Sleep Blog

Medicare recently made a determination that it will not cover in-home sleep studies in many parts of the county. That’s an inherently bad decision, yet one applauded by many professional organizations.

It’s a bad decision because there are, for one example, far too many in need to sleep studies and far too few sleep labs.

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Ann Arbor, MI – Here is one more thing to add to the growing list of health challenges faced by obese children: A new study from the University of Michigan Health System finds that obese children are much more likely than normal-weight children to have problems with airway obstruction and other breathing-related functions during surgery.

Obese children were found to have a higher rate of difficult mask ventilation, airway obstruction, major oxygen desaturation — a decrease in oxygen in the patient’s blood — among other airway problems. The study appears in the March 2008 issue of the journal Anesthesiology.

“To our knowledge, this is the first study of its kind,” says lead author Alan R. Tait, Ph.D., professor in the Department of Anesthesiology at the U-M Health System. This large-scale prospective study examines the effect of overweight and obesity on the outcomes of operations in children undergoing elective non-cardiac surgery.

“Based on current trends, it is likely that anesthesiologists will continue to care for an increasing number of children who are overweight or obese,” Tait says, “so it is vital that we are aware of the higher risk they face in the operating room.”

Researchers studied the experiences of 2,025 children who were having elective surgery. Of those, 1,380 were normal weight, 351 were overweight and 294 were obese. Children ranged in age from 2 to 18 years old.

In addition to the problems the obese patients experienced during surgery, they also had a higher rate of illnesses and conditions including asthma, hypertension, sleep apnea and Type II diabetes. These conditions all can contribute to problems during surgery, Tait notes.

Childhood obesity by the numbers:

• An estimated 15 to 17 percent of children and adolescents in the United States are considered obese.
• Major airway obstructions occurred in 19 percent of obese children, compared with 11 percent of normal-weight children.
• Nearly nine percent of obese children experienced difficult mask ventilation, compared with 2 percent of normal-weight children.
• 17 percent of obese children in the study experienced major oxygen desaturation (decreased oxygen in the blood), compared with 9 percent of normal-weight children.
• 28 percent of obese children had asthma, compared with 16 percent of normal-weight children.

It should be noted however, that despite the increased risk of adverse events among children who are obese, none resulted in significant illness.

In addition to Tait, authors were Ian Lewis, MBBS, MRCP, FRCA; Terri Voepel-Lewis, MSN, RN; Constance Burke, BSN, RN; and Amy Kostrzewa, M.D., all of the U-M Department of Anesthesiology.

The research was funded by the U-M Department of Anesthesiology.

Reference: Anesthesiology, March 2008, Vol. 108, Issue 3

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A news story on the Australian Broadcasting Corp. site tells of a wrongful death case involving a hospitalized patient with apnea is being heard.

It seems the brother of a now-deceased man diagnosed with sleep apnea had told hospital workers that whenever his brother is asleep, he needs to use his CPAP machine. According to testimony presented to the Adelaide Coroners Court, workers at the mental health facility where the man’s brother was a patient, failed to ensure the man had his CPAP on one day while in a “music room.”

According to the article, Marek Tarnowski, age 33 at the time of his death in May 2005, died at Woodleigh House at Modbury Hospital. Prior to his admission, Mr. Tarnowski suffered back injury at work in 1997, the article noted, adding that severe pain and lack of mobility soon led to depression. That depression led to the man checking himself into mental health care facility.

The article notes that his younger brother, who was not named, who cared for his brother on a regular basis, and explained to the court that he told two staff members of the hospital that his brother needed to use his CPAP machine every time he feel asleep, and that, at times, the staff may need to assist in ensuring his brother’s nasal CPAP mask was fitted over his nose properly.

In his testimony, the 23-year-old brother says nothing about his now-deceased older brother’s apnea, or CPAP use, was ever written into his brother’s medical records.

About a year later, according to the article, Marek Tarnowski was found dead after falling asleep in the music room of Woodleigh House.

The court heard testimont that the staff would usually wake the man when he fell asleep, according to the article, the day the brother died in his sleep, it was explained in court, a nurse decided to let him sleep without the machine.

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The Agency for Healthcare Research and Quality (AHRQ) is sponsoring the Institute of Medicine’s Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety.

The committee will focus on two tasks: (1) reviewing and synthesizing the evidence on optimal resident work schedules, and (2) developing strategies for implementing optimal resident work schedules.

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