies at the Mayo Clinic Sleep Disorders Center.  Data was taken from 1987 to 2003 study sleep tests.  After the test 78 percent were found to have sleep apnea and in the span of follow up for 15 years, study showed that 142 had sudden cardiac arrest.  The research study leader, Dr. Apoor Gami, a cardiac electrophysiologist, said that oxygen saturation drops when air doesn’t flow into the lungs.  “ if the lowest oxygen saturation was 78 percent, or less, the risk of sudden cardiac death is increased by 80 percent.

What is Sleep Apnea:

According to Healthguide, Sleep apnea is a common and most of the time unnoticed serious disorder wherein your breathing repeatedly stops and starts as you sleep.  Lapses in breathing last between 10 to 20 seconds and can occur up to hundred  times a night.   The result is sleep deprivation which results in daytime sleepiness, slow reflexes, and poor concentration.  Sleep apnea can lead to serious health problems like diabetes, high blood pressure, weight gain and with the recent findings, heart attack.

During the sleep apnea episode, the oxygen level in your blood drops.  Your brain responds by briefly disturbing your sleep which is often manifested with a gasp or a choking sound.  You won’t remember these episodes, most of the time.

Types of sleep apnea

• Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly.
• Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, occurring when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.
• Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea.

Treatments:

 According to Mayo clinic,for milder cases, it is suggested to have a change of lifestyle, like quit smoking and losing weight.  But if there are cases from moderate to severe, there may be some devices  which can open blocked airway and sometimes surgery.  One recommended therapy is the CPAP machine or the Continuous positive airway pressure.  This delivers air pressure through a mask placed over your nose while you sleep.  With CPAP, the air pressure is just enough to keep your upper airway passages open, preventing apnea and snoring.  CPAP is the most common and reliable method of treating sleep apnea.

Immediate home remedies may find helpful also in treating sleep apnea.  It is suggested that try various throat exercises to open up the air passageway.  Others said skipping food 2-3 hours before bedtime can possible cure sleep apnea.  How about trying it?

Sleep Apnea And Sudden Cardiac Death:

In the study conducted by the team of Dr. Gami, they have found a link between Sleep apnea and the sudden cardiac death.  According to Dr. Gami, sleep apnea is related to the type of heart rhythm problem that causes cardiac death.

Moreover, as disclosed bythe American College of Cardiology, it points out that sleep apnea patients’ risk of sudden cardiac death does not simply shift from daytime hours to nighttime hours but that their increased danger of sudden cardiac death is higher than people without sleep apnea.  Treating sleep apnea can improve the quality of life and may have added benefit of preventing cardiovascular disease, as said by Dr. Virend K. Somers of Mayo Clinic College.

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Cardiac events in children with epilepsy

A new study claims that cardiac events are predictable in children with epilepsy.

Cardiopulmonary abnormalities were associated with predictable patient and seizure characteristics in in children with epilepsy, researchers reported here.

Seizure-related apnea was associated with younger age, symptomatic-generalized seizure (versus primary-generalized seizure), seizure duration, anti-epileptic drug use, and seizure-related bradycardia, according to Kanwaljit Singh, MD, of Boston Children's Hospital, and colleagues.

Seizure-related tachypnea was associated with age, right-sided seizure, and was inversely related to anti-epileptic drug use, Singh said in a poster presentation during the Associated Professional Sleep Societies meeting.

Prior research has not extensively explored cardiopulmonary abnormalities that may result in sudden unexpected death in epilepsy (SUDEP) in pediatric epileptic seizures, the authors noted.

They recorded cardiopulmonary changes in 26 pediatric patients during 101 epileptic seizures through pulse oximetry, EKG, and respiratory inductance to provide associations between those changes with seizure and patient characteristics.

The researchers found significant associations between patient and seizure characteristics with seizure-related apnea, bradycardia, bradypnea, tachypnea, bradycardia, post-seizure bradycardia, and tachycardia.

Seizure-related apnea was significantly associated with:

• Younger age (P=0.01)
• Occurrence in the temporal lobe (P=0.0005)
• Left-sided seizure (P=0.003)
• Symptomatic-generalized seizure versus primary-generalized seizure (P=0.01)
• Longer seizure duration (P=0.0002)
• Desaturation (P<0.0001)
• Seizure-related bradycardia (P=0.02)
• Greater use of anti-epileptic drugs (P=0.006)

Apnea approached significance in male patients (P=0.08), in a comparison of symptomatic-generalized versus complex-partial seizures (P=0.08), and in complex-partial versus primary generalized seizures (P=0.08). There was a decreased prevalence of apnea in patients who had frontal lobe seizures (P=0.004).

Seizure-related bradypnea was significantly elevated in those whose seizures were left-sided (P=0.04) and symptomatic-generalized versus complex-partial and primary-generalized seizures (P=0.005 for both). This association showed a trend in those whose seizures occurred in the temporal lobe (P=0.07), whose seizures were lesional (P=0.09), in those with desaturation (P=0.07), and among those who received more anti-epileptic drugs (P=0.07).

Similarly, decreased prevalence trended among those with frontal lobe seizures (P=0.07).

Ictal-tachypnea was significantly associated with older age (P=0.01), frontal lobe versus nontemporal lobe foci (P=0.02), right-sided seizure (P=0.0008), and use of fewer anti-epileptic drugs (P=0.005). There also was a trend toward ictal-tachypnea with female gender (P=0.05) and frontal lobe seizure versus temporal lobe seizure (P=0.09).

Bradycardia in pediatric patients with epileptic seizures was significantly tied to male gender (P=0.03), longer seizure duration (P=0.03), desaturation (P=0.001), and use of more anti-epileptic drugs (P=0.04). There was also a trend with younger age (P=0.09) and a decreased association in those with frontal-lobe seizures (P=0.01).

Tachycardia in the population elevated among female patients (P=0.001) and trended among older patients (P=0.08) and those with frontal lobe seizures (P=0.06). There was a significantly decreased association in those who had lesional seizures (P=0.01) and who received more anti-epileptic drugs (P=0.01).

The authors also found that desaturation increased with longer seizures (P<0.0001), in those with seizure-related apnea (P<0.0001), in those with seizure-related bradycardia (P=0.001), and in those who received more anti-epileptic drugs (P=0.001).

Singh concluded that understanding the patient and seizure characteristics associated with pediatric seizures may allow for future prevention strategies in patients at risk for SUDEP and may help identify the underlying mechanisms of the condition.

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