Sleep Apnea Syndromes: Collop NA

Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R, Anonymous00275. · Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. · J Clin Sleep Med. · Pubmed #18198809 links to  free full text

Abstract: Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea. At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM. The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards. Under the conditions specified above, PM may be used for unattended studies in the patient's home. Afollow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography.

Collop NA, Epstein LJ. · No affiliation provided · J Clin Sleep Med. · Pubmed #18763419 links to  free full text

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Collop NA. · No affiliation provided · Chest. · Pubmed #16424404 links to  free full text

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Collop NA. · No affiliation provided · Chest. · Pubmed #15006933 links to  free full text

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Collop NA. · No affiliation provided · Chest. · Pubmed #12377825 links to  free full text

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Collop NA. · No affiliation provided · Chest. · Pubmed #11742898 links to  free full text

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Collop NA. · No affiliation provided · Chest. · Pubmed #11713111 links to  free full text

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Collop NA. · Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Curr Opin Pulm Med. · Pubmed #18812829 No free full text.

Abstract: PURPOSE OF REVIEW: The demand for expedient diagnosis of suspected obstructive sleep apnea (OSA) has increased due to improved awareness of sleep disorders. Polysomnography (PSG) is the current preferred diagnostic modality but is relatively inconvenient, expensive and inefficient. Portable monitoring has been developed and is widely used in countries outside the United States as an alternative approach. A portable monitor records fewer physiologic variables but is typically unattended and can be performed in the home. RECENT FINDINGS: Numerous portable monitor studies have been performed over the past two to three decades. The US government and medical societies have extensively reviewed this literature several times in an attempt to determine if portable monitoring should be more broadly used for diagnosing OSA. In March 2008, the US Centers for Medicare and Medicaid Services released a statement allowing the use of portable monitoring to diagnose OSA and prescribe continuous positive airway pressure. This has potentially opened the door for more widespread use of these devices. This review will focus on the literature that has examined portable monitoring as a diagnostic tool for OSA. SUMMARY: It is anticipated that portable monitoring as a diagnostic modality for OSA will be used more frequently in the United States following the Centers for Medicare and Medicaid Services ruling. Physicians and others considering the use of portable monitors should thoroughly understand the advantages and limitations of this technology.

Collop NA. · Department of Medicine, Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21205, USA. · Semin Respir Crit Care Med. · Pubmed #16052414 No free full text.

Abstract: Complete or partial collapse of the upper airway during sleep has different effects on the human body ranging from noisy breathing (snoring) to significant cardiovascular sequelae as seen in obstructive sleep apnea (OSA). Snoring is very common in the adult population and has been associated with morbidity in epidemiological studies. A variety of treatments may be used for primary snoring (snoring without symptoms) but none are universally successful. The upper airway resistance syndrome is thought to occur when incomplete obstruction of the upper airway results in frequent disruptions in sleep. Whether it is a true "syndrome" or just one end of the continuum of OSA is unclear. Obstructive sleep apnea causes not only sleep disruption but oxygen desaturation. It has been associated with numerous cardiovascular sequelae, including hypertension (systemic and pulmonary), arrhythmias, and stroke. Nasal continuous positive airway pressure (CPAP) is the current treatment of choice, with lesser alternatives including oral appliances, surgery, and weight loss. Further study on outcomes is required to determine how aggressively to treat these syndromes.

Collop NA. · Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA. · Am J Cardiovasc Drugs. · Pubmed #15725038 No free full text.

Abstract: Obstructive sleep apnea (OSA) is a common disorder in adults. It is becoming increasingly recognized as a risk factor for cardiovascular diseases such as hypertension, pulmonary hypertension, myocardial infarction, and stroke. Knowing the pathophysiologic effects that occur during obstructive apnea assists in understanding how chronic complications and sequelae develop. OSA is also being recognized as associated with glucose intolerance and motor vehicle accidents. Polysomnography in a sleep laboratory remains the diagnostic method of choice. Treatment options are somewhat limited in scope, but nasal continuous positive airway pressure is the first line and has been shown to clearly improve many of the symptoms and sequelae of the syndrome. Cardiovascular physicians require a working knowledge of OSA and its complications, as many of the diseases they manage have shown links to this sleep disorder.

