Screening for OSA among DOT Examinees: Challenges and Advancement

Size: px
Start display at page:

Download "Screening for OSA among DOT Examinees: Challenges and Advancement"

Transcription

1 Screening for OSA among DOT Examinees: Challenges and Advancement Chunbai Zhang, MD, MPH Medical Director Employee Occupational Health Service (EOHS) Silverman Institute of Healthcare Quality and Safety Beth Israel Deaconess Medical Center, Boston, MA Instructor of Medicine, Harvard Medical School PLEASE STANDY BY WEBINAR WILL BEGIN AT 12:00 PM PST FOR AUDIO: CALL / ACCESS CODE: #

2 Conflict of Interest Disclosures: I have no financial relationships with commercial entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients relevant to the content I am planning, developing, presenting, or evaluating.

3 Content Attestation I, Chunbai Zhang, hereby declare that the content for this activity, including any presentation of therapeutic options, is well balanced, unbiased, and to the extent possible, evidence-based.

4 Outline 1. Brief background of OSA 2. Epidemiology of OSA among CMV Operators 3. Diagnostic Approaches among CMV Operators 4. Screening/Diagnostic Challenges 5. Case Discussion 6. Future Outlook

5 Obstructive Sleep Apnea

6 Who is at Risk for OSA?

7 OSA prevalence in U.S. is 2-10% OSA prevalence among commercial drivers : 17-28%

8 Prevalence of OSA among DOT examinees

9 Consequences (clues) of OSA

10

11

12 OSA Increases the Risk of Crash by 2-11 Fold

13 Case #1! 52 y.o. obese man presented to your office for biannual DOT exam. He reports of normal health. He denies significant medical history. He has been a driver for a local trucking company for 20 years.! You assess his sleepiness by a questionnaire Epworth Sleepiness Scale (ESS)

14

15 JTF Guideline 2008 for OSA Adapted from :Screening Recommendations for Commercial Drivers With Possible or Probable Sleep Apnea from Hartenbaum et al. J Occup Environ Med. 2006;48(9 Suppl):S4-S37.

16 ESS background:! Australia added the Epworth Sleepiness Scale (ESS) to its CDL health questionnaire.! At an occupational clinic setting, drivers behave differently from those found in sleep clinic (Durand JOEM 2009 and Parks JOEM 2009)! Low Epworth Score (avg: < 3 out of 24)! Low self-reported symptoms! doctor shopping

17 Epworth Sleepiness Scale (ESS)

18 Epworth SS = 0!!!

19 OSA Screening or Case - finding Methodology Subjective Questionnaires Objective Measurements Method I Method II Method III Test Name Methodology Type False Negative Rate Ease of Use Test accuracy by DOR Applicability for Universal Screening (US) or Case Finding (CF) Both BQ I Poorexcellent CHSQ I Utilizes BQ, no separate evaluation ESS II poor Both STOP_BANG II Averageexcellent Case Finding SA-SDQ III Averagegood Case Finding MAP III Poor-good Both Kushida III Excellent Case Finding Index Predictive Modeling Ease-of-use scale, with 0 defining easy and 3 meaning complex methodology: 1 point each for four or more test elements or variables, log scale, and need for additional techniques measurements or investigations. Tests applicable for universal screening were previously validated in a general population while those applicable for case finding have been validated only in sleep clinics or populations with a high prevalence of OSA. DOR = diagnostic odds ratio BQ = Berlin Questionnaire, CHSQ = Cleveland Sleep Habits Questionnaire, ESS = Epworth Sleepiness Scale, STOP-BANG = Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender, SA-SDB = Sleep Apnea scale of the Sleep Disorders Questionnaire, MAP = Multivariate Apnea Risk Index

20 Physical Exam: NAD, BMI 36, neck size 18 inch, tonsils size 0 x2 Mallampatti II. VS: BP mildly elevated. Otherwise normal exam What do you do next? Give him a normal 2 year DOT card? Give him a 6 month DOT card? Further testing? Call a sleep specialist?

21 Mallampatti Scale

22

23 Which tests shall you choose next? Home study or In-Lab sleep study?

24 In-lab polysomnogram (PSG)

25

26 MBTA Newton, MA (2008): NTSB Recommendations on OSA To all U.S. Rail Transit agencies: Medical exams should elicit prior diagnoses of obstructive sleep apnea or other sleep disorders and presence of risk factors. Identify operators at high risk for OSA or other sleep disorders and require that such operators be evaluated and treated. NTSB 2009

27 SCOPER Categorization System for Sleep Studies

28 PM Devices by SCOPER Categorization

29 Home Sleep Study (Portable Monitor)

30 Sleep Study Choices/Chain of Custody technology --- a moving target!

31 Advantages and Disadvantages of PMs vs. PSG

32 Sensitivity and specificity of various portable monitors to diagnose OSA

33 Potential Applicability of PM Studies among 100 High-risk CMV Operators

34 Adding a Z-Axis (Time) to the graph: It gets even more complicated!

35

36

37 The Watkins Study (2009)

38 Watkins Study (cont.)

39 Answer: it depends. on the pre-test probability (BMI, neck size, symptoms etc.)! High Pre-Test Probability! PM would suffice! Low/Moderate Pre-Test Probability! PSG considered!? Other sleep disorders! PSG considered! Occupational Setting! Chain of Custody if using PM

40 Case #2! The DOT examinee returns with a diagnosis of OSA! The DOT examinee reports of using CPAP now! You look at the sleep report:! AHI is 39! CPAP titration showed a pressure of 9 cm water was recommended by the sleep specialist! What do you do next?! 1. give him a one year DOT card! 2. check his CPAP compliance then decide! 3. ask for a CPAP titration study report! 4. he is disqualified because he has severe OSA.

