Thoracic and Sleep Group Queensland People caring for how you breathe and sleep

July 13, 2017

Electronic CPAP data management – Implications for management, privacy and medico-legal issues.

Filed under: Blog — Tags: , , , , , — Trent Segal @ 5:47 am

Technology has seen improvements in the amount and types of data CPAP machines record and more recently manufacturers have utilised wi-fi or modems to transmit data to cloud based databases so it is readily available without necessarily going into the clinic for review.

The Australasian Sleep Association (ASA) have reviewed the current literature on CPAP monitoring systems to provide guidance on their use in the Australasian context.

CPAP monitoring systems

Three leading CPAP manufacturers were compared and all were found to measure and record data in slightly different ways due to their patented algorithms.  For example, the machines algorithms all calculate the residual apnoea-hypopnoea index (AHI) and mask leakage from the flow sensors in the machine.  However all the compared manufacturers did this in a different way based off different criteria of changes in the flow signals.  Additionally during sleep study polysomnography (PSG), many other sensors are used such as respiratory effort, blood oxygen and EEG changes to ultimately determine the AHI, so can this be directly compared to the AHI of a CPAP data system?

Studies have found discrepancies between CPAP AHI and PSG AHI particularly the hypopnoea index.   It was only found to be clinically useful when the CPAP AHI is very low <10 or high >20 however treatment should always be assessed with clinical expertise.  It is also unknown how the long term CPAP AHI values mean clinically in terms of improving cardiovascular, cognitive and daytime function.

Privacy and security policies

The three major manufactures offer cloud based databases for storage of therapy data and patient information which has improved access and patient management.  How secure is this data though?  All have created privacy policies to comply with the relevant legislation and have measures in place to protect it.  However they do need to be reviewed and updated regularly to prevent data breaches and should be checked to ensure they comply with any legislation changes.  Patients should also be explained how their data is hosted and managed and they should carefully read the privacy policies before they consent to their use.

Legal implications

With the ability to now manage CPAP data remotely the question arises, what are the legal implications for providers of therapy?  For example, if a CPAP user has not been adherent or therapy is sub-optimal, then falls asleep driving and causes an accident, what are the legal implications for the treating physician or CPAP providers?  The ASA recognised that some liability does fall on the treating medical professionals and their practices should have good risk management and insurance practices in place.  The frequency of follow up using the new technology and optimal treatment guidelines need to be legally reviewed and no guidelines exist at present however the ASA recommends that CPAP data be reviewed in accordance with the ‘Best Practice Guidelines for CPAP Therapy’.

CPAP data for improving adherence

The modems and wireless transmission means have enabled better tracking of patients therapy however no guidelines have been published on how this data should be used, particularly the frequency in which they should be checked.  Some studies have shown improved adherence to therapy when using this technology in a way so that struggling patients are quickly followed up via telephone compared to standard routinely set follow ups.  The rapid delivery of data makes this information more available for providers to more easily identify struggling patients and follow them up.  New apps and websites allowing patients to view their own data and usage has also been shown to yield an improved adherence in patients who made use of these features compared to those who did not.

Take home messages

  • Standardisation is needed for the algorithms for detecting AHI, leak by CPAP machines.
  • A new name for CPAP AHI (AHIflow) should be adopted as it is not the same measure as PSG AHI.
  • CPAP AHI should not replace comprehensive clinical assessment and follow up. CPAP AHI is clinically useful if the AHI is very low <10 or high >20.
  • Patients should be encouraged to read privacy policies to follow understand how their data is securely stored and used.
  • CPAP data should be reviewed at 7, 30, 60 days then at 12 months and yearly thereafter. CPAP data should not be assessed in isolation and should occur within the context of an overall clinical review by a medical practitioner.
  • Data should be used to help stratify access to review for those that need it most to improve adherence and treatment.
  • Patients should be encouraged to engage in their own CPAP data to improve their usage.

 

http://www.sleep-journal.com/article/S1389-9457(17)30154-5/pdf

June 28, 2017

Drink coffee or sleep in?

Filed under: Blog — Tags: , , — Trent Segal @ 6:56 am

Caffeine is the world’s most widely used psychoactive stimulant, a natural drug occurring in tea, coffee and chocolate.   It works to promote wakefulness by blocking adenosine receptors in the brain.  The adenosine receptors when activated normally act to slow down neural transmissions and promote sleep, thus blocking their action has the opposite effect and prevents sleep.  There is a wide variety of new caffeine containing products available these days but are they safe for everyone and what are your kids getting their hands on?

Children aged 2-19 have steadily increased their consumption from the 70s through the 90s with a similar decrease in dairy and increase in soda.  Since the 90s the rise of the energy drink has taken on some with very high caffeine contents.

