Sleep Apnea Screening is Necessary Before Surgery

For patients undergoing surgery, unidentified Obstructive Sleep Apnea is associated with increased risk of complications. Untreated sleep apnea patients are at greater risk of cardiovascular disease, type II diabetes, and premature death. During October 16-20, 2010 the annual meeting of the American Society of Anesthesiologists two similar studies were presented regarding screening presurgical patients for sleep apnea. The patients who screened positive for sleep apnea could be definitively diagnosed and treated and/or monitored more carefully during their time in surgical care.

One study used a comprehensive home sleep study or a full in-laboratory study. 819 patients were enrolled and a stunning 536 patients, 2/3 of the total (65.4%) tested positive for sleep apnea. Of these 85.5% of the patients with severe sleep apnea were not identified by the surgeons and 47% of the severe sleep apnea patients were not identified by the anesthesiologists based on clinical assessment alone.

In a second study a questionnaire followed by an overnight oxygen recorder screened for possible sleep apnea. Although this protocol did not diagnose sleep apnea, it identified patients at greater risk for sleep apnea and therefore at greater risk for surgical complications. 367 patients patients completed the study. It was concluded that simply performing the questionnaire followed by the overnight oxygen overnight screening test identified greater than 90% of the cases of sleep apnea.

The doctors could send the patients for full diagnostic sleep testing to reduce the surgical risks.

In our practice we routinely evaluate and treat patients before surgery. Since surgery often requires a specific time frame, we work closely with the surgical team, cardiology team, or other procedural team to integrate with their surgical schedules. As a result our services are often requested to assist patients in pre-operative evaluation. We use comprehensive questionnaires, home screening tests when appropriate, and state of the art full diagnostic sleep testing to assess patients

When speaking with your surgeon, cardiologist, or other physician prior to a surgery or significant procedure, ask for a referral to  Sleep Medicine for a pre-operative assessment for Obstructive sleep apnea.

Darius Zoroufy

Aerobic Exercise Relieves Insomnia

Insomnia is a common problem of sleep leaving millions awake for hours at night. Many interventions are tried, some successfully, some without success. Often the most effective techniques over the long term are behavioral techniques such as consistent bedtime, relaxing nighttime routine without work and stimulating media, etc.

Regular aerobic exercise during the day improves nighttime sleep quality as well. A study from Northwestern Medicine reported in Sleep Review in the October 27, 2010 issue included 23 sedentary insomniac women who were enrolled in a 30-40 min/day stationary bicycle or treadmill program 4 days per week for 16 weeks. A control group had 45 minuted meetings instead of exercise.

Both groups had exercise about good sleep behaviors.

Exercise improved self-reported sleep quality in the exercise group with participants no longer describing themselves as poor sleepers. They described fewer depressive symptoms and less daytime sleepiness as well. These improvements were not seen in the control group.

For those suffering from insomnia, regular aerobic exercise is an effective intervention. Consistently applying an exercise regime may be one of the most helpful tools for treating insomnia.

Darius Zoroufy, M.D.

A clean mask every day makes CPAP a much better experience

Mask Care Advice From Dr. Zoroufy

Every day I hear complaints about how the mask does not seal correctly, slides to one side in the night, needs to be put on so tightly it is painful and a long list of other complaints.

I ask, quite innocently, "How often do you wash your mask?"

I get answers like, "I try to do it once a week." If they try to do it once a week that means they are probably not succeeding to do it that often. I will even get answers like, "I was supposed to wash that thing? It looks fine to me."

Keeping mask or nasal pillows and headgear is not only hygienic and will help prolong the life of your mask, it will also help your mask seal better against your skin. The problem is that adding another long procedure to your daily routine is not likely to be welcome. Some of the official instructions recommend filling the sink and using dish soap and soaking in an undertaking lasting 15 precious minutes as you are trying to get yourself and possibly your children out the door on time on a busy morning.

Here is a much easier technique that works well and leaves your mask smelling nice at the end of the day.

When your morning alarm rings and you remove your mask, disconnect it from the tubing and shuffle to the bathroom where you hang the mask in the shower. Do not take the mask apart.

When you take your shower the steps of washing the mask are as follows:

1. Hold the mask and headgear in the water until it is all wet.
2. Use a small amount of liquid soap or shampoo to wash all surfaces and headgear. Key word: "small" amount. If you use too much you will be rinsing soap out for a long time. Remember, you will be doing this every day, so it will not be that dirty. Avoid expecially greasy, slimy soaps or they will build up on your mask. The whole process should take only a few minutes. If you spend more than 5 minutes, you are taking too long.
3. Rinse your mask.
4. Shake it out and hang it up
5. Get your mask the next night. It should be dry or nearly dry.
6. *** As a courtesy, tell others in the household you will be leaving your mask in the shower.
7. Once a week take the tube into the shower, wash it and hang it with a similar procedure.
8. The CPAP machine itself does NOT get washed in the shower.

I hope this advice makes your CPAP use better and easier.

Darius Zoroufy, M.D.