41 Case #2 Definition of CPAP Compliance Medicare Criteria for Compliance: 1.! 4 hours/night AND 2. 70% of the Nights in 30 day period

42 Case 2 (answer)! Check his compliance:! Either a note from his sleep specialist, or! A compliance report print out from his CPAP machine: Does his CPAP compliance Meet the Medicare Criteria? What do you do now? -A year DOT card -Or 3 month DOT card

43

44 Case #3 The same DOT examinee returns 1 year later.!he tells you that despite his perfect CPAP compliance, he had residual daytime sleepiness.!his sleep specialist has placed him on Nuvigil (armodafinil) a week ago, which he claims is helpful.!what do you do next?! Disqualify him because CPAP did not help! Refer for CPAP re-titration study! Give him a one-year DOT card! Contact his sleep specialist for clearance

45 Modafinil (Provigil ) and Armodafinil (Nuvigil )! Mechanism is unclear (on dopamine receptors)! the viagra of the brain! Armodafinil is the R-enantiomer of Modafinil! FDA approved for adjuvant therapy for OSA! also used in Narcolepsy and Circadian rhythm disorder! Adverse Rxn: SJS, insomnia, nausea, dizziness

46 FMCSA guidelines on Modafinil! Need close monitoring by the prescriber! Usually titrated up to 150 mg or 250 mg! Recommend a 6-week monitor period! Documentation that the medication helps (?)! MSLT (multiple sleep latency test) may be needed! Rule out Narcolepsy (a rare but disqualifying condition)! Maximum 1 year DOT card if approved.

47 Key factoids in Obstructive Sleep Apnea (OSA) at Occupational Settings! OSA symptoms (daytime sleepiness, physical exam findings, sleep study)! DOT examinee s self-reported symptoms not reliable! Biometrics and Exams are important! Pre-test probability is important for choosing an appropriate study PM vs. PSG! Follow up and enforcement of sleepy drivers on the road! Keep in mind the goal: sleepiness, not OSA per se

48 Day-time Sleepiness independent of OSA During naps, sleep latency & wake time were significantly lower in obese subjects However, during nighttime testing, obese patients demonstrated significantly higher wake time Obesity may affect day-time sleepiness via a pathway independent of breathing-related sleeping disorder (BRSD)

49 Other Determinants of Sleepiness Age Obesity Diabetes Insulin Resistance/Visceral Adiposity Level of Physical Activity Depression/Emotional Stress *Vgnontzas AN, Sleep Med October; 9(7)

50 The Ultimate Questions for DOT exam: How do we know if a driver is sleepy enough to crash? On going research: PVT vs. Driving Simulation (JOEM, Zhang et. al. 2010)

51 Wrap Up:! OSA is a surrogate measure of sleepiness: Not everyone with OSA are sleepy; the sleepy ones may not have OSA! DOT examinees may not volunteer subjective reporting of sleepiness ( A Unique Challenge for Occ Med Providers)! Portable Monitors (PM): an evolving technology ( A Moving Target ). Chain of Custody is much needed! PSG vs. PM will depend on Pre-Test Probability! Post treatment compliance is important! Further data using PM in DOT examinees are needed! New tools are in development for sleepy driving

52 Q & A:! Questions? Or Comments?

53 Thank You

54 Thank you for participating in today s webinar. At the conclusion of this call you will receive an with a link to a post-webinar questionnaire. You will need to complete this questionnaire in order to receive CME for this webinar. This webinar presentation can be downloaded at

Obstructive Sleep Apnea in Truck Drivers

Obstructive Sleep Apnea in Truck Drivers Rocky Mountain Academy of Occupational and Environmental Medicine Denver, Colorado February 6, 2010 Obstructive Sleep Apnea in Truck Drivers Philip D. Parks, MD, MPH, MOccH Medical Director, Lifespan Health

More information

Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM I have no disclosures to make.

Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM I have no disclosures to make. Maryland College of Occupational and Environmental Medicine April 2014 Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM fczarnecki@gablesgroup.com I have no disclosures to make. Guidelines 2006: Joint Task

More information

Stefanos N. Kales MD, MPH, FACP, FACOEM HARVARD UNIVERSITY

Stefanos N. Kales MD, MPH, FACP, FACOEM HARVARD UNIVERSITY Sleep & Transportation Accidents Stefanos N. Kales MD, MPH, FACP, FACOEM HARVARD UNIVERSITY NECOEM / MaAOHN 2017 Newton, MA Stefanos N. Kales MD, MPH, FACP, FACOEM DIVISION CHIEF, OCCUPATIONAL MEDICINE

More information

Checklist for Completion of Training Requirements in Sleep Medicine Pathway 2

Checklist for Completion of Training Requirements in Sleep Medicine Pathway 2 Checklist for Completion of Training Requirements in Sleep Medicine Pathway 2 This checklist follows the mandatory components of training in sleep medicine for physicians who have followed Pathway 2. Please

More information

Drug Prior Authorization Form Alertec (modafinil)

Drug Prior Authorization Form Alertec (modafinil) This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required

More information

Polysomnography (PSG) (Sleep Studies), Sleep Center

Polysomnography (PSG) (Sleep Studies), Sleep Center Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)

More information

PORTABLE OR HOME SLEEP STUDIES FOR ADULT PATIENTS:

PORTABLE OR HOME SLEEP STUDIES FOR ADULT PATIENTS: Sleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing MP9132 Covered Service: Prior Authorization Required: Additional

More information

OBSTRUCTIVE SLEEP APNEA and WORK Treatment Update

OBSTRUCTIVE SLEEP APNEA and WORK Treatment Update OBSTRUCTIVE SLEEP APNEA and WORK Treatment Update David Claman, MD Professor of Medicine Director, UCSF Sleep Disorders Center 415-885-7886 Disclosures: None Chronic Sleep Deprivation (0 v 4 v 6 v 8 hrs)

