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Tomasz J. Kuzniar, M.D., Ph.D.

Tomasz J. Kuzniar, M.D., Ph.D.

Tomasz J. Kuzniar, M.D., Ph.D.

Sleep Medicine, Pulmonary/Critical Care
  • Locations
    Locations
    A

    NorthShore Medical Group

    2180 Pfingsten Rd.
    Suite 2000
    Glenview, IL 60026
    847.570.2714 847.733.5109 fax Get Directions This location is wheelchair accessible.
    B

    NorthShore Medical Group

    1000 Central St.
    Suite 615
    Evanston, IL 60201
    847.570.2714 847.733.5109 fax Get Directions This location is wheelchair accessible.
    C

    NorthShore Medical Group

    2150 Pfingsten Rd.
    Suite 3000
    Glenview, IL 60026
    847.570.2714 847.733.5109 fax Get Directions This location is wheelchair accessible.
    D

    NorthShore Medical Group

    9669 Kenton Ave.
    Suite 602
    Skokie, IL 60076
    847.570.2714 847.236.9637 fax Get Directions This location is wheelchair accessible.
  • Publications
    Publications
    • CPAP Adherence, Mortality, and Progression-Free Survival in Interstitial Lung Disease and OSA.

      Chest 2020 May 22

      Authors: Adegunsoye A, Neborak JM, Zhu D, Cantrill B, Garcia N, Oldham JM, Noth I, Vij R, Kuzniar TJ, Bellam SK, Strek ME, Mokhlesi B
      Abstract
      Obstructive sleep apnea (OSA), a common co-morbidity in ILD, could contribute to a worsened course if untreated. It is unclear if adherence to CPAP therapy improves outcomes.
      We conducted a ten-year retrospective observational multicenter cohort study, assessing adult patients with ILD who had undergone polysomnography. Subjects were categorized based on OSA severity into 'no/mild OSA' (AHI <15) or 'moderate/severe OSA' (AHI ≥15). All subjects prescribed and adherent to CPAP were deemed to have 'treated OSA'. Cox regression models were used to examine the association of OSA severity and CPAP adherence with all-cause mortality risk and progression-free survival (PFS).
      Of 160 subjects that met inclusion criteria, 131 had OSA and were prescribed CPAP. 66 patients (41%) had no/mild untreated OSA, 51 (32%) had moderate/severe untreated OSA, and 43 (27%) had treated OSA. Subjects with no/mild untreated OSA did not differ from those with moderate/severe untreated OSA in mean survival time (127±56 months vs 138±93 months; P=0.61) and crude mortality rate (2.9/100 person-years vs 2.9/100 person-years; P=0.60). Adherence to CPAP was not associated with improvement in all-cause mortality risk (HR, 1.1; 95% CI=0.4-2.9; P=0.79), or PFS (HR, 0.9; 95% CI=0.5-1.5; P=0.66) compared to those that were non-adherent or untreated. Among subjects requiring supplemental oxygen, those adherent to CPAP had improved PFS (HR, 0.3; 95% CI, 0.1-0.9; P=0.03) compared to non-adherent or untreated subjects.
      Neither OSA severity nor adherence to CPAP was associated with improved outcomes in ILD patients except those requiring supplemental oxygen.
      PMID: 32450237 [PubMed - as supplied by publisher]
    • New Approaches to Positive Airway Pressure Treatment in Obstructive Sleep Apnea.

      Sleep medicine clinics 2016 Jun

      Authors: Kuźniar TJ
      Abstract
      Continuous positive airway pressure (CPAP) is a mainstay of therapy in patients with obstructive sleep apnea (OSA). This technology has gone through tremendous changes that resulted in devices that can recognize and differentiate sleep-disordered breathing events, adjust their output to these events, monitor usage, and communicate with the treatment team. This article discusses recent developments in treatment of OSA with PAP.
      PMID: 27236053 [PubMed - as supplied by publisher]
    • Treatment-emergent central sleep apnea at high altitude.

      Sleep medicine 2015 Mar

      Authors: Kuźniar TJ
      PMID: 25465532 [PubMed - as supplied by publisher]
    • Sleep apnea, continuous positive airway pressure, and renal health.

      American journal of respiratory and critical care medicine 2014 Sep 01

      Authors: Kuźniar TJ, Klinger M
      PMID: 25171309 [PubMed - as supplied by publisher]
    • The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy.

