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VA Patients More Likely to Suffer Sleep Apnea, Have More Treatment Options
Problem for PTSD Patients
Yaggi and Bravata both said they have been struck by the significant proportion of patients with a concurrent diagnosis of post-traumatic stress disorder (PTSD) who have trouble using the CPAP device. The mask might remind them of a gas mask or trigger claustrophobia, they said.
“We work with mental-health professionals in these cases to acclimate patients to the mask, but Provent is certainly much better tolerated,” Yaggi said.
Patients with more severe sleep apnea also have some better options than the traditional CPAP. The new generation of devices auto-titrates to adjust pressure breath-to-breath as the patient’s needs dictate.
“A person may need less pressure when sleeping on his side and more when sleeping on his back,” noted Yaggi. In addition, the auto-titrating positive airway pressure (APAP) device does not require a second study to calibrate the correct pressure for newly diagnosed patients. Its “smart-card” technology also allows sleep medicine physicians to track whether a patient is using the APAP, identify leaks around the mask and tell how long a patient uses the device at night.
As a result of the reporting features, sleep-medicine providers can focus on coaching patients who have lower compliance rates. The wireless controls limit the need to travel long distances for assessments and allow the provider to change the device’s setting remotely.
Bravata noted the advantages of focusing on patients who were not using the APAP or were or not using the device as recommended. “We blew the control arm out of the water,” in terms of improving device usage and effective treatment rates in the “Go To Sleep” study, she said.
Bravata said she could not reveal the specific improvement seen in treatment rates prior to the study’s publication, but the researchers initially had hypothesized an increase from 15% for usual care to 50% with intervention.
1. Samson P, Casey KR, Knepler J, Panos RJ. Clinical characteristics, comorbidities, and response to treatment of veterans with obstructive sleep apnea, Cincinnati Veterans Affairs Medical Center, 2005-2007. Prev Chronic Dis 2012;9:110117. DOI: http://dx.doi.org/10.5888/pcd9.110117
2. Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med. 2009 Dec;122(12):1122-7. PubMed PMID: 19958890; PubMed Central PMCID: PMC2799991.
3. Bravata DM, Concato J, Fried T, Ranjbar N, Sadarangani T, McClain V, Struve F, Zygmunt L, Knight HJ, Lo A, Richerson GB, Gorman M, Williams LS, Brass LM, Agostini J, Mohsenin V, Roux F, Yaggi HK. Continuous positive airway pressure: evaluation of a novel therapy for patients with acute ischemic stroke. Sleep. 2011 Sep 1;34(9):1271-7. PubMed PMID: 21886365; PubMed Central PMCID: PMC3157669.
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