More information

Coding for Sleep Disorders Jennifer Rose V. Molano, MD

Coding for Sleep Disorders Jennifer Rose V. Molano, MD Practice Coding for Sleep Disorders Jennifer Rose V. Molano, MD Accurate coding is an important function of neurologic practice. This section of is part of an ongoing series that presents helpful coding

More information

The Effect of Sleep Deprivation on Health & Productivity

The Effect of Sleep Deprivation on Health & Productivity The Effect of Sleep Deprivation on Health & Productivity Andy Rosa, AmeriGas Jean Tyrell, RN, AmeriGas Scott Mattes, AmeriGas Allan Pack, MBChB, PhD, UPenn Learning Objectives The Science Basic sleep/circadian

More information

Provigil Nuvigil. Provigil (modafinil) / Nuvigil (armodafinil) Description

Provigil Nuvigil. Provigil (modafinil) / Nuvigil (armodafinil) Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.60.14 Subject: Provigil Nuvigil Page: 1 of 6 Last Review Date: December 8. 2017 Provigil Nuvigil Description

More information

Sleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing

Sleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing MP9132 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes as indicated

More information

J. J. Keller & NPTC Webcast

J. J. Keller & NPTC Webcast Sleep Apnea and Fatigue Management May 11 th, 2017 Drug & Alcohol Clearinghouse This webcast will cover... A regulatory overview Best practices in compliance A case study in implementation Question & Answer

More information

QUESTIONS FOR DELIBERATION

QUESTIONS FOR DELIBERATION New England Comparative Effectiveness Public Advisory Council Public Meeting Hartford, Connecticut Diagnosis and Treatment of Obstructive Sleep Apnea in Adults December 6, 2012 UPDATED: November 28, 2012

More information

Inspire Therapy for Sleep Apnea

Inspire Therapy for Sleep Apnea Inspire Therapy for Sleep Apnea Patient Guide Giving You the FREEDOM TO SLEEP Like Everyone Else Take Comfort. Inspire therapy can help. Inspire therapy is a breakthrough implantable treatment option for

More information

Emerging Sleep Testing Methods

Emerging Sleep Testing Methods Emerging Sleep Testing Methods Matt T. Bianchi MD PhD Director, Sleep Division MGH Neurology www.mghsleep.com May 2015 Funding and Disclosures Funding: MGH Neurology Department Harvard Clinical Investigator

More information

Kim Olszewski DNP, CRNP, COHN-S/CM, FAAOHN. Mid State Occupational Health Services Inc Lewisburg, Pennsylvania

Kim Olszewski DNP, CRNP, COHN-S/CM, FAAOHN. Mid State Occupational Health Services Inc Lewisburg, Pennsylvania Kim Olszewski DNP, CRNP, COHN-S/CM, FAAOHN Mid State Occupational Health Services Inc Lewisburg, Pennsylvania Bloomsburg University Bloomsburg, Pennsylvania Operate vehicles for interstate commerce or

More information

CERT PAP Errors: The DME CERT Outreach and Education Task Force Responds

CERT PAP Errors: The DME CERT Outreach and Education Task Force Responds CERT PAP Errors: The DME CERT Outreach and Education Task Force Responds DME CERT Outreach and Education Task Force National PAP Webinar, December 17, 2014 PAP CERT Errors Medical Records: Face-to-Face

More information

Study of Prevalence of OSA in VIET NAM EPSASIE STUDY

Study of Prevalence of OSA in VIET NAM EPSASIE STUDY Study of Prevalence of OSA in VIET NAM EPSASIE STUDY S. Duong-Quy*, K. Dang Thi Mai, N. Tran-Van, H. Nguyen Xuan Bich, T. Hua-Huy, F. Chalumeau, A.T. Dinh-Xuan, F. Soyez, F. Martin Sy DUONG-QUY, MD, PhD,

More information

Inspire Therapy for Sleep Apnea

Inspire Therapy for Sleep Apnea Inspire Therapy for Sleep Apnea Patient Guide Giving You the FREEDOM TO SLEEP Like Everyone Else Take Comfort. Inspire therapy can help. Inspire therapy is a breakthrough implantable treatment option for

More information

Goals Session Putting it all Together

Goals Session Putting it all Together Goals Session Putting it all Together Adherence to therapy Case presentations Treatment issues Charles Atwood, MD, FCCP, FAASM University of Pittsburgh Disclosures Advisory - Carecore National; Philips;

More information

Sleep 101. Kathleen Feeney RPSGT, RST, CSE Business Development Specialist

Sleep 101. Kathleen Feeney RPSGT, RST, CSE Business Development Specialist Sleep 101 Kathleen Feeney RPSGT, RST, CSE Business Development Specialist 2016 Why is Sleep Important More than one-third of the population has trouble sleeping (Gallup) Obstructive Sleep Apnea Untreated

More information

Clinical Trials in OSA

Clinical Trials in OSA 24th ANNUAL ADVANCES IN SLEEP APNEA AND SNORING February 16-17, 2018 Grand Hyatt on Union Square San Francisco, California Clinical Trials in OSA Samuel T. Kuna, MD Department of Medicine Center for Sleep

More information

Health Provider Partnerships for OSA Management in Transportation. Paul S. Valentine Chief Executive Officer Sleep HealthCenters LLC

Health Provider Partnerships for OSA Management in Transportation. Paul S. Valentine Chief Executive Officer Sleep HealthCenters LLC Health Provider Partnerships for OSA Management in Transportation Paul S. Valentine Chief Executive Officer Sleep HealthCenters LLC Sleep Apnea & Multi-Modal Transportation Conference November 2011 Programs

