What Pro2 is Up2

The benefits of using CPAP therapy to treat obstructive sleep apnea (OSA) have been proven: lessening or elimination of snoring; restoring restful sleep; lowering the risk for high blood pressure, heart disease, heart attack, and stroke; and an improvement in overall quality of life.

But there may be one other benefit that is just coming to light: reduced sensitivity to pain.

In a study recently released, patients with severe OSA underwent a training session to see what their sensitivity to a radiant heat stimulus was. The next night, these patients were titrated on CPAP therapy. After six to eight weeks of using CPAP therapy, the patients returned to the laboratory to be tested again for sensitivity to the radiant heat stimulus.

Finally, the patients in the study were asked to stop using their CPAP for two nights and then return to the laboratory. The sensitivity testing was performed again. All of the sensitivity testing was compared and what the researchers found was that sensitivity to pain was reduced while on CPAP therapy, whether just for one night or for the consecutive 6-8 weeks of therapy.

You can read the entire study here.

If you think you or someone you know may suffer from obstructive sleep apnea (OSA) or another sleep breathing disorder, there are several simple tests you can take. Be sure to always discuss your concerns with your health care provider.

One of the best tests may be a complaint by your bed partner that you snore loudly or stop breathing repeatedly while you're asleep. Findings recently presented at CHEST 2012 (the annual meeting of the American College of Chest Physicians) showed that being elbowed or poked by a bed partner while sleeping was a good indicator of having OSA.

Three tests that you can take right now are the American Sleep Apnea Association's Snore Score, the Epworth Sleepiness Scale, and the Berlin Sleep Questionnaire.

If you have any questions regarding your results, please contact your physician or one of our Respiratory Therapists at 716.667.9600. CPAP can change your life!

Approved by the Food and Drug Administration in 2008, Provent has spread mostly by word of mouth. But it has caught on fast. Its manufacturer, Ventus Medical, says it has shipped one million of the devices in the past 12 months, up from a half million total in the two years prior. Doctors say it has given them a new weapon in the battle against sleep apnea, and many patients who struggled with CPAP call it a godsend.

Bob Bleck, who owns a computer networking firm in Ohio, struggled with poor sleep and chronic fatigue for decades. But it was only a year and a half ago that he finally went to a sleep clinic, prodded by his wife, who worried about his heavy snoring.

The diagnosis was severe sleep apnea. Tests showed that in a typical night, Mr. Bleck, 47, awoke or stopped breathing 42 times an hour.

“After I started using it, I noticed a difference right away,” he said. “My symptoms subsided dramatically.”

Provent works like a traditional CPAP machine but is only a fraction of the size. When people with apnea fall asleep, their throat muscles collapse, constricting the airway and causing the body to fight for air. CPAP machines use mild air pressure to keep the airway from constricting.

Provent does too, but in a different way. The device contains two pinhole-size valves, one over each nostril. The valves let air in easily — most people breathe through their nostrils while asleep — but there is resistance as the user exhales. That resistance creates a backpressure in the airways, dilating the muscles that would otherwise collapse in the middle of the night. In the morning, the patch is removed; a new one is used every night.

Last year, in a large study of 250 apnea sufferers published in the medical journal Sleep and subsidized by Ventus, researchers found that those who used Provent devices over a three-month period saw their apnea episodes fall sharply, compared with people who were given a sham, or placebo, device. A follow-up study tracked people over the course of a year and had similar results.

Unlike CPAP, Provent is not covered by Medicare and most major insurers, though some doctors say they expect that will change in the near future. In the meantime, a 30-day supply of the patches costs $65 to $80.

For now, CPAP will continue to be the gold standard, and certainly the first option for patients with severe apnea. But for the roughly 50 percent of patients in whom CPAP fails, Provent may be a reliable alternative.

[Excerpts taken from Well: The New York Times Health/Science Blog. To Treat Sleep Apnea Without the Mask by Anahad O'Connor. Click here to read the entire story.]


Source: O'Connor, Anahad. (April 9, 2012). To Treat Sleep Apnea Without the Mask. Well: The New York Times Health/Science Blog. Retrieved October 16, 2012 from http://well.blogs.nytimes.com/2012/04/09/treating-sleep-apnea-without-the-mask/

Patients ask us on a daily basis to explain some of the terms they hear when going for a sleep study or read when they receive their sleep study results. We thought it would be helpful to compile a list of some of most commonly used terms.

Actigraph: A biomedical instrument for the measurement of body movement.

Apnea: Cessation of airflow at the nostrils and mouth lasting at least ten seconds. There are three types of apnea- obstructive, central, and mixed. Obstructive apnea is secondary to upper airway obstruction; central apnea is associated with a cessation of all respiratory effort; and mixed apnea has both central and obstructive components.

Apnea-hypopnea Index (AHI): The number of apneic episodes (obstructive, central, and mixed) plus hypopneas per hour of sleep as determined by all-night polysomnography.

Autotitration Device: A device that increases and decreases pressure in response to specific events, such as snore, flow limitation, apneas, and leak.

