Higher VPC Frequency Found in Severe Obstructive Sleep Apnea

A 24-hour Holter ECG would display all the VPCs a patient has in a day, added Dr. Watanabe. If a person has frequent VPCs, they could well show up during a routine office ECG, but if a few minutes of recording do not show anything, a 24-hour ECG would help. According to our study, VPCs seem to be caused by apnea, so VPCs that are more frequent at night may be a sign that a person has OSAS.

Many patients have more than one sleep disorder and I find that a patient questionnaire can be helpful in screening for these, added Dr. Wardrop (see sample form, pp. 13-14). In addition to questions regarding breathing/snoring during sleep, questions about sleep hygiene, alcohol/sedative use, and sleepy driving should be included. A medical history that includes obesity, hypertension, stroke, congestive heart failure, or cardiac arrhythmia suggests the presence of OSAS and the patient should be sent for a PSG.

The natural conclusion of our study would be that once a patient is properly diagnosed, his or her sleep apnea would be treated with a CPAP or BiPAP machine that could help to prevent heart arrhythmia during sleep, Dr. Watanabe said. However, this hypothesis would need to be tested.

Some ENTs are comfortable treating all aspects of sleep disorders and are very qualified to do so, while others may choose to work closely with other sleep medicine colleagues and specialists, said Dr. Wardrop. The decision to refer a patient to a cardiologist would be made based upon the patient’s symptoms while working in conjunction with the patient’s primary care physician. If a serious cardiac abnormality is detected by the otolaryngologist, then referral would naturally occur.

As long as our patients receive excellent care for their sleep disorders, either model works, said Dr. Wardrop.

Certification in Sleep Medicine

The American Board of Otolaryngology (ABOto), in conjunction with the American Boards of Internal Medicine, Pediatrics, and Psychiatry/Neurology, now subcertifies eligible otolaryngologists in Sleep Medicine. Applications are currently being taken for the first examination, which will be given in November 2007. Otolaryngologists interested in becoming subcertified in Sleep Medicine should go to the ABOto Web site (www.aboto.org/sleep_medicine.aspx ) to obtain more information.

For Further Information

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem

Institute of Medicine

www.iom.edu/Object.File/Master/34/114/Sleep%20for%20web.pdf

Sleep Disorders for Otolaryngology: OSAS

B. Tucker Woodson, MD; Nalin J. Patel, MD; Eric M. Genden, MD

www.entresources.org/source/Orders/index.cfm?ETask=1&Task=1&SEARCH_TYPE=FIND&FindIn=0&FindSpec=OSAS

Practice parameters for the indications for PSG:

www.aasmnet.org/PDF/indications.pdf

Practice parameters for the use of CPAP and BiPAP: www.aasmnet.org/PDF/PP_PostiveAirwayPressure.pdf