The PAP-NAP one decade later: patient risk factors, indications, and clinically relevant emotional and motivational influences on PAP use.

Study Objectives: Positive airway pressure (PAP) noncompliance remains a major barrier in obstructive sleep apnea (OSA) treatment. The PAP-NAP, a daytime PAP "test-drive," has been associated with increased PAP use, but risk factors and indications for the procedure remain unspecified.

Methods: A retrospective chart review was conducted on 139 patients who (1) were diagnosed with OSA (n = 116) or upper airway resistance syndrome (UARS) (n = 23); (2) adamantly refused to proceed with either a full-night attended titration or in-home trial of PAP; and (3) elected to proceed with a PAP-NAP instead.

Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea: a retrospective, nonrandomized controlled study.

Background: Sleep disorders frequently occur in posttraumatic stress disorder (PTSD) patients. Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD. Another sleep disorder, obstructive sleep apnea (OSA), also occurs frequently in PTSD, and emerging research indicates OSA fuels chronic insomnia.

Sleep disorder prevalence in at-risk adolescents and potential effects of nightmare triad syndrome.

Objective At-risk high school students, those considered to have a higher probability for academic failure or dropping out, were assessed for various sleep disorders. Effects were compared between students with and without the nightmare triad syndrome (NTS+), the sleep disorders' cluster of frequent nightmares, insomnia disorder and suspected sleep-disordered breathing (SDB). Methods Data were gathered at a charter school for at-risk youth using: computer based surveys, physical airway exams, and mental health interviews by school social worker.

Positive airway pressure adherence and subthreshold adherence in posttraumatic stress disorder patients with comorbid sleep apnea.

Study Objectives: Patients with comorbid posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) manifest low adherence to continuous positive airway pressure (CPAP) due to fixed, pressure-induced expiratory pressure intolerance (EPI), a subjective symptom and objective sign aggravated by anxiety sensitivity and somatosensory amplification. As advanced PAP therapy modes (ie, auto-bilevel PAP [ABPAP] or adaptive servo-ventilation [ASV]) may address these side effects, we hypothesized such treatment would be associated with decreased expiratory intolerance and increased adherence in posttraumatic stress patients with co-occurring OSA.

Methods: We reviewed charts of 147 consecutive adult patients with moderately severe posttraumatic stress symptoms and objectively diagnosed OSA.

Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients.

Purpose: Emerging evidence shows that positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) in chronic insomnia patients (proposed "complex insomnia" disorder) leads to substantial decreases in insomnia severity. Although continuous PAP (CPAP) is the pressure mode most widely researched, intolerance to fixed pressurized air is rarely investigated or described in comorbidity patients. This retrospective study examined dual pressure, autoadjusting PAP modes in chronic, complex insomnia disorder patients.

Reversal of PAP Failure With the REPAP Protocol.

Background: Re-titrations, an atypical approach to reverse PAP failure, was investigated retrospectively.

Methods: Application of our re-titration of PAP (REPAP) protocol in subjects with previous PAP failure assessed original technology (masks, modes, and pressures) in 273 subjects, of which 70% reported co-occurring psychiatric conditions. The REPAP protocol emphasized changes in pressure modes and settings to address expiratory pressure intolerance and residual breathing events; mask changes were facilitated.

A Novel Therapy for Chronic Sleep-Onset Insomnia: A Retrospective, Nonrandomized Controlled Study of Auto-Adjusting, Dual-Level, Positive Airway Pressure Technology.

Objective: Evidence indicates that behavioral or drug therapy may not target underlying pathophysiologic mechanisms for chronic insomnia, possibly due to previously unrecognized high rates (30%-90%) of sleep apnea in chronic insomnia patients. Although treatment studies with positive airway pressure (PAP) demonstrate decreased severity of chronic sleep maintenance insomnia in patients with co-occurring sleep apnea, sleep-onset insomnia has not shown similar results. We hypothesized advanced PAP technology would be associated with decreased sleep-onset insomnia severity in a sample of predominantly psychiatric patients with comorbid sleep apnea.

Adherence and Subthreshold Adherence in Sleep Apnea Subjects Receiving Positive Airway Pressure Therapy: A Retrospective Study Evaluating Differences in Adherence Versus Use.

Background: Research on subthreshold compliance with positive airway pressure (PAP) therapy in sleep apnea patients may inform clinical sleep medicine practice. We retrospectively assessed compliant and subthreshold compliant sleep apnea subjects to test whether regular but fewer hours of PAP use would demonstrate clinically meaningful improvements and correlate with outcomes.

Methods: A chart review was conducted of 113 consecutive sleep apnea subjects, naive to treatment, who completed a titration study and filled a PAP therapy prescription.

Prevalence of potential nonallergic rhinitis at a community-based sleep medical center.

Purpose: Nonallergic rhinitis (NAR) is a common condition involving symptomatic nasal congestion, stuffiness, or rhinorrhea, which overlap with symptoms of allergic rhinitis. Scant research has examined NAR and sleep. The aim of this study was to assess the frequency of potential NAR symptoms in a large sample of sleep center patients.

Posttraumatic stress disorder and sleep-disordered breathing: a review of comorbidity research.

