Restrictive Lung Disease

Restrictive lung disease is another category of pulmonary disorders that may require nocturnal PAP therapy. Lung restriction is most commonly seen in obesity, kypho-scoliosis, neuromuscular disease, interstitial lung disease, and pregnancy. PAP therapy should be used unequivocally in these patients if they have coexisting OSA. However, in the absence of OSA, PAP therapy must be considered on a case-by-case manner, depending upon the disease process being considered. Obese patients without OSA...

Signs and Symptoms of Hypoventilation

The presence of clinical symptoms and or physiologic markers of hypoventilation are useful in identifying clinical severity as it relates to therapeutic decision-making with regard to initiation of nocturnal NIPPV. In the course of a typical progressive disease, two successive steps occur more or less rapidly (i) nocturnal hypoventilation reversible during wake associated with none or a few clinical symptoms and (ii) nocturnal and daylight hypoventilation associated with clinical symptoms,...

Employers Liability for Employees Negligence

The application of traditional vicarious liability rules renders employers vicariously liable for the acts of their employees when performed in the scope of their employment (93). Thus, when Norman Munnal killed a woman when he fell asleep at the wheel of a tractor-trailer while driving for his trucking company employer, it was W.L. Logan Trucking Company that faced liability for its driver's acts (94). The trucking company invoked Ohio's version of the sudden blackout doctrine to defend...

Polymyositis and Dermatomyositis

Polymyositis and dermatomyositis (PM DM) are chronic inflammatory myositis characterized by proximal muscle weakness. Respiratory complications due to pharyngeal and respiratory weakness are common. Although SRBD has not been reported in these patients, alveolar hypoventilation is common (83). Patients with PM DM, symptoms of snoring, hypersomnolence, and respiratory complications should undergo polysomnography to rule out sleep apnea or hypoventilation. CPAP or BPAP should be implemented if...