More information

TESTIMONY OF JOHN RISCH NATIONAL LEGISLATIVE DIRECTOR SMART TRANSPORTATION DIVISION BEFORE THE FEDERAL MOTOR CARRIER SAFETY ADMINSTRATION

TESTIMONY OF JOHN RISCH NATIONAL LEGISLATIVE DIRECTOR SMART TRANSPORTATION DIVISION BEFORE THE FEDERAL MOTOR CARRIER SAFETY ADMINSTRATION TESTIMONY OF JOHN RISCH NATIONAL LEGISLATIVE DIRECTOR SMART TRANSPORTATION DIVISION BEFORE THE FEDERAL MOTOR CARRIER SAFETY ADMINSTRATION AND FEDERAL RAILROAD ADMINISTRATION Public Listening Sessions on

More information

Rest Stop #101. Sleep & Fatigue-What s the difference and what to do about it.

Rest Stop #101. Sleep & Fatigue-What s the difference and what to do about it. Rest Stop #101 This Photo by Unknown Author is licensed under CC BY-NC-ND Sleep & Fatigue-What s the difference and what to do about it. Presented by Mary Convey, Director of Key Accounts & Risk Mitigation

More information

Evaluation of the Brussells Questionnaire as a screening tool

Evaluation of the Brussells Questionnaire as a screening tool ORIGINAL PAPERs Borgis New Med 2017; 21(1): 3-7 DOI: 10.5604/01.3001.0009.7834 Evaluation of the Brussells Questionnaire as a screening tool for obstructive sleep apnea syndrome Nóra Pető 1, *Terézia Seres

More information

J. J. Keller & NPTC Webcast. July 21, 2016

J. J. Keller & NPTC Webcast. July 21, 2016 Webcast Logistics Please note the start time of today s webcast: 11:00 AM Eastern Time (New York) 10:00 AM Central Time (Chicago) 9:00 AM Mountain Time (Denver) 8:00 AM Pacific Time (Los Angeles) Webcast

More information

WHAT YOU NEED TO KNOW ABOUT SLEEP APNEA

WHAT YOU NEED TO KNOW ABOUT SLEEP APNEA WHAT YOU NEED TO KNOW ABOUT SLEEP APNEA Wayne Driscoll Clinical Education Specialist 2 SLEEP APNEA IN THE NEWS Carrie Fisher died from sleep apnea, other factors, coroner says USA Today NJ Transit engineer

More information

Inspire. therapy for sleep apnea. Giving you the freedom to sleep like everyone else

Inspire. therapy for sleep apnea. Giving you the freedom to sleep like everyone else Inspire therapy for sleep apnea Giving you the freedom to sleep like everyone else Take Comfort. Take Action. Inspire therapy can help. Here are some reasons people like you have chosen Inspire therapy

More information

Managed Care and Sleep Medicine

Managed Care and Sleep Medicine Managed Care and Sleep Medicine Denice Logan, DO, FACOI Regional Medical Director Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue

More information

Sleep Disorders and Excessive Sleepiness: Impact on Quality of Life

Sleep Disorders and Excessive Sleepiness: Impact on Quality of Life CME/CE POSTTEST Sleep Disorders and Excessive Sleepiness: Impact on Quality of Life CME Information Program Overview Excessive sleepiness is a complaint found in patients who experience sleepiness at unwanted

More information

Asleep at the Wheel Understanding and Preventing Drowsy Driving

Asleep at the Wheel Understanding and Preventing Drowsy Driving LIFESAVERS April 23, 2018 San Antonio, TX 2:15 3:45 PM Room 214 D Sleepiness and Accidents: A Crash Course EVOLVING SAFETY PRIORITIES AND SOLUTIONS Asleep at the Wheel Understanding and Preventing Drowsy

More information

I would like for my patient to be seen in Sleep Medicine consultation and managed by the sleep physician. Yes No

I would like for my patient to be seen in Sleep Medicine consultation and managed by the sleep physician. Yes No 701 E. COUNTY LINE ROAD, SUITE 207. GREENWOOD, IN. 46143 OFFICE317-887-6400 FAX 317-887-6500 indianasleepcenter.com REFERRAL FOR SLEEP EVALUATION Patient Name:_ Phone: I would like for my patient to be

More information

Sleep in the Patient with Diabetes

Sleep in the Patient with Diabetes Sleep in the Patient with Diabetes ANDREA RINN, DO SEPTEMBER, 2017 Learning Objectives 1. Recognize the correlation between sleep apnea and diabetes 2. Review potential relationships between sleep and

More information

Update on Sleep Apnea Diagnosis and Treatment

Update on Sleep Apnea Diagnosis and Treatment Update on Sleep Apnea Diagnosis and Treatment Damien Stevens MD Pulmonary/Critical Care/Sleep Medicine Medical Director KU Medical Center Sleep Laboratory Objectives Discuss physiology of sleep and obstructive

More information

UPDATES IN SLEEP APNEA:

UPDATES IN SLEEP APNEA: UPDATES IN SLEEP APNEA: CPAP,CPAP COMPLIANCE, & ALTERNATIVES MICHELLE ZETOONY, DO, FCCP, FACOI BOARD CERTIFIED PULMONARY, CRITICAL CARE, SLEEP & INTERNAL MEDICINE CLEARWATER, FL DISCLOSURE I have no conflicts

More information

Physician Dentist Collaboration

Physician Dentist Collaboration Physician Dentist Collaboration Ronald S. Prehn, ThM, DDS Legal Perspective MD CAN LEGALLY MAKE PROPER DIAGNOSIS DDS CAN LEGALLY FABRICATE DENTAL SLEEP APPLIANCES Legal Perspective TWO PROFESSIONS WORK

More information

Pharmacy Benefit Determination Policy

Pharmacy Benefit Determination Policy Policy Subject: CNS Stimulant Medications Policy Number: SHS PBD06 Category: CNS Drugs Policy Type: Medical Pharmacy Department: Pharmacy Product (check all that apply): Group HMO/POS ASO PPO Individual

More information

Polysomnography and Sleep Studies

Polysomnography and Sleep Studies Polysomnography and Sleep Studies Policy Number: Original Effective Date: MM.02.016 09/14/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 05/01/2014 Section: Medicine Place(s)

More information

Tired of being tired?

