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Pre and Post Blood pressures
I am wondering how many labs take blood pressure before and after studies....especially CPAP titrations. It has been the standard in all labs I have worked for over the many years, and has been a benefit to the patients on more than one occasion. I have recently come to find out this is not being done in a lot of labs around the country. Are you taking BPs in your labs, and if not why? And i think it would be nice to lobby the AASM to make this standard practice......What do you think?
Views: 80
Replies to This Discussion
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Permalink Reply by Mike on
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i don't think my blood pressure was taken before or after my sleep study. But I'll leave it to the pros to speak for their labs . . .
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Permalink Reply by RockRpsgt on
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Hey Lee, What's up? How are you and Walt doing? How is the weather on the East coast this week? Welcome to sleepguide. I almost linked this post to Walt"s binary argument on the same topic. Then I realized it was you. Sorry I have not visited the chatroom lately. My wife and I have been hitting the books pretty hard.
My lab does not check BP. Not sure why. I would think it would be important to know the before, during, and post blood pressures if possible. As I have told you before the only BP I have ever checked is my own. I think that I will make it a personal mission this week to make sure that I know how to do it correctly.
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Permalink Reply by D. W. Conn on
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The lab where I work now has not been checking blood pressures. We have now restarted the practice. Severe untreated apnea can have an increase in blood pressure. An increase or decrease in blood pressure can happen over a few days to a few months.
Our physician at the time didn’t think it was needed. We now have 5 AASM Physicians and they all want before and after pressures. They also have us doing holter Monitor report (Heartbeat and rhythm), and checking temperatures.
IMHO pressures before and after should be done.
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Permalink Reply by Judy on
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The sleep lab I usually use does not take BP before and after a PSG, but each visit to the lab to see the sleep doctor they take BP, pulse and 02 readings.
Our blood pressure is usually highest in the mornings so certainly a BP check after the PSG in the morning could be of benefit. And I suppose a BP check before sleeping for the PSG would then give a baseline for comparison. But I see your point as well, jnk.
Ever been in the hospital where they come in during the middle of the night to take your BP? I've never had BP problems but doggone it after my surgery when I just wanted to sleep and did NOT appreciate having that sleep disturbed they took it during the night for days afterwards. Of course that was back in the "old days" when they didn't kick you out whilst you were still dead and dying with pain from the surgery.
Come to think of it though, back then my normal BP was very low and I was slow recovering from anesthetic. Like 3 months after surgery my BP was still in the basement according to my family doctor.
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Permalink Reply by Lee Longnecker on
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Lots of good posts on this, We have managed to catch a patient with internal bleeding with a pre test BP...It kept dropping when he would stand, then go back to normal while sitting....That one act probably saved that patient that night. Also knowing the basics on your patients...Hight/Weight/ BP....Isint that just basic medicine?...I am thinking about lobbying the AASM to make that protocal.
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There is often high blood pressure associated with sleep apnea, A pre and post BP can help to show any worstening hypertension during sleep due to apnea, or it can show a benefit to the blood presure after a CPAP titraton. Also just general knowledge of your patients status as the come in the door, and then you have a baseline to monitor any health changes over night...IE hypertensive episodes.
j n k said:I'm not a pro, so I'm not sure how much I belong in this discussion, but . . .
What would be the specific clinical benefit achieved by taking BP before and after a sleep study?
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This is definately a way that we could show are pts an immediate cause and effect relationship of apnea.
being able to show someone that has probably lived with high blood pressure for a very long time any type of reduction is huge.
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Comendable.....I am really suprised how many labs dont check the basic patient stats.
D. W. Conn said:The lab where I work now has not been checking blood pressures. We have now restarted the practice. Severe untreated apnea can have an increase in blood pressure. An increase or decrease in blood pressure can happen over a few days to a few months.
Our physician at the time didn’t think it was needed. We now have 5 AASM Physicians and they all want before and after pressures. They also have us doing holter Monitor report (Heartbeat and rhythm), and checking temperatures.
IMHO pressures before and after should be done.
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I can see your point, jnk. Altho most everyone's BP is highest in the morning, I can see where the stress or excitement of being hooked up for a sleep study would tend to raise the BP for some, much as they refer to the "white coat syndrome" wherein patients will often have a higher BP when seeing the doctor than when at home.
j n k said:Everyone's BP should be lower upon awakening compared to during a wire-up before a study.
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Everyones Bp should be lower under normal healthy conditions. Apnea is not a normal healthy condition. In a sleep lab we are evaluating sleep. If high BP is a result of bad sleep then should it not be tested? We are talking about a 2 minute procedure jnk. We live in a society in which you can have your BP checked at your local convenience store. Why would we not want it in a sleep lab.
What about the 25 old man that just died? I bet a little more attention to detail would have gone a long way that night.
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I do not know your medical history jnk. I would not want to comment on your doc being remiss or not. I find it odd that you of all people would say that checking BP twice would prove nothing. Most of the time you may be right, but if in that 1% chance that you are not a life may be saved. What do I know though.
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http://www.ncbi.nlm.nih.gov/pubmed/19515590?itool=EntrezSystem2.PEn...
Obstructive sleep apnea/hypopnea and systemic hypertension.
Durán-Cantolla J, Aizpuru F, Martínez-Null C, Barbé-Illa F.
Unidad de Trastornos del Sueño, Hospital Txagorritxu, Universidad del País Vasco, C/ José Achótegui s/n, E-01009 Vitoria-Gasteiz, Alava, Spain. Joaquin.durancantolla@gmail.com
Obstructive sleep apnea/hypopnea (OSAH) syndrome is a highly prevalent condition. Severe OSAH affects 2-6% of the population, although only 10% of subjects are correctly diagnosed and treated. OSAH is an important and unresolved public health care problem because of its role in the development of cardiovascular events, negative impact on quality of life, and as a cause of traffic accidents. Longitudinal and cross-sectional studies have shown a strong association between OSAH and hypertension. Moreover, a number of open-label studies, the majority of 21 controlled studies included in the present review, a systematic review, and 4 recent meta-analyses have shown a reduction of blood pressure (BP) of about 2 mm Hg with continuous positive airway pressure (CPAP). This lowering of blood pressure is significant in terms of reduction of both cardiovascular and cerebrovascular risk and death. The effect is greater in hypertensive subjects and in those with more severe OSAH. Accordingly, treatment with CPAP could be considered in patients with severe OSAH and hypertension even in the absence of symptoms. The challenge to researchers is to find markers for discriminating subjects in whom blood pressure will decrease from non-responders. This will help to refine relevant clinical indicators for CPAP treatment in clinical practice.
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