WHAT WAS NEW AT THE “VENDOR FAIR”

The annual Support Group “Vendor Fair” was held in July and was well attended by members and the medical equipment supply community. The CPAP manufacturers were represented by; Respironics and Fisher & Paykel. Representatives from the Contra Costa Sleep Center and from the Durable Medical Equipment supplier, OxygenPlus, were present to explain their services.

Dr. Peter F. Chase DDS MA also was present at the Vendor Fair this year. Dr. Chase has spoken before the support group on several occasions in the past and is now associated with the Contra Costa Sleep Center specializing in the application of oral appliances for mild/moderate Obstructive Sleep Apnea treatment.

The manufacturer’s emphasis this year was on redesigned and more comfortable nasal pillows and masks in addition to state of the art software controlled CPAP machines. Respironics exhibited their new unique in shape “GoLife” nasal pillows custom designed for both men and women and their “TrueBlue” gel nasal mask as well as their “System One” intelligent CPAP machine.

More information on the Respironics product line can be found at their website: http://respironicssleeptherapysystems.respironics.com/ Fisher & Paykel was present to describe the three new “Zest” Range nasal masks designed to fit better, feel lighter and be easier to use.

More information on the “Zest” Range nasal Masks and Fisher & Paykel’s full range of “ICON” clinical therapy solutions on their website: www.fphcare.com/osa/cpap-solutions.html Although unable to attend this year’s Vendor Fair, ResMed, also has a full line of nasal pillows, masks and system solutions. Information can be obtained at their website: http://www.resmed.com/us/index.html

30 YEARS AGO CPAP WAS INVENTED!

Thirty years ago Dr. Colin Sullivan, an Australian pulmonologist studying the problem of airway collapse, hit on CPAP as a possible solution. Here, (extracted), is how he described it in the Lancet 1981;1:862-65. “One afternoon we were setting up for a nighttime study on a patient with severe OSA who was to have a tracheotomy. He was participating in a series of nightly studies before and after the procedure to measure breathing while he was asleep.

The patient was eager to know if there was anything else that might work. I suppose I was thinking out loud, looking at the mask and all the tubing sitting around for the experimental procedure, when it occurred to me that putting pressure in the upper airway might just hold it open.

The patient was keen to give it a try, and so we started searching around for equipment that we could use. We had large bore tubing into which we cut holes for the nasal prongs (pillows) to fit.

Our next problem was finding a blower to create an appropriate pressure. We had a blower we used to calibrate the Fleish pneumotach (airflow measuring device) and thought that might work. In hours, the first CPAP device for OSA was born.

We were very tentative going into this, not knowing what would happen, how the patient might respond or even if we might ‘blow the patient up.’

What we weren’t prepared for was how quickly and easily we were able to unblock the upper airway obstruction. As we turned the pressure up, the obstruction disappeared, and the patient went immediately into REM (sleep). We then reduced the pressure and recreated the classic obstructive pattern. Turning the pressure up again relieved the obstruction. After a few runs of switching the apnea on and off by changing the pressure level, we realized what a fantastic physiological tool we now had to study obstructive sleep apnea and mechanisms.

However, it wasn’t obvious to me at this stage that this could be a long-term treatment for the patient. Although we had planned to use the pressurized system for just a short time during that first night, the impressive response in terms of sleep quality and respiratory, as well as the patient’s tolerance to it, made me decide to continue on for the whole night. After all, just because it worked for five minutes, it didn’t mean it would work for five hours You have to remember, (in 1981) we knew the airway was collapsing, but no one knew why. Was this passive collapse, or was it an active response? I reasoned that if what we were seeing was a reflexive response, then the patient would adapt to the continuous pressure over time. On the other hand, if it was a physical problem of passive collapse, then CPAP would act as a splint and no adaptation would be seen. I realized that we could answer that question by the end of the night so we continued with pressurization. And we had an extremely satisfied and rested patient next morning. The results we saw were absolutely clear-cut, and I knew right away that the upper airway obstruction was a passive process by how easy it was to unobstruct the airway.”

….. and thus was born the device that has benefitted the one in every 15 people worldwide who suffer from Obstructive Sleep Apnea.

Gender Differences Of Sleep Disordered Breathing

Many studies have shown that men have more sleep disordered breathing problems than women. The one study showed that men had 3 times more sleep apnea than women when compared for Body Mass Index (BMI).

It is known that obesity is a risk for sleep apnea and accounts for 80% of male patients, but 20% of patients are thin or normal weight. Women have less sleep apnea with obesity for unclear reasons, but obesity is still an important risk factor for women also.

It is also known that a larger neck circumference also has more risk for sleep apnea in both men and women. If men have greater than 18 inch collar size, they will more likely to have sleep apnea. If women have a greater than 16 inch collar they will more likely to have sleep apnea.

The upper airway mechanics and muscle tone are important for maintaining an open airway during sleep. Men experience more airway obstruction and collapse than women. Men do have a longer airway length and this may allow for more obstruction. Even though women have smaller upper airways, they have more favorable airway mechanics than men.

Pre-menopausal women appear to be protected as are post-menopausal women with hormone-replacement therapy. After menopause, the risk of obstructive sleep apnea increases in women by 4-fold. This marked increase compares to almost as much as males of the same age.

Much still needs to be learned about disordered breathing during sleep and the search goes on.