Tired of being tired? Tired of being tired? Narval CC MRD ResMed.com/Narval Sleepiness and snoring are possible symptoms of sleep apnea. Did you know that one in every four adults has some form of sleep disordered-breathing

More information

Index. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Actigraphy, 475, 485, 496 Adolescents, sleep disorders in, 576 578 Adults, sleep disorders in, 578 580 Advanced sleep phase disorder, 482 Age,

More information

Jill D. Marshall. Professor Boye. MPH 510: Applied Epidemiology. Section 01 Summer A June 28, 2013

Jill D. Marshall. Professor Boye. MPH 510: Applied Epidemiology. Section 01 Summer A June 28, 2013 1 Obstructive Sleep Apnea: Capstone Screening Project By Jill D. Marshall Professor Boye MPH 510: Applied Epidemiology Section 01 Summer A 2013 June 28, 2013 2 Sufficient sleep should be considered a vital

More information

Sleep Apnea and Fatigue: Impact on Commercial Motor Vehicle Safety

Sleep Apnea and Fatigue: Impact on Commercial Motor Vehicle Safety Sleep Apnea and Fatigue: Impact on Commercial Motor Vehicle Safety Sleep Apnea-Multimodal Transportation Conference American Sleep Apnea Association November 9, 2011 Benisse Lester, MD, Chief Medical Officer

More information

OSA - Obstructive sleep apnoea What you need to know if you think you might have OSA

OSA - Obstructive sleep apnoea What you need to know if you think you might have OSA OSA - Obstructive sleep apnoea What you need to know if you think you might have OSA Obstructive sleep apnoea, or OSA, is a breathing problem that happens when you sleep. It can affect anyone men, women

More information

A New, Clinically Proven Sleep Apnea Therapy for people unable to use CPAP.

A New, Clinically Proven Sleep Apnea Therapy for people unable to use CPAP. A New, Clinically Proven Sleep Apnea Therapy for people unable to use CPAP. Take Heart. If You Have OSA, You re Not Alone. Like you, more than 18 million Americans are estimated to have Obstructive Sleep

More information

Shyamala Pradeepan. Staff Specialist- Department of Respiratory and Sleep Medicine. John Hunter Hospital. Conjoint lecturer University of New Castle.

Shyamala Pradeepan. Staff Specialist- Department of Respiratory and Sleep Medicine. John Hunter Hospital. Conjoint lecturer University of New Castle. Shyamala Pradeepan Staff Specialist- Department of Respiratory and Sleep Medicine. John Hunter Hospital. Conjoint lecturer University of New Castle. What is sleep apnoea?? Repetitive upper airway narrowing

More information

Web-Based Home Sleep Testing

Web-Based Home Sleep Testing Editorial Web-Based Home Sleep Testing Authors: Matthew Tarler, Ph.D., Sarah Weimer, Craig Frederick, Michael Papsidero M.D., Hani Kayyali Abstract: Study Objective: To assess the feasibility and accuracy

More information

Inspire Therapy for Sleep Apnea

Inspire Therapy for Sleep Apnea Inspire Therapy for Sleep Apnea Patient Guide Giving You the FREEDOM TO SLEEP Like Everyone Else Take Comfort. Inspire therapy can help. Inspire therapy is a breakthrough implantable treatment option for

More information

Provigil / Nuvigil. Provigil (modafinil) / Nuvigil (armodafinil) Description. Section: Prescription Drugs Effective Date: July 1, 2014

Provigil / Nuvigil. Provigil (modafinil) / Nuvigil (armodafinil) Description. Section: Prescription Drugs Effective Date: July 1, 2014 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Section: Prescription Drugs Effective Date: July 1, 2014 Subject: Provigil / Nuvigil Page: 1 of 7 Last Review Date: June 12, 2014

More information

Sleepiness, Napping and Health Risk in the Elderly

Sleepiness, Napping and Health Risk in the Elderly Sleepiness, Napping and Health Risk in the Elderly ANNE B. NEWMAN, MD, MPH PROFESSOR OF EPIDEMIOLOGY AND MEDICINE UNIVERSITY OF PITTSBURGH 8th Annual Bedside to Bench Conference Sleep, Circadian Rhythms,

More information

Get on the Road to Better Health Recognizing the Dangers of Sleep Apnea

Get on the Road to Better Health Recognizing the Dangers of Sleep Apnea Get on the Road to Better Health You Will Learn About The importance and benefits of sleep Sleep deprivation and its consequences The prevalence, symptoms, and treatments for major sleep problems/ disorders

More information

SLEEP DEPRIVATION IN THE WORKPLACE

SLEEP DEPRIVATION IN THE WORKPLACE SLEEP DEPRIVATION IN THE WORKPLACE Stephen G. Kaiser D.O., FACOEP Medical Director Summa Center for Corporate Health 444 North Main Street Akron, Ohio 44310 330-379-5959 kaisers@summahealth.org March 15,