Maximum safe intake levels appears to be around 400mg / day in healthy adults, 100mg/day in adolescents and 2.5mg/kg/day in children (less than 12 years old).  One standard sized can of energy drink provides 77mg of caffeine.   The safe levels are much lower for people with cardio vascular issues or pregnant women.  Certain energy drinks have been measured with up to 500mg of caffeine which is higher than the adult safe intake let alone an adolescent.

A recent study on 309 children ages 8-12 years showed 41% drink tea or coffee and 40 % drink caffeinated sodas making up an average intake of 10.2+- 17.4 mg/day.  Caffeine consumption was significantly associated with sleep routine, morning tiredness, restless sleep and internalising behavioural problems.  Although the overall intake was low compared to normal adult consumption, there was an effect on sleep problems and related behaviour.

Remember that caffeine is a drug even if it is sold on every street corner of the city.  Recommendations are to not consume caffeine 6 hrs prior to going to bed.  If you have trouble sleeping or getting the jitters after too many cups of coffee, consider curbing your intake and sleep in for the extra rest.

The full review can be read at http://journal.frontiersin.org/article/10.3389/fpsyt.2017.00080/full#h13

https://www.ncbi.nlm.nih.gov/pubmed/28162144

June 27, 2017

June 26, 2017

June 20, 2017

Humidification – Is it full of hot air?

Filed under: Blog — Tags: , , , — Trent Segal @ 6:18 am

With the recent release of smaller CPAP units, many people are looking at these alternatives for the CPAP treatment for travel purposes or even the primary machine at home.  One of the biggest things these smaller devices forgo is the conventional pass over heated humidifier system with heated tube in place for a heat exchange unit or even nothing at all.

There has been significant evidence showing heated humidifier systems increase adherence to CPAP1, particularly in patients who suffer upper airway or nasopharyngeal symptoms such as dry throat and mouth2.  As a result quality of life when using CPAP has been shown to improve when using humidification3.

Heated tubes were introduced to prevent condensation build up occurring at the mask particularly during the cooler seasons.  The humidifier air would cool as it travels through the tube away from the heater source of the humidifier.  Once it cools enough, the water vapour would turn back into a liquid and flood the mask.  Heated tubes allow the air temperature to remain high all the way from the humidifier to the mask, preventing this ‘rain out’ and ensuring warm, moist air is inhaled by the patient.  The addition of the heated tube has solved this problem however has not been shown to improve adherence of CPAP use overall4.

Humidification is particularly important for sufferers of chronic airways disease.  Disorders such as COPD and bronchiectasis are often associated with persistent airway inflammation with mucus retention.  These patients can suffer exacerbations which often require hospitalisation.  Long term daily humidification use in this group of patients has been shown to significantly reduce exacerbations, improve lung function and quality of life5.

While humidification is often seen as comfort feature in regular CPAP therapy it is important to speak with your doctor or healthcare provider to ensure your treatment is optimised to reduce your symptoms.

  1. https://www.ncbi.nlm.nih.gov/pubmed/10453869
  2. https://www.ncbi.nlm.nih.gov/pubmed/27220350
  3. https://www.ncbi.nlm.nih.gov/pubmed/25957615
  4. https://www.ncbi.nlm.nih.gov/pubmed/26727475
  5. https://www.ncbi.nlm.nih.gov/pubmed/20144858

June 15, 2017

Could a blood test predict OSA?

Filed under: Blog — Tags: , , , , , , — Trent Segal @ 4:23 am

OSA is linked to common cardiovascular risk factors such as obesity, high blood pressure and type 2 diabetes.  Having a blood test is common place as part of a general checkup at the doctors to give important information about possible diabetes, high cholesterol or that there is some other dysfunction in the body.

Common blood tests include the Monocyte count which are a type of white blood cell.  High numbers of these indicate the body is fighting off an infection or may also indicate a more serious blood disorder.  High density lipoproteins (HDL) are also commonly measured along with low density lipoproteins (LDL) and triglycerides which together are used as an indicator of heart health which may show possible early signs of atherosclerosis and cardiovascular disease.

A recent study has looked at the Monocyte to HDL ratio (MHR) in the blood serum and if the ratio was a predictor for obstructive sleep apnoea.

The investigators found that OSA patients (AHI>5 and excessive daytime tiredness) had a significantly lower monocyte to HDL ratio (MHR) to that of controls (AHI <5).  Furthermore, they also found significant differences in the MHR between subgroups of mild, moderate and severe OSA.