Bi-level Device: A device that provides two levels of positive pressure, one for inspiration (breathing in) and one for expiration (breathing out). Beneficial for some CPAP patients who are unable to tolerate high fixed pressures and for patients who present with hypoventilation.

Body Mass Index (BMI): Evaluates weight independent of height and may be correlated with mortality and other health-related factors. It is not a direct measure of body fatness and varies with body composition in relation to gender, age, and ethnicity. BMI= weight divided by height squared.

Central Sleep Apnea (CSA): Respiratory event that is characterized by no air flow for at least ten seconds during which no respiratory effort is evident.

Continuous Positive Airway Pressure (CPAP): A device that delivers continuous positive pressure to a patient's airway through an interface. The positive pressure acts as an air splint to keep the upper airway patent during sleep.

Electroencephalogram (EEG): A recording of the electrical activity of the brain by means of electrodes placed on the surface of the head. Together with EMG and EOG, EEG is one of the three basic variables used to score sleep stages and arousals.

Excessive Daytime Sleepiness (EDS): Subjective report of difficulty in maintaining the alert awake state, usually accompanied by a rapid entrance into sleep when the individual is sedentary; daytime tiredness or fatigue.

Hypersomnia: Excessively deep or prolonged major sleep period. May be associated with difficulty in awakening or sleep drunkenness.

Hypopnea: An episode of shallow breathing (airflow reduced by at least 50%) during sleep lasting ten seconds or longer, usually associated with an arousal or an oxygen desaturation.

Mixed Apnea: Respiratory event characterized by no air flow for at least ten seconds with both a central and obstructive component. The central component precedes the obstructive component.

Multiple Sleep Latency Test (MSLT): A series of measurements of the interval from "lights out" to sleep onset that is utilized in the assessment of excessive sleepiness. Subjects are allowed a fixed number of opportunities to fall asleep during their customary awake period. Excessive sleepiness is characterized by short sleep latencies. Long latencies are helpful in distinguishing physical tiredness or fatigue from true sleepiness.

Obstructive Sleep Apnea (OSA): Respiratory event characterized by no air flow for at least ten seconds with continuous respiratory effort.

Periodic Leg Movement (PLM): A rapid, partial flexion of the foot at the ankle, extension of the big toe, and a partial flexion of the knee and hip that occurs during sleep. The movements occur with a periodicity of 20-60 seconds in a stereotypical pattern lasting 0.5-5.0 seconds in duration and are a characteristic feature of the periodic limb movement disorder.

Polysomnogram (PSG): The continuous and simultaneous recording of physiological variables during sleep (i.e. EEG, EOG, EMG, EKG, airflow, respiratory movements, lower limb movements, and other electrophysiological variables).

Respiratory Disturbance Index (RDI): The number of respiratory events (apneas, hypopneas, and RERAS) per hour of total sleep time which cause an arousal or an oxygen desaturation as determined by all-night polysomnography.

Sleep-disordered Breathing (SDB): Describes a number of breathing disorders which occur during sleep, such as OSA, CSA, Cheyne-Stokes respiration, nocturnal hypoventilation.

Upper Airway Resistance Syndrome (UARS): Presence of repetitive arousals following periods of increased respiratory effort; are undetected by thermal sensors (i.e. thermistors or thermocouples) but can be identified by a nasal pressure transducer signal.


Source: Glossary of Terms Used in Sleep Disorders Medicine, Resmed.

According to DME MAC A, the Medicare Administrative Contractor for Durable Medical Equipment, more than two-thirds of all claims denied in their latest audit were denied because of issues with face-to-face clinical evaluation documentation.

DME MAC A reviewed claims processed between November 2011 and January 2012 for CPAP devices. Of claims that were denied, almost half (46.5%) were missing the required clinical documentation and medical records to support the medical necessity of the device.

"These claims had no Face to Face clinical evaluations from the beneficiaries' medical records. Included in these were no Face to Face evaluations conducted by the treating physicians where the beneficiaries were seeking PAP replacement following the 5 year RUL or when requiring coverage of a replacement PAP upon entering FFS Medicare."

About 20% of the claims that were denied had insufficient clinical documentation to support the medical necessity of the device, such as:

- No detailed narrative describing the presenting symptoms of sleep disordered breathing, daytime sleepiness/fatigue, observed apneas, choking/gasping during sleep; duration of symptoms; or Epworth Sleepiness Scale scores
- The face-to-face clinical re-evaluation failed to demonstrate an improvement in obstructive sleep apnea (OSA) symptoms and that the patient continued to benefit from PAP therapy
- Insufficient clinical documentation for face-to-face evaluations where the patient is seeking PAP replacement or when requesting coverage of a replacement PAP upon entering FFS Medicare

Finally, just over 6% of denied claims were missing the signature and/or date on the face-to-face evaluation and a handful had illegible documents.


Source: Results of Widespread Prepayment Review of Claims for HCPCS E0601, (Continuous Positive Airway Pressure Devices). NHIC, Corp. Retrieved August 20, 2012 from http://www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin_pca/042012_cpap.pdf