Methods for Treating Sleep Apnea in Veterans Prescribed Opioids

by U.S. Medicine

January 11, 2013

DETROIT–Using a titration protocol with continuous positive airway pressure (CPAP) and then positive (PAP) with oxygen effectively eliminates central sleep apnea (CSA) in veterans with underlying comorbid conditions and prescription opioid use, according to a new study from the John D. Dingell Veterans Affairs Medicine Center in Detroit.1

Noting that (PAP) titration protocols for CSA are poorly defined, the authors used retrospective chart review to determine the impact of a stepwise titration protocol using PAP therapy and supplemental oxygen in a sleep clinic population of patients with multiple comorbid conditions and particularly with prescription opioid drug use.

They point out that CPAP eliminates central apneas in 50% of CSA cases, while CPAP in combination with oxygen is effective in an additional 25%.

“There are no standard therapies for the management of central sleep apnea (CSA),” the authors explained in the Journal of Clinical Sleep Medicine article. “Either positive pressure therapy (PAP) or supplemental oxygen (O(2)) may stabilize respiration in CSA by reducing ventilatory chemoresponsiveness. Additionally, increasing opioid use and the presence of comorbid conditions in U.S. veterans necessitates investigations into alternative titration protocols to treat CSA.”

With 162 patients diagnosed with CSA, the protocol was effective in eliminating CSA in 84% of patients. CPAP was effective in 48%, while CPAP plus oxygen was effective in an additional 25%. BPAP with oxygen was effective in 11%, but the remaining 16% were nonresponders.

Of the patients with CSA, 47 (29%) were on prescribed opioid therapy for chronic pain. For them, CPAP, CPAP+O(2), or BPAP+O(2) eliminated CSA in 54%, 28%, and 10% cases, respectively.

1.Chowdhuri S, Ghabsha A, Sinha P, Kadri M, Narula S, Badr MS. Treatment of Central Sleep Apnea in US Veterans. J Clin Sleep Med. 2012 Oct 15;8(5):555-63. doi: 10.5664/jcsm.2156. PubMed PMID: 23066368; PubMed Central PMCID: PMC3459202.

Quick Stress Reduction Technique Improves Sleep for Heart Patients

BETHESDA, MD — An easy 10-minute stress reduction technique can substantially improve sleep quality, according to researchers from Walter Reed National Military Medical Center.

The 10-minute Tension Tamer was tested on 334 patients in a heart health program. Subjects attended a 30-minute introductory workshop, then were given instruction and guided opportunities to practice 10-minute Tension Tamers over the course of four 30-minute visits with a stress-management specialist.

Their study was presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, held in October in Atlanta.

“A growing body of evidence substantiates the important roles of stress and sleep in cardiovascular disease,” according to the authors. “We sought to determine the effect of a brief, portable stress reduction technique, the ten-minute Tension Tamer on improvement of stress levels and sleep parameters in a heart health program.”

Involving deep breathing and imagery selected by the patients, the brief technique is designed to be used at bedtime. Of the study group, 65% improved their perceived stress by 6.6 points, although those who did not respond to the treatment showed worsened stress levels by 4.6 points.

The majority of the group helped by the stress reduction exercise also reported better sleep quality, decreased sleep latency and decreased fatigue.

The study group with mean age of 55.7 years included adult men and women self-referred or referred to the Integrative Cardiac Health Project. All were assessed for levels of perceived stress and sleep quality using validated surveys.

The authors concluded that “a novel stress reduction technique, the ten-minute Tension Tamer, can reduce perceived stress levels in a majority of subjects resulting in improved sleep quality, decreased sleep latency and improved fatigue.”

They suggested that using a portable stress-reduction technique in short intervals “may be a unique approach to improve cardiovascular risk through sleep improvement.”

1. Kashani M, Eliasson A, Bailey K, Vernalis M. Novel Stress Reduction Technique Improves Sleep and Fatigue. CHEST. October 2012;142(4_MeetingAbstracts):1052A-1052A. doi:10.1378/chest.136173

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