More information

Sleep Studies Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe

More information

Sleep Disorders The Effect on our Lives Every Day

Sleep Disorders The Effect on our Lives Every Day Sleep Disorders The Effect on our Lives Every Day Julie Hatleli, RN Sheri Krenz, RN Regional Sleep Disorders Center-Mankato, MN 2016 MFMER slide-1 Agenda Sleep Stages Sleep Apnea Sleep Disorders DOT requirements

More information

Diagnostic Accuracy of the Multivariable Apnea Prediction (MAP) Index as a Screening Tool for Obstructive Sleep Apnea

Diagnostic Accuracy of the Multivariable Apnea Prediction (MAP) Index as a Screening Tool for Obstructive Sleep Apnea Original Article Diagnostic Accuracy of the Multivariable Apnea Prediction (MAP) Index as a Screening Tool for Obstructive Sleep Apnea Ahmad Khajeh-Mehrizi 1,2 and Omid Aminian 1 1. Occupational Sleep

More information

18/06/2009 NZ Respiratory & Sleep Institute

18/06/2009 NZ Respiratory & Sleep Institute Sleep Disorders in Primary Care - a personal view 18/06/2009 Andrew G Veale NZ Respiratory & Sleep Institute Abnormal Sleep Disorders of the initiation & maintenance of sleep (DIMS) Insomnia 1 o or 2 o

More information

Questions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI?

Questions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI? Pediatric Obstructive Sleep Apnea Case Study : Margaret-Ann Carno PhD, CPNP, D,ABSM for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee April 2014. Facilitator s guide Part

More information

Inspire Therapy for Sleep Apnea

Inspire Therapy for Sleep Apnea Inspire Therapy for Sleep Apnea Take Heart. If you have OSA, you re not alone. More than 18 million Americans are estimated to have Obstructive Sleep Apnea (OSA). OSA occurs when the tongue and other soft

More information

DOWNLOAD OR READ : WHAT ARE SLEEP DISORDERS PDF EBOOK EPUB MOBI

DOWNLOAD OR READ : WHAT ARE SLEEP DISORDERS PDF EBOOK EPUB MOBI DOWNLOAD OR READ : WHAT ARE SLEEP DISORDERS PDF EBOOK EPUB MOBI Page 1 Page 2 what are sleep disorders what are sleep disorders pdf what are sleep disorders PAMF's Sleep Medicine Center doctors can help

More information

Pre-Operative Services Teaching Rounds 11 March 2011

Pre-Operative Services Teaching Rounds 11 March 2011 Pre-Operative Services Teaching Rounds 11 March 2011 Deborah Richman MBChB FFA(SA) Director Pre-Operative Services Department of Anesthesia Stony Brook University Medical Center, NY drichman@notes.cc.sunysb.edu

More information

What is Oral Appliance Therapy?

What is Oral Appliance Therapy? You may have been diagnosed by your physician as required treatment for sleep-disordered breathing (snoring and/or obstructive sleep apnea). This condition may pose serious health risks since it disrupts

More information

Medical Affairs Policy

Medical Affairs Policy Medical Affairs Policy Service: Sleep Disorder Testing (Polysomnogram, Split Night Polysomnogram, Sleep Study, Multiple Sleep Latency Test (MSLT), Maintenance of Wakefulness Testing (MWT), Home Sleep Apnea

More information

Pediatric OSA. Pediatric OSA: Treatment Options Beyond AT. Copyright (c) 2012 Boston Children's Hospital 1

Pediatric OSA. Pediatric OSA: Treatment Options Beyond AT. Copyright (c) 2012 Boston Children's Hospital 1 Pediatric OSA Treatments Options Beyond AT Report of Financial Relationships (past 12 months) with commercial entities producing, marketing, re selling, or distributing health care goods or services consumed

More information

Writing Committee. Amir Qaseem, MD, PhD, MHA; Laurel Borowski, MPH; Robert A. Gluckman, MD; Nasseer A. Masoodi, MD; and David W.

Writing Committee. Amir Qaseem, MD, PhD, MHA; Laurel Borowski, MPH; Robert A. Gluckman, MD; Nasseer A. Masoodi, MD; and David W. PERFORMANCE MEASURE REVIEW Diagnosis and Management of Obstructive Sleep Apnea: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians Writing

More information

CPAP The Treatment of Choice for Patients with OSA

CPAP The Treatment of Choice for Patients with OSA CPAP The Treatment of Choice for Patients with OSA Samuel T. Kuna, M.D. Department of Medicine Center for Sleep and Respiratory Neurobiology University of Pennsylvania Pulmonary, Critical Care & Sleep

More information

CHALLENGES OF RECOGNIZING AND TREATING EXCESSIVE SLEEPINESS

CHALLENGES OF RECOGNIZING AND TREATING EXCESSIVE SLEEPINESS CHALLENGES OF RECOGNIZING AND TREATING EXCESSIVE SLEEPINESS Russell Rosenberg, Ph.D. Neurotrials Research and Atlanta School of Sleep Medicine DISCLOSURES Research grant funds from: Merck Jazz Pharmaceuticals

More information

Management of OSA in the Acute Care Environment. Robert S. Campbell, RRT FAARC HRC, Philips Healthcare May, 2018

Management of OSA in the Acute Care Environment. Robert S. Campbell, RRT FAARC HRC, Philips Healthcare May, 2018 Management of OSA in the Acute Care Environment Robert S. Campbell, RRT FAARC HRC, Philips Healthcare May, 2018 1 Learning Objectives Upon completion, the participant should be able to: Understand pathology

More information

Sleep Apnea: Diagnosis & Treatment

Sleep Apnea: Diagnosis & Treatment Disclosure Sleep Apnea: Diagnosis & Treatment Lawrence J. Epstein, MD Sleep HealthCenters Harvard Medical School Chief Medical Officer for Sleep HealthCenters Sleep medicine specialty practice group Consultant