Posttraumatic stress disorder (PTSD) and sleep-disordered breathing (SDB) are common disorders, but limited data address their co-morbidity. Emerging research indicates PTSD and SDB may co-occur more frequently than expected and may impact clinical outcomes. This review describes historical developments that first raised suspicions for a co-morbid relationship between PTSD and SDB, including barriers to the recognition and diagnosis of this co-morbidity.

Pharmacotherapeutic failure in a large cohort of patients with insomnia presenting to a sleep medicine center and laboratory: subjective pretest predictions and objective diagnoses.

Objective: To measure the frequency of pharmacotherapeutic failure and its association with the diagnosis of sleep-disordered breathing among patients with chronic insomnia disorder.

Patients And Methods: In a retrospective review of medical records from January 1, 2005, through December 31, 2012, we identified an inclusive, consecutive series of 1210 patients with insomnia disorder, 899 (74.3%) of whom used sleep aids either occasionally (168 [18.

Rapid healing of chronic venous ulcers following ultrasound-guided foam sclerotherapy.

Objective: To measure the short term response of venous ulcers in patients treated with ultrasound-guided foam sclerotherapy (UGFS) at a two-week clinic in Honduras.

Methods: Nine females (ages 25-86; mean 48.1 years) with 13 venous ulcers and saphenofemoral junction reflux were treated with UGFS (polidocanol 3% foam; 1-4 injections; 2-11 cc; Mean Volume 5.

Federal guidelines update.

This article reviews laws and regulations that were introduced recently and that will see special application for the allergist/immunologist in 2005. The current work plan of the Office of Inspector General of the Department of Health and Human Services is analyzed New implications of the Medicare Modernization Act of 2003, Health Insurance Portability and Accountability Act (HIPAA) security standards, the Administrative Simplification Compliance Act provider identifier number, and Stark II regulations deserve attention.

Complying with federal guidelines: Medicare Prescription Drug, Improvement, and Modernization Act of 2003: amendments to Social Security Act.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is the most comprehensive health legislation since the initiation of Medicare. It has many other ramifications in addition to establishing a prescription drug payment. This review outlines the prescription drug benefit and attempts to extract the topics important to practicing physicians from the other eleven titles.

Chronic illness care in Russia: a pilot project to improve asthma care in a "closed city".

Context: In Russia, where health status has deteriorated since the late 1960s, asthma is a growing medical and public health problem.

Objective: To create a model for improving care and outcomes of patients with asthma through altering the culture of health care, physician behavior, and public policy in a Russian community.

Design: A 6-month, nonrandomized, before-and-after intervention evaluation.

Rigorous new approach to constructing a gold standard for validating new diagnostic criteria, as exemplified by the eosinophilia-myalgia syndrome.

Background: Constructing diagnostic criteria, a common problem in clinical medicine, is particularly difficult for diseases that lack a pathognomonic "gold standard." To develop an improved strategy for constructing such criteria, we used the eosinophilia-myalgia syndrome as an example. The goal, for research classifications, was to construct validated clinically sensible criteria and to develop improved methods that can be used for other disorders.

Spirituality in medical practice.

Body, mind, and spirit are integrally connected. Medical training in the Western world has been strong concerning the more easily measured physical aspects, and on the mental needs it has been virtually mute on how to minister to the spiritual needs of our patients. Learning the spiritual aspects of medical care is not a typical part of the medical school curriculum, and yet it is emerging as something that our patients want and expect us to do as part of our caring for them.

Criteria for the definition of the eosinophilia-myalgia syndrome.

The widely disseminated surveillance case definition of the eosinophilia-myalgia syndrome (EMS) recommended by the Centers for Disease Control in 1989 has never been validated by an appropriate challenge and has commonly been used for unintended purposes. To accurately classify patients for clinical and epidemiologic studies and to properly diagnose individual patients, an acceptable set of criteria must be established. In determining which combination of clinical and laboratory manifestations should be properly included in criteria for EMS the following elements should be considered: (1) the presence of a well delineated, documented acute episode with characteristic symptoms, signs, and laboratory abnormalities; (2) the presence of characteristic histopathological abnormalities; (3) the presence of objective evidence for involvement of the most commonly affected major organs: skin, muscle, nerve, and/or lung; and (4) the absence of premorbidities or comorbidities that could explain the components of illness on which the diagnosis is based.

The eosinophilia-myalgia syndrome: status of 205 patients and results of treatment 2 years after onset.

Objective: To describe the course of the eosinophilia-myalgia syndrome during a 2-year period.

Design: 15 physicians completed a structured review form to describe symptoms, physical findings, laboratory data, and responses to treatments in 205 patients with the eosinophilia-myalgia syndrome at the onset of illness and after 18 to 24 months of follow-up.

Setting: 15 university and private clinical practice settings.

Association of asthma with serum IgE and skin test reactivity to allergens among children living at high altitude. Tickling the dragon's breath.

Asthma in children and young adults is strongly associated with immediate hypersensitivity to indoor allergens, notably those derived from the house dust mite. In addition, outdoor air pollution is considered to aggravate existing asthma. We investigated the prevalence of asthma and the pattern of allergen sensitization in a mite-free environment with low levels of outdoor air pollution.