Exar EN, Collop NA. · Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston 29425, USA. · Chest. · Pubmed #10208219 links to  free full text

Abstract: The upper airway resistance syndrome (UARS) is a recently described form of sleep-disordered breathing in which repetitive increases in resistance to airflow within the upper airway lead to brief arousals and daytime somnolence. This review will first describe the chronological progression of our understanding of UARS within the broader context of sleep-disordered breathing. The primary symptom, daytime somnolence, appears to result directly from repetitive EEG arousals. The level of negative intrathoracic pressure is the most likely stimulus for arousal, possibly mediated by mechanoreceptors in the upper airway. A general consensus regarding the exact clinical definitions and the physiologic measurement techniques leading to a diagnosis does not exist, although esophageal manometry and pneumotachographic airflow measurements taken during polysomnography are the "gold standard." Less invasive diagnostic modalities have been proposed, but none of them have been well-validated. Aside from daytime somnolence, hypertension is an important sequela of this disorder, likely resulting from autonomic and cardiovascular changes induced by increased negative intrathoracic pressure. Nasal continuous positive airway pressure is the most efficacious form of therapy, although low patient compliance may limit its practical application. The safety and efficacy of surgical treatments are poorly documented in the literature. Palatal tissue reduction by radiofrequency ablation and the use of oral appliances hold promise as safe and effective modalities, but these treatments require further study.

Krishnan V, Collop NA, Scherr SC. · Metrohealth Medical Center, Cleveland, OH, USA. · Chest. · Pubmed #18339793 links to  free full text

Abstract: BACKGROUND: Oral appliances (OAs) are first-line therapy for mild-to-moderate obstructive sleep apnea (OSA) and are being used with increasing frequency. Additionally, best practice of OA titration is unknown. We describe the experience of patients treated with an OA, identify factors that predict treatment success with an OA, and offer a protocol for OA titration. METHODS: We retrospectively studied patients seen in a dental sleep clinic between 2002 and 2006. Patients selected for OA treatment underwent baseline polysomnography, were individually fit with an OA, and were instructed to titrate it at home until symptom resolution or discomfort. During follow-up polysomnography, additional titration was performed as needed. Primary outcome was successful treatment, defined as apnea-hypopnea index (AHI) <10 events per hour and AHI decrease at least 50% from baseline. Logistic regression models were created to identify associations between patient characteristics and successful treatment. Overall differences in AHI at baseline, after home titration, and after final titration were compared using Kruskal-Wallis test, and post hoc comparisons were performed with sign tests, with Bonferroni corrections. RESULTS: Of 57 subjects treated with an OA, 37 subjects (64.9%) were successfully treated with OA therapy. Of the 49 subjects for whom data were available for AHI after home titration, 27 subjects (55%) achieved successful treatment of OSA by self-titration, without need for further titration during follow-up polysomnography. CONCLUSIONS: A majority of subjects, regardless of OSA severity, are successfully treated with an OA. Men and younger patients were found to be the best responders. The titration protocol for an OA offers a beneficial initial step in the treatment of OSA.

Lee-Chiong TL, Collop NA. · National Jewish Medical and Research Center, Denver, Colorado, USA. · Semin Respir Crit Care Med. · Pubmed #16052412 No free full text.

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Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA. · Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. · Chest. · Pubmed #10084504 links to  free full text

Abstract: We developed a short-length document that clearly delineates a prudent approach to and criteria for reimbursement of positive airway pressure (PAP) costs for the treatment of obstructive sleep apnea (OSA). Treatment modalities for OSA with PAP include continuous positive airway pressure, bilevel or variable PAP, and autotitrating PAP. This guidance on the appropriate criteria for PAP use in OSA is based on widely acknowledged peer-reviewed studies and widely accepted clinical practice. These criteria reflect current opinion on the appropriate clinical management of OSA in lieu of data pending from the Sleep Heart Health Study and upcoming outcome studies. This document is not intended to provide a complete review and analysis of the OSA clinical literature. The key to the success of this document is to foster consensus within and outside the clinical sleep community by providing a common sense and easily understood approach to the treatment of OSA with PAP.