More information

Polycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners. M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017

Polycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners. M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017 Polycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017 Case of S.R. S.R. is a 39 year old female referred for suspected obstructive

More information

Use of Technology in the Assessment of Type 2 Diabetes and Sleep Apnea

Use of Technology in the Assessment of Type 2 Diabetes and Sleep Apnea Use of Technology in the Assessment of Type 2 Diabetes and Sleep Apnea Eileen R. Chasens, PhD Associate Professor University of Pittsburgh September 3, 2014 Disclosure I do not own a Smart Phone, I have

More information

GARDEN STATE SLEEP CENTER REGISTRATION FORM PATIENT INFORMATION:

GARDEN STATE SLEEP CENTER REGISTRATION FORM PATIENT INFORMATION: GARDEN STATE SLEEP CENTER REGISTRATION FORM (Please Print) Today s Date: Primary Care Physician: PATIENT INFORMATION: Last Name: First: Middle: Mr. Miss Dr. Mrs. Ms. Marital Status (Please check one) Single

More information

RESEARCH PACKET DENTAL SLEEP MEDICINE

RESEARCH PACKET DENTAL SLEEP MEDICINE RESEARCH PACKET DENTAL SLEEP MEDICINE American Academy of Dental Sleep Medicine Dental Sleep Medicine Research Packet Page 1 Table of Contents Research: Oral Appliance Therapy vs. Continuous Positive Airway

More information

Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical

Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical Director, Faulkner EEG and Sleep Testing Center Course

More information

Positive Airway Pressure (PAP) Devices Physician Frequently Asked Questions December 2008

Positive Airway Pressure (PAP) Devices Physician Frequently Asked Questions December 2008 Positive Airway Pressure (PAP) Devices Physician Frequently Asked Questions December 2008 Based on questions received from the clinical community, the following Frequently Asked Questions will address

More information

Daytime Sleepiness, Sleep Apnea and Obesity. Alexandros Vgontzas, M.D. Professor of Psychiatry Pennsylvania State University Hershey

Daytime Sleepiness, Sleep Apnea and Obesity. Alexandros Vgontzas, M.D. Professor of Psychiatry Pennsylvania State University Hershey Daytime Sleepiness, Sleep Apnea and Obesity Alexandros Vgontzas, M.D. Professor of Psychiatry Pennsylvania State University Hershey Excessive Daytime Sleepiness Is there an epidemic? Is obesity a major

More information

Joel Reiter*, Bashar Zleik, Mihaela Bazalakova, Pankaj Mehta, Robert Joseph Thomas

Joel Reiter*, Bashar Zleik, Mihaela Bazalakova, Pankaj Mehta, Robert Joseph Thomas Joel Reiter*, Bashar Zleik, Mihaela Bazalakova, Pankaj Mehta, Robert Joseph Thomas Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA *ומעבדת השינה הדסה עין כרם, ירושלים חיפפ ירושלים,

More information

SLEEP APNEA IN THE ELDERLY SLEEP THAT KNITS UP THE RAVELED SLEEVE OF CARE

SLEEP APNEA IN THE ELDERLY SLEEP THAT KNITS UP THE RAVELED SLEEVE OF CARE SLEEP APNEA IN THE ELDERLY SLEEP THAT KNITS UP THE RAVELED SLEEVE OF CARE OBJECTIVES 1. TO DESCRIBE THE NORMAL AGE RELATED CHANGES TO SLEEP 2. TO DESCRIBE THE SPECTRUM OF SLEEP-DISORDERED BREATHING. 3.

More information

3/13/2014. Home Sweet Home? New Trends in Testing for Obstructive Sleep Apnea. Disclosures. No relevant financial disclosures

3/13/2014. Home Sweet Home? New Trends in Testing for Obstructive Sleep Apnea. Disclosures. No relevant financial disclosures 2014 Big Sky Pulmonary Conference Home Sweet Home? New Trends in Testing for Obstructive Sleep Apnea Eric Olson, MD Associate Professor of Medicine Co-Director, Center for Sleep Medicine Mayo Clinic olson.eric@mayo.edu

More information

UPDATE FOR MEDICAL EXAMINERS

UPDATE FOR MEDICAL EXAMINERS NECOEM NRCME Update 1 UPDATE FOR MEDICAL EXAMINERS NATIONAL REGISTRY OF CERTIFIED MEDICAL EXAMINERS (NRCME) FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION US DEPARTMENT OF TRANSPORTATION New England College

More information

What is SDB? Obstructive sleep apnea-hypopnea syndrome (OSAHS)

What is SDB? Obstructive sleep apnea-hypopnea syndrome (OSAHS) Have a Good Sleep? Estimated 70 million Americans have clinically significant sleep problems Chronic insomnias report decreased quality of life, memory and attention problems, decreased physical health

More information

Managing the Driving Risks of OSA

Managing the Driving Risks of OSA Managing the Driving Risks of OSA Kingman P Strohl M.D. Professor of Medicine, Physiology & Biophysicis, and Oncology Center for sleep Disorders Reseach Case Western Reserve University, Cleveland OH, USA

More information

2016 Physician Quality Reporting System Data Collection Form: Sleep Apnea (for patients aged 18 and older)

2016 Physician Quality Reporting System Data Collection Form: Sleep Apnea (for patients aged 18 and older) 2016 Physician Quality Reporting System Data Collection Form: Sleep Apnea (for patients aged 18 and older) IMPORTANT: Any measure with a 0% performance rate (100% for inverse measures) is not considered

More information

OSA OBSTRUCTIVE SLEEP APNEA

OSA OBSTRUCTIVE SLEEP APNEA OSA OBSTRUCTIVE SLEEP APNEA Anna-Marie Wellins DNP, ANP-C Objectives Describe consequences of Obstructive Sleep Apnea Outline sleep facts/stages Define OSA and clinical symptoms Describe Pathophysiology

More information

QUESTIONS AND ANSWERS: WEBINAR - NEW AND REVISED ITEMS FOR RESPIRATORY AND SLEEP STUDIES

QUESTIONS AND ANSWERS: WEBINAR - NEW AND REVISED ITEMS FOR RESPIRATORY AND SLEEP STUDIES QUESTIONS AND ANSWERS: WEBINAR - NEW AND REVISED ITEMS FOR RESPIRATORY AND SLEEP STUDIES Webinar date: 29 November 2018 Time: 11:30 am (Australia/Sydney UTC+11:00) The webinar can be viewed online here.

