Publications by authors named "Peter Gay"

Background: Not all hypercapnic COPD patients benefit from home noninvasive ventilation (NIV), and mechanisms through which NIV improves clinical outcomes remain uncertain. We aimed to identify "responders" to home NIV, denoted by a beneficial effect of NIV on arterial partial pressure of carbon dioxide (), health-related quality of life (HRQoL) and survival, and investigated whether NIV achieves its beneficial effect through an improved .

Methods: We used individual patient data from previous published trials collated for a systematic review.

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Objective: Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA.

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Background: Respiratory failure is a significant concern in neuromuscular diseases (NMDs). This CHEST guideline examines the literature on the respiratory management of patients with NMD to provide evidence-based recommendations.

Study Design And Methods: An expert panel conducted a systematic review addressing the respiratory management of NMD and applied the Grading of Recommendations, Assessment, Development, and Evaluations approach for assessing the certainty of the evidence and formulating and grading recommendations.

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This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation).

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Article Synopsis
  • The study aimed to compare the apnea-hypopnea index (AHI) from a home sleep apnea test (PAT-HSAT) and an under-mattress device (WSA) over multiple nights in patients suspected of having obstructive sleep apnea (OSA).
  • 35 out of 61 enrolled patients completed the study, with results showing that the WSA-AHI significantly differed from the PAT-AHI, both under different desaturation criteria.
  • Although the WSA provides undisruptive AHI estimates, its accuracy compared to PAT-AHI varies, suggesting that further research is needed to refine its clinical application.
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Study Objectives: There are multiple stressors in the perioperative period for patients with restless legs syndrome (RLS) that may be implicated in the worsening of symptoms. Our primary objective was to compare the perioperative course of patients with RLS to patients without the diagnosis.

Methods: This was a single-center, matched-cohort, retrospective chart review of patients with RLS undergoing inpatient procedures from 2015-2019 matched 1:1 with patients without the diagnosis.

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Article Synopsis
  • As reliance on medical devices increases, recalls can cause anxiety and disruptions for patients, especially with common devices like positive airway pressure treatment machines.
  • An established recall plan helps healthcare providers respond quickly, minimizing stress and maintaining access for new patients while managing medical supplies.
  • Clear and empathetic communication with patients during recalls not only reduces their anxiety but also improves the overall effectiveness of the recall response plan.
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The current national coverage determinations (NCDs) for noninvasive ventilation for patients with thoracic restrictive disorders, COPD, and hypoventilation syndromes were formulated in 1998. New original research, updated formal practice guidelines, and current consensus expert opinion have accrued that are in conflict with the existing NCDs. Some inconsistencies in the NCDs have been noted, and the diagnostic and therapeutic technology has also advanced in the last quarter century.

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Background: Noninvasive ventilation (NIV), a form of positive airway pressure (PAP) therapy, is the standard of care for various forms of acute respiratory failure (ARF). Communication impairment is a side effect of NIV, impedes patient care, contributes to distress and intolerance, and potentially increases intubation rates. This study aimed to evaluate communication impairment during CPAP therapy and demonstrate communication device improvement with a standardized protocol.

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Objectives: With over 2 million cases of acute respiratory failure in the United States per year, noninvasive ventilation has become a leading treatment modality, often supplanting invasive mechanical ventilation as the initial treatment of choice. Most acute respiratory failure patients use a full face (oronasal) mask with noninvasive ventilation, which is known to impair communication, but its popularity and benefit has led many providers to accept the communication impairment. Medical staff periodically remove masks to communicate with patients, but patients are often limited to short utterances and risk lung derecruitment upon removal of positive pressure.

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The Payer Policy Review Committee of the American Academy of Sleep Medicine launched an initiative to assess the alignment between clinical practice guidelines and private payer medical policies. This article summarizes the importance of the initiative, details the scorecard development process, including an analysis of policy scores and subsequent revisions, and discusses the impact of the scorecards particularly as related to the scorecards on the clinical practice guideline for diagnosis of obstructive sleep apnea in adults. This initiative has increased communication and engagement among members of the Payer Policy Review Committee and private payers, creating opportunities to advocate on behalf of sleep medicine providers and patients with sleep disorders, encouraging payers to modify existing policies so that evidence-based care is provided to patients with sleep disorders.

