Improving the performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea.

Outside sleep laboratory settings, peripheral arterial tonometry (PAT, eg, WatchPat) represents a validated modality for diagnosing obstructive sleep apnea (OSA). We have shown before that the accuracy of home sleep apnea testing by WatchPat 200 devices in diagnosing OSA is suboptimal (50%-70%). In order to improve its diagnostic performance, we built several models that predict the main functional parameter of polysomnography (PSG), Apnea Hypopnea Index (AHI).

Performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea in a large sleep clinic cohort.

Study Objectives: Peripheral arterial tonometry (PAT)-based technology represents a validated portable monitoring modality for the diagnosis of OSA. We assessed the diagnostic accuracy of PAT-based technology in a large point-of-care cohort of patients studied with concurrent polysomnography (PSG).

Methods: During study enrollment, all participants suspected to have OSA and tested by in-laboratory PSG underwent concurrent PAT device recordings.

Legal Aspects of Sleep Medicine in the 21st Century.

Multiple manifestations of sleep disorders may interact with the law, making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable because of the actions of sleepy employees.

Legal and Regulatory Aspects of Sleep Disorders.

Sleep disorders may interact with the law, making awareness important. Insufficient sleep and obstructive sleep apnea (OSA) are prevalent and associated with excessive sleepiness. Patients with excessive sleepiness may have civil or criminal liability if they fall asleep and cause a motor vehicle accident.

Restless legs syndrome.

Restless legs syndrome is a common sensorimotor disorder characterized by an urge to move, and associated with uncomfortable sensations in the legs (limbs). Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Brain iron deficiency and dopaminergic neurotransmission abnormalities play a central role in the pathogenesis of this disorder, along with other nondopaminergic systems, although the exact mechanisms are still.

Sleep and sleep disorders in the hospital.

Sleep abnormalities are common and underrecognized in hospitalized patients. Sleep restriction is common and can have undesirable behavioral and physiologic effects. The general pattern of polysomnographic abnormalities observed in hospitalized patients is reduction in total sleep time, stages R (rapid eye movement), and N3 (slow wave) and increase in stage N1 percentage.

Sleep-disordered breathing during pregnancy.

Pregnancy is associated with many physiologic and hormonal changes along with changes in sleep architecture, placing pregnant women at risk for the development of sleep-disordered breathing or worsening of preexisting sleep apnea. Snoring, the most common symptom of sleep-disordered breathing, is markedly increased during pregnancy. The exact prevalence of obstructive sleep apnea in pregnant women is unknown.

The utility of spirometry in diagnosing pulmonary restriction.

The aim of this retrospective study was to determine the utility of the spirometric measurements FVC, FEV1, and FEV1/FVC in diagnosing pulmonary restriction. Spirometry and lung volume measurements performed on the same patient visit were analyzed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (1) FVCor=LLN were compared to diagnose restriction based on lung volume measurements.

An open-label trial of granulocyte macrophage colony stimulating factor therapy for moderate symptomatic pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is a rare idiopathic autoimmune lung disease in adults characterized by the accumulation of lipoproteinaceous material within the alveoli of the lung. The natural history of this disease is poorly defined. Current therapy of bilateral whole-lung lavage (WLL) under general anesthesia is invasive and has its limitations.

Surgical intervention in patients with moderate to severe pulmonary arterial hypertension.

Background: Patients with pulmonary arterial hypertension are believed to experience severe postoperative complications after major surgery.

Methods: We retrospectively analyzed the data of 21 patients with pulmonary arterial hypertension who underwent 28 surgical procedures at our institution between 1996 and 2002.

Results: The average mean pulmonary arterial pressure was 53 +/- 14.

Estimating FVC from FEV2 and FEV3: assessment of a surrogate spirometric parameter.

Background: In the context that accurate measurement of FVC is important in diagnosing airflow obstruction and in assessing restriction, strategies to achieve reliable and accurate FVC measurement have drawn much attention.

Objectives: Because the rate of achieving end-of-test criteria during spirometry has been shown to be low, with resultant under-recording of the FVC, the current study proposes a regression equation for estimating FVC from measured values of the forced expiratory volume in 2 s (FEV2) and forced expiratory volume in 3 s (FEV3).

Methods: The predictive equation for the estimated FVC from volume measurements within the first 3 s of exhalation (estimated FVC3) was generated based on 330 consecutive acceptable spirograms performed in the Cleveland Clinic Foundation Pulmonary Function Laboratory.

Pulmonary alveolar proteinosis. Clinical manifestations and optimal treatment strategies.

Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of surfactant phospholipids and proteins within the lung alveoli. Important advances have been made over the past 8 years in our understanding of this disease, offering new directions for research and patient care. First, genetically altered mice that are homozygous for a disrupted granulocyte-macrophage colony-stimulating factor (GM-CSF) gene developed a lung lesion with histologic resemblance to PAP.