      Sleep 2014 May 01

      Authors: Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC
      Abstract
      Prior studies show that adaptive servoventilation (ASV) is initially more effective than continuous positive airway pressure (CPAP) for patients with complex sleep apnea syndrome (CompSAS), but choosing therapies has been controversial because residual central breathing events may resolve over time in many patients receiving chronic CPAP therapy. We conducted a multicenter, randomized, prospective trial comparing clinical and polysomnographic outcomes over prolonged treatment of patients with CompSAS, with CPAP versus ASV.
      Qualifying participants meeting criteria for CompSAS were randomized to optimized CPAP or ASV treatment. Clinical and polysomnographic data were obtained at baseline and after 90 days of therapy.
      We randomized 66 participants (33 to each treatment). At baseline, the diagnostic apnea-hypopnea index (AHI) was 37.7 ± 27.8 (central apnea index [CAI] = 3.2 ± 5.8) and best CPAP AHI was 37.0 ± 24.9 (CAI 29.7 ± 25.0). After second-night treatment titration, the AHI was 4.7 ± 8.1 (CAI = 1.1 ± 3.7) on ASV and 14.1 ± 20.7 (CAI = 8.8 ± 16.3) on CPAP (P ≤ 0.0003). At 90 days, the ASV versus CPAP AHI was 4.4 ± 9.6 versus 9.9 ± 11.1 (P = 0.0024) and CAI was 0.7 ± 3.4 versus 4.8 ± 6.4 (P < 0.0001), respectively. In the intention-to-treat analysis, success (AHI < 10) at 90 days of therapy was achieved in 89.7% versus 64.5% of participants treated with ASV and CPAP, respectively (P = 0.0214). Compliance and changes in Epworth Sleepiness Scale and Sleep Apnea Quality of Life Index were not significantly different between treatment groups.
      Adaptive servoventilation (ASV) was more reliably effective than CPAP in relieving complex sleep apnea syndrome. While two thirds of participants experienced success with CPAP, approximately 90% experienced success with ASV. Because both methods produced similar symptomatic changes, it is unclear if this polysomnographic effectiveness may translate into other desired outcomes.
      Clinicaltrials.Gov NCT00915499.
      PMID: 24790271 [PubMed - as supplied by publisher]
    • The complexities of complex sleep apnea.

      Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2013 Nov 15

      Authors: Kuźniar TJ
      PMID: 24235902 [PubMed - as supplied by publisher]
    • Clinical heterogeneity of patients with complex sleep apnea syndrome.

      Sleep & breathing = Schlaf & Atmung 2013 Dec

      Authors: Kuźniar TJ, Kasibowska-Kuźniar K, Ray DW, Freedom T
      Abstract
      The definition of complex sleep apnea (CompSAS) encompasses patients with obstructive sleep apnea (OSA) who develop central apnea activity upon restitution of airway patency. Presence of arterial hypertension (HTN), coronary artery disease (CAD) and heart failure (HF) have been proposed as risk factors for CompSAS among OSA patients. Using our database of patients with CompSAS, we examined the prevalence of these risk factors and defined other clinical characteristics of patients with CompSAS.
      Through retrospective search of the database, we examined the medical and clinical characteristics of consecutive patients diagnosed with CompSAS between 11/1/2006 and 6/30/2011 at NorthShore University HealthSystem.
      One hundred and fifty patients with CompSAS were identified. Among patients included in the study, 97 (64.7 %) had at least one risk factor for CompSAS, while 53 (35.3 %) did not have any of them. Prevalence of low left ventricular ejection fraction and hypocapnia were low. Therapeutic interventions consisted of several positive airway pressure therapies, mainly adaptive servo ventilation. A hundred and ten patients (73.3 %) complied with recommended therapy and improved clinically.
      Although most patients with CompSAS have cardiac comorbidities, about one third of patients do not have any risk factors of CompSAS prior to sleep testing. Further research on factors involved in development of CompSAS will allow for better tailoring of therapy to pathophysiology involved in an individual case.
      PMID: 23436008 [PubMed - as supplied by publisher]
    • Pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease--case report and literature review.

      Pneumonologia i alergologia polska 2012

      Authors: Anderson M, Kuźniar TJ
      Abstract
      Nocardiosis is an infrequent but potentially serious pulmonary infection that typically affects patients with immune suppression or structural lung disease. We report a case of a 70-year-old patient with chronic obstructive pulmonary disease (COPD) treated with inhaled steroids, theophylline, short-acting beta-agonists and anticholinergics, and long-term oxygen therapy, who presented with non-resolving pneumonia. Following a diagnosis of nocardiosis, made based on sputum culture, the patient was treated with trimethoprim/sulphamethoxazole and then, due to treatment side effects, with minocycline. We review the literature data on nocardiosis in COPD patients.
      PMID: 23109210 [PubMed - as supplied by publisher]
    • Treatment of complex sleep apnea syndrome.

      Chest 2012 Oct

      Authors: Kuźniar TJ, Morgenthaler TI
      Abstract
      Complex sleep apnea syndrome (CompSAS) describes the coexistence or appearance and persistence of central apneas or hypopneas in patients with obstructive sleep apnea upon successful restoration of airway patency. We review data on treatment of CompSAS with CPAP, bilevel positive airway pressure, and adaptive servoventilation and discuss evidence for the addition of medications (analgesics, hypnotics, acetazolamide) and gases (oxygen, CO2) to positive airway pressure therapy. Future research should focus on defining outcomes in patients with CompSAS and allow for more accurate tailoring of therapy to the pathophysiology present in the individual patient.
      PMID: 23032455 [PubMed - as supplied by publisher]
    • The emergence of central sleep apnea after surgical relief of nasal obstruction in obstructive sleep apnea.

      Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2012 Jun 15

      Authors: Goldstein C, Kuzniar TJ
      Abstract
      By the current definition, complex sleep apnea (CompSA) refers to the emergence of central sleep apnea (CSA) during the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). However, new-onset CSA has been described with use of other treatments for OSA, including tracheostomy, maxillofacial surgery, and mandibular advancement device. We present a patient with CSA beginning after endoscopic sinus and nasal surgery for nasal obstruction in the setting of mild OSA. This case highlights the importance of non-PAP mechanisms in the pathogenesis of CompSA.
      PMID: 22701391 [PubMed - as supplied by publisher]