Posted by Strohl on April 09, 2003 at 15:45:02:In Reply to: central apnea, PLMD, soporifics (misc questions) posted by David Bresch on April 08, 2003 at 08:07:04:
1) in central sleep apnea seen in the setting of CHF the purpose is not necessarily to stop the apneas although that does happen, but to increase cardiac output and to inflate th elungs (with a higher oxygen store). This tends to stabilize the breathng pattern.
2) There are no randomized or even case series of treatment for PLMs in the absenc eof RLS. There is quite a debate about what PLMs really produce in terms of daytime symptoms. See Pro and Con last year at the APSS.
3) Thyroid testing is recommended by most of the textbooks, but I have s=not seen a case series.
4) I don't treat PLMs. If there is no airflow limitation and there are PLMs that are uncovered, I assign the term cyclic alternating pattern (say it in Italian) and move on.
5)It was on the test one year several years ago (5-7 years ago). Proposed by Chokoverty, and one paper but still the people were shown a figure and asked what it was. If on the test, shame on the Part B committee.
6)I have not found soporifics used in print. There was an answer to a mock test that suggested the possible use. In regard to afalse negative, the only report I know of is from Millman's group who reported it in 1 in 200-300 studies where OSA is suspected. How to avoid it? The Atlas has an example that a person had too much rebound SWS (maybe better head position or something) and therefore (they concluded) the RDI was falsely low. Go figure. I plan to say that I would follow-up and if suspicion remains re-assess for UARS-like stuff.