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Article Synopsis
  • The article talks about a famous sleep doctor named Christian Guilleminault and his important ideas about sleep.
  • It explores how sleep affects health, especially related to high blood pressure (hypertension).
  • The authors reflect on Guilleminault's dreams and visions for better sleep research and understanding.
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Article Synopsis
  • * Recent studies show that VAPS doesn’t seem to be much better than another treatment called bilevel positive airway pressure (BPAP) in improving breathing or sleep for patients, but it might help reduce flare-ups in certain lung disease patients.
  • * VAPS can provide steady support for breathing as diseases get worse, but researchers haven't yet studied how it affects long-term health, like overall survival.
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Study Objectives: Adaptive servoventilation (ASV) is the suggested treatment for many forms of central sleep apnea (CSA). We aimed to evaluate the impact of treating CSA with ASV on health care utilization.

Methods: In this population-based study using the Rochester Epidemiology Project database, we identified patients over a 9-year period who were diagnosed with CSA (n = 1,237), commenced ASV therapy, and had ≥ 1 month of clinical data before and after ASV initiation.

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Study Objectives: At the sleep laboratory, noninvasive positive pressure ventilation titration protocols in patients with neuromuscular disease (NMD) are based on standard pressure cycle devices in a spontaneous/timed mode (BPAP-ST). Experience integrating protocols on average volume-assured pressure support (AVAPS) mode is limited, prompting us to develop a practical single-night titration protocol that provides information to assist clinicians and patients as they decide between BPAP-ST and AVAPS modes.

Methods: We implemented a sequential titration protocol of BPAP-ST followed by AVAPS during a single-night polysomnography study in patients with NMD and reported polysomnographic and clinical metrics.

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The purpose of this workshop was to identify knowledge gaps in the perioperative management of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). A single-day meeting was held at the American Thoracic Society Conference in May, 2016, with representation from many specialties, including anesthesiology, perioperative medicine, sleep, and respiratory medicine. Further research is urgently needed as we look to improve health outcomes for these patients and reduce health care costs.

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Acute respiratory compromise describes a deterioration in respiratory function with a high likelihood of rapid progression to respiratory failure and death. Identifying patients at risk for respiratory compromise coupled with monitoring of patients who have developed respiratory compromise might allow earlier interventions to prevent or mitigate further decompensation. The National Association for the Medical Direction of Respiratory Care (NAMDRC) organized a workshop meeting with representation from many national societies to address the unmet needs of respiratory compromise from a clinical practice perspective.

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Although precise numbers are difficult to obtain, the population of patients receiving long-term ventilation has increased over the last 20 years, and includes patients with chronic lung diseases, neuromuscular diseases, spinal cord injury, and children with complex disorders. This article reviews the equipment and logistics involved with ventilation outside of the hospital. Discussed are common locations for long-term ventilation, airway and secretion management, and many of the potential challenges faced by individuals on long-term ventilation.

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The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients.

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Article Synopsis
  • Chronic obstructive pulmonary disease (COPD) affects around 20 million adults in the U.S., and many of these patients also experience sleep-disordered breathing (SDB), which is not well understood.
  • Noninvasive ventilation (NIV) is proving effective for acute COPD flare-ups in hospitals and is crucial for long-term management of SDBs.
  • Initial studies suggest that COPD patients with chronic hypercapnia (high levels of carbon dioxide in the blood) have lower long-term survival rates compared to those with normal carbon dioxide levels.
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Introduction: Obstructive sleep apnea (OSA) may increase the incidence of postoperative complications when undiagnosed. The purpose of this study was to evaluate the perspectives of Canadian anesthesiologists regarding the perioperative management of patients with diagnosed or suspected OSA.

Methods: This study was conducted as a survey of Canadian anesthesiologists using a self-administered scenario-based questionnaire.

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