Sleep Apnea Syndromes: Goldberg R

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.

Goldberg R. · Department of Internal Medicine and Neurology, Medical College of Pennsylvania-Hahnemann School of Medicine, Philadelphia, USA. · Curr Opin Pulm Med. · Pubmed #11100959 No free full text.

Abstract: Treatment, other than with continuous positive airway pressure, for patients with obstructive sleep apnea remains an active area of investigation. The long-established behavior modification approaches (eg, weight loss and avoidance of alcohol and sedatives) are applicable to many patients, though unlikely to be curative. Oral appliances and surgical techniques are used, although treatment success is hindered by the site-specific nature of the therapies. These treatments are traditionally used for the patient with mild sleep apnea, but more recent studies are questioning their possible benefits in a moderate-to-severe apnea patient population. Surgical techniques range from uvulopalatopharyngoplasty and more extensive skeletal modifications (maxillomandibular advancement), to laser-assisted uvulopalatoplasty and newer minimally invasive techniques. Preoperative evaluation, patient selection, and measures of success vary somewhat between publications, making comparison of treatments and their application to the individual patient challenging.

Goldberg R, Grandi E. · American Sleep Apnea Association, USA. · AHIP Cover. · Pubmed #18488803 No free full text.

Abstract: Obstructive sleep apnea (OSA) was first identified in the early 1960s. It is likely to have been affecting adults for thousands of years, due to an anatomical feature in humans that makes us different from other mammals. The oropharynx, the space between the uvula and the epiglottis, is unique to humans and is responsible in part for our ability to speak. It is the space where the tongue and the uvula meet to obstruct the upper airway.

Phillips B, Collop N, Goldberg R. · University of Kentucky College of Medicine. Lexington, KY 40536-00847, USA. · Chest. · Pubmed #10858390 links to  free full text

Abstract: STUDY OBJECTIVES: To determine attitudes and knowledge about sleep medicine among chest physicians. DESIGN:: Interactive survey of self-selected respondents. SETTING: Interactive session at the 1998 American College of Chest Physicians (ACCP) annual meeting. PARTICIPANTS: Approximately 60 chest physicians. INTERVENTIONS: Interactive questions about the knowledge, training, attitudes, and practice of sleep medicine. MEASUREMENTS AND RESULTS: Response rates demonstrated that 65% of respondents directed or were on the staff of a sleep laboratory, 18% had American Board of Sleep Medicine (ABSM) certification, and only 3% had completed formal sleep medicine training, and performance on test questions about sleep-disordered breathing was better than that on questions about "nonpulmonary" sleep disorders. We polled approximately 60 participants in an interactive session called "Issues in Sleep Medicine Education and Practice" at the ACCP annual meeting in October 1998. The group was well-credentialed, with about one third of participants being board-certified in pulmonary medicine and critical care medicine, and about 17% having passed the ABSM examination. About two thirds of the group spent < or = 25% of their time in the practice of sleep medicine, but > 30% directed sleep laboratories. Respondents thought that sleep training was better addressed in pulmonary fellowship training than in medical school or other postgraduate training experiences. Forty-three percent of the group had received training in sleep medicine as part of a pulmonary fellowship. About half of the sample thought that formal training should be required for eligibility to take the ABSM examination. When presented with two "nonpulmonary" sleep disorder cases, this well-trained and self-selected group did not perform very well. The findings suggest that pulmonologists are actively involved in the practice of sleep medicine and that they both need and desire formal training in sleep disorders during pulmonary fellowship training. CONCLUSIONS: Participants were actively involved in the practice of sleep medicine, most had trained informally, and performance on questions about nonpulmonary sleep disorders was not good.