These findings suggest the MHR, easily performed by a blood test, could be a useful predictor for OSAS.  Another reason to go to have a regular checkup at the doctor.

https://www.ncbi.nlm.nih.gov/pubmed/28607881

 

May 31, 2017

Wesley Emergency Centre

Filed under: Blog — Tags: , , — Trent Segal @ 5:23 am

Whether it’s a sudden accident, illness, injury or pain, the Wesley Emergency Centre is available 24/7, 365 days a year to patients of all ages. With low wait times and a comprehensive range of services available, you can be sure that your health is in the best hands.

“When every minute matters, choose Wesley”

Emergencies can happen at any unsuspecting time.  Chronic sleep and respiratory conditions can lead to sudden deterioration or exacerbation requiring hospitalisation.  During the winter months, infections are more likely and so it is important to see your doctor if you notice changes to your respiratory health.  This may be the difference between needing to go to hospital or not.

If you are unlucky enough to need an Emergency department, the Wesley Emergency Centre (WEC) is an important and trusted hospital service.

“Here when you need us. And even when you don’t.”

A comprehensive list of services means any condition can be treated within the Wesley by the highly skilled professional staff.  No one likes waiting to be seen and the low wait times at the WEC means you will be quickly triaged and rapidly treated for the best outcomes.

For more information, visit the website:

http://wesley.com.au/services/clinical-services/emergency-centre

 

May 9, 2017

World Road Safety Week

Filed under: Blog — Tags: , , — Trent Segal @ 2:19 am

It is the fourth United Nations World Road Safety week from 8-14th May 2017.  The primary message from the UN is to promote speed reduction, so how can we achieve this?

  • Safe drivers. Research shows that a 5% cut in average speed can result in a 30% reduction in the number of road fatalities.
  • Safe roads. Speed management should be part of every road design to ensure the speeds can be maintained and limits are set appropriately.
  • Safe vehicles. Make sure you keep your car in good condition. A car leaking oil can become a serious hazard to others sharing the road. Modern cars generally have improved safety technologies such as airbags and emergency braking systems.

We can all do our part to ensure we are safe drivers but this doesn’t stop at not speeding. Campaigns against drunk and drug driving have been advertised at times with shocking graphical content.

But what about driving tired, or driving with an untreated sleep disorder?

Research has shown that after sleep deprivation, drivers tend to drift significantly further from side to side on the road. Additionally reaction times are significantly reduced when sleep deprived.  A recent study looked at untreated sleep apnoea and driving performance over time.  They found that both healthy and untreated sleep apnoea sufferers drove similarly at the start of the drive, however during the course of the drive the performance degraded much more quickly in the group with sleep apnoea.

If you suspect you have a sleep disorder then visit your local GP to discuss your options or for referral to a sleep Physician. For more information on the UN road safety week visit their website.

https://www.unroadsafetyweek.org/en/home

https://www.ncbi.nlm.nih.gov/pubmed/27697552

https://www.ncbi.nlm.nih.gov/pubmed/26851617

May 4, 2017

Put plants for your bedroom to help you sleep

Filed under: Blog — Tags: , , , — Trent Segal @ 6:39 am

Many people have trouble sleeping at night, and while many may have an underlying sleep disorder, sometimes we can just find it hard to ‘switch off’ and relax at night due to the stresses of day to day living.

Some try medication, meditation, burning incense, expensive pillows and mattresses we should not forget that bringing the outdoors inside can also actually help.

Plants are part of nature use sunlight to turn carbon dioxide into oxygen by a process called photosynthesis.  Did you know they also have some cleansing and relaxation qualities you may not be aware of?

1 – Aloe Vera

This plant has oxygen producing properties which occur at night, rather than requiring sunlight.  This may help insomnia and assist in relaxation.  A study in 2016 found a similar sedative effect to taking a sleeping pill in rats who were given an Aloe Vera extract.

2 – Lavender

Often used as an essential oil to reduce anxiety, and is probably the most widely used and studied plant.  Positive effects on depression, rest, pain and sleep quality have all been shown by use of Lavender.  Why not put a plant of it in your bedroom?

  1. – Jasmine

Another fragrant plant has been shown to help improve alertness and productivity the following day.

4 – English Ivy

The NASA clean air study back in 1989 looked a numerous plants for their air cleaning capabilities.  English Ivy was high on the list at removing a number of contaminants from the air which can potentially trigger allergies and asthma.

5 – Snake Plant

Another plant thought to improve air quality and help to avoid eye irritation, respiratory symptoms and headaches.

 

Don’t stop at this list, a lot of plants can thrive indoors.  They look great and often smell great too.

Original articles:

http://www.healthy-holistic-living.com/5-plants-for-your-bedroom-to-help-you-sleep-better.html

https://www.ncbi.nlm.nih.gov/pubmed/27610170

https://www.ncbi.nlm.nih.gov/pubmed/28169902

http://online.liebertpub.com/doi/pdf/10.1089/acm.2013.0311

https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/19930073077.pdf

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