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Adventures in Sleep

COPD in the Sleep Lab

Published August 28, 2014 10:50 AM by Penny Mehaffey

We had a COPD patient in the lab this week. This is not an unusual occurrence, but it was an exclamation point for me, given that CMS adds COPD to the list of targeted and tracked diseases this October. I thought our patient was a prime example of why COPD is so difficult to treat and why it made the list.

Upon arrival to the lab all was well, but an hour and a half later he begins to complain of SOB; he can get air in but can't move it out well. He said it was painful to breathe and he could take only short breaths. His oxygen saturation remained in the 90s. We did not make it past hook-up. Due to worsening symptoms, we called our RAT (rapid assessment team). He was assessed and taken to the ED for treatment. According to the RAT, the patient was tiring and would have gone into respiratory arrest. Fortunately for us, the MD on call with the RAT was also the patient's pulmonologist.

Interestingly, earlier the sleep tech tried to get the patient to go to the ED but he refused. He did not want to have a blood gas drawn. He thought he would be okay if he rested. Once he was in the ED, he refused the jet neb treatments. This is part of what makes COPD so difficult. These patients are hard to manage and have a host of reasons why not to comply. He was well known to the ED and had multiple admissions. His doctor stated that he really needs CPAP. He was kept in the ED's observation area for about 16 hours and then discharged home with a sleep study rescheduled.

This is a typical scenario that is played out on nursing wards all the time. I see it coming to a sleep lab near you soon, as we take on our roles with the CPAP action plans. I am glad that our tech was alert, diligent and used good assessment skills. I am glad that we had a plan in place and that she followed it. I hope we are ready for October.

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Sounds like this patient needs a Trilogy. It has been my experience COPD pt's are generally not compliant with CPAP therapy because they feel air hungry. They need Bilevel to treat both OSA and COPD. No sleep study is needed for the use of a Trilogy, just an accurate diagnosis.

Aimee Hoyle, Homecare - RRT/RCP, Lincare September 7, 2014 2:23 AM
Clyde NC

When they have both COPD and OSA, it's called "Overlap Syndrome", and you're right. These patients are notoriously difficult to treat. Another comorbidity often seen with these patients is pulmonary artery hypertension, often with resultant right heart failure. It's often the heart failure that finally kills them. They desperately need the postive airway pressure to help keep the right heart failure in check, but the COPD makes this very difficult for them to tolerate this. Bilevel with as long an expiratory time as practical can help, along with 02 bleed in.

  This is near and dear to my heart, since my father just died of this tetralogy. Towards the end he no longer needed CPAP because of extreme wasting, but he was always on pretty high levels of 02. You did the right thing by TURFing him to the ER.

Sudden dyspnea can be a very ominous sign with this population.

Marc, Sleep - Reg. Polysom Tech, Christus Regional Sleep Center September 3, 2014 11:27 AM
Santa Fe NM

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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