More information

TOPIC: Continuing Coverage of CPAP Machines and Supplies for the Treatment of Obstructive Sleep Apnea

TOPIC: Continuing Coverage of CPAP Machines and Supplies for the Treatment of Obstructive Sleep Apnea These documents are not used to determine benefits or reimbursement. Please reference the appropriate certificate or contract for benefit information. BLUE CROSS BLUE SHIELD of MI MEDICAL POLICY Enterprise:

More information

Case Study on a Worksite Sleep Disorder Program for Commercial Motor Vehicle Drivers

Case Study on a Worksite Sleep Disorder Program for Commercial Motor Vehicle Drivers Case Study on a Worksite Sleep Disorder Program for Commercial Motor Vehicle Drivers Richard Hanowski, Ph.D. Director, Center for Truck and Bus Safety Virginia Tech Transportation Institute Blacksburg,

More information

Technology Enabled Management of Sleep Loss as a Strategy to Mitigate the Underlying Cause of Fatigue in Transportation

Technology Enabled Management of Sleep Loss as a Strategy to Mitigate the Underlying Cause of Fatigue in Transportation Technology Enabled Management of Sleep Loss as a Strategy to Mitigate the Underlying Cause of Fatigue in Transportation Jeffrey Durmer, MD, PhD Dr. Jeffrey Durmer Chief Medical Officer, FusionHealth Chief

More information

Sleep Science: better sleep for you and your patients CHUNBAI ZHANG, MD MPH UW MEDICINE VALLEY MEDICAL CENTER

Sleep Science: better sleep for you and your patients CHUNBAI ZHANG, MD MPH UW MEDICINE VALLEY MEDICAL CENTER Sleep Science: better sleep for you and your patients CHUNBAI ZHANG, MD MPH UW MEDICINE VALLEY MEDICAL CENTER Disclosure: Financial - none Non-Financial - none Selected Topics Sleep epidemiology Sleep

More information

Sleep and Executive Performance

Sleep and Executive Performance Sleep and Executive Performance 2017 United Fresh Produce Executive Development Program Ana C. Krieger, MD, MPH, FAASM, FCCP Medical Director, Center for Sleep Medicine Associate Professor, Weill Cornell

More information

Sleep Disorders Diagnostic Center 9733 Healthway Drive, Berlin, MD , ext. 5118

Sleep Disorders Diagnostic Center 9733 Healthway Drive, Berlin, MD , ext. 5118 Sleep Questionnaire *Please complete the following as accurate as possible. Please bring your completed questionnaire, insurance card, photo ID, Pre-Authorization and/or Insurance referral form, and all

More information

Mandibular Advancement Device vs CPAP in the Treatment of Obstructive Sleep Apnea: Are they Equally Effective in Short Term Health Outcomes?

Mandibular Advancement Device vs CPAP in the Treatment of Obstructive Sleep Apnea: Are they Equally Effective in Short Term Health Outcomes? NoSnores Mandibular Advancement Device (mouthguard) for Snoring & Sleep Apnea CLINICAL REFERENCES J Clin Sleep Med. 2013 Sep;9(9):971-2. doi: 10.5664/jcsm.3008. Mandibular Advancement Device vs CPAP in

More information

A Winning Combination

A Winning Combination The Physiologic Sleep Bite and the Micr0 2 Sleep Device A Winning Combination There is no doubt that using the best bite technique available will improve overall treatment success, but how important is

More information

Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute

Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute Parkinson s Disease 2 nd most common neurodegenerative disorder Peak age at onset is 60 years

More information

FAQ CODING & REIMBURSEMENT. WatchPAT TM Home Sleep Test

FAQ CODING & REIMBURSEMENT. WatchPAT TM Home Sleep Test FAQ CODING & REIMBURSEMENT WatchPAT TM Home Sleep Test TABLE OF CONTENTS PATIENT SELECTION CRITERIA 3 CODING & MODIFIERS 4-6 PLACE OF SERVICE 6 FREQUENCY 7 ACCREDITATION 7 SLEEP MEDICINE GLOSSARY AND ACRONYMS

More information

Surgical Options for the Successful Treatment of Obstructive Sleep Apnea

Surgical Options for the Successful Treatment of Obstructive Sleep Apnea Surgical Options for the Successful Treatment of Obstructive Sleep Apnea Benjamin J. Teitelbaum, MD, FACS Otolaryngology Head and Neck Surgery Saint Agnes Medical Center Fresno, California Terms Apnea

More information

OSA and COPD: What happens when the two OVERLAP?

OSA and COPD: What happens when the two OVERLAP? 2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine

More information

Faculty/Presenter Disclosure

Faculty/Presenter Disclosure A Little CBT I With My Tea Please: Cognitive Behavioural Therapy for insomnia (CBT I) and Its Use In the Treatment of Sleeplessness W. Jerome Alonso, MD Medical Director, Canadian Sleep Consultants Clinical

More information