Ral Antic Director Thoracic Medicine Head of Sleep Service Royal Adelaide Hospital. Visiting Respiratory and Sleep Physician Alice Springs Hospital

Size: px
Start display at page:

Download "Ral Antic Director Thoracic Medicine Head of Sleep Service Royal Adelaide Hospital. Visiting Respiratory and Sleep Physician Alice Springs Hospital"

Transcription

1 Ral Antic Director Thoracic Medicine Head of Sleep Service Royal Adelaide Hospital Visiting Respiratory and Sleep Physician Alice Springs Hospital

2 Conflict of Interest Past member of ResMed Medical Board Honoraria from lectures for Novartis, Boehringer, Glaxo Investigator in Insomnia Clinical Trials

3 To discuss Sleep what is normal Disordered breathing in sleep and its treatment Sleep and the CVS The connection between sleep apnoea and chronic CV diseases the mechanisms by which abnormal sleep leads to cardiac injury the management

4 4 key aspects of health Nutrition Exercise Healthy sleep Mental health/stress

5 Risk to health in sleep Sleep is restorative In sleep there is a downturn in activity of all organs This is needed for ongoing health This state can be destabilised by factors, conditions or pre existing diseases This impairs homeostasis and creates a risk to the development of disease

6 Classification of Sleep Disorders CSD 2 SYSTEM American Academy of Sleep Medicine, 2005 Insomnia conditions that are characterized by difficulty initiating or maintaining sleep, or by poor quality sleep Sleep related breathing disorders abnormal respiration during sleep Hypersomnias of central origin primary complaint is daytime sleepiness that is not due to disturbed sleep or misaligned circadian rhythms Circadian rhythm sleep disorