Safe use of donated positive airway pressure devices to increase access to treatment for obstructive sleep apnea: a clinical outreach program.

Unlabelled: Coverage to provide positive airway pressure (PAP) therapy for patients with obstructive sleep apnea (OSA) by the Centers for Medicare and Medicaid Services (CMS) and most private insurers is limited to those patients who meet diagnostic criteria for OSA based on a sleep study. Despite PAP therapy being a covered benefit by most insurers, many patients have high out-of-pocket costs due to copays and deductibles. Also, a subset of patients may be diagnosed per the American Academy of Sleep Medicine (AASM) recommended rule (H3A), while not meeting the diagnosis using the acceptable rule (H4) that their insurer requires.

Images: unilateral rhinorrhea in a patient starting autotitrating positive airway pressure therapy for obstructive sleep apnea.

Unlabelled: We report a case of a 65-year-old obese female who developed a unilateral nasal cerebrospinal fluid leak after starting autotitrating positive airway pressure therapy for obstructive sleep apnea. The cerebrospinal fluid leak was confirmed by β-2 transferrin testing of the nasal fluid, as well as by identification of the leak through the anterior cribriform plate after administration of intrathecal fluorescein. The cerebrospinal fluid leak was successfully repaired endoscopically, and autotitrating positive airway pressure was reinitiated 1 month postoperatively.

Use of positive airway pressure in mild cognitive impairment to delay progression to dementia.

Study Objectives: The aim was to assess the relationship between continuous positive airway pressure (CPAP) therapy and cognitive function in patients with mild cognitive impairment (MCI) and obstructive sleep apnea (OSA).

Methods: This was a retrospective chart review of patients with MCI and OSA. CPAP therapy compliance was defined as average use of CPAP therapy for at least 4 hours per night.

When using two patient identifiers is not enough with CPAP therapy.

Begum J, Skiba V. When using two patient identifiers is not enough with CPAP therapy. .

Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea.

Study Objective: Esophageal manometry (Pes) is the gold standard to detect repetitive episodes of increased respiratory effort followed by arousal (RERAs). Because RERAs are not included in the apnea-hypopnea index (AHI), we often refer patients with symptoms of sleep disordered breathing (SDB) and AHI < 5 for a second polysomnogram (PSG) with Pes. Often, the second PSG will demonstrate AHI > 5, confirming a diagnosis of OSA.

Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial.

Importance: Improvement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date.

Objectives: To compare the safety of and to estimate the efficacy for symptomatic outcomes from standard PCS care alone, care supplemented with HBO, or a sham procedure.

Development of chronic epilepsy after recurrent episodes of posterior reversible encephalopathy syndrome associated with periodic lateralized epileptiform discharges.

Posterior Reversible Encephalopathy Syndrome (PRES) is a syndrome comprising headache, altered mentation, and seizures, associated with neuroimaging findings characteristic of subcortical edema in the posterior regions. It is usually seen in patients treated with immunosuppressants, in renal failure, or with eclampsia. Recurrent episodes of PRES in the same patient are rarely observed.

Central nervous system manifestations of Q fever responsive to steroids.

We report the clinical and radiological central nervous system manifestations of a 27-year-old man with Q fever who subsequently developed acute disseminated encephalomyelitis and showed a significant response to steroids. The patient presented with headache and fever and quickly progressed to develop acute respiratory failure and hepatitis. A prompt evaluation revealed positive serology for Q fever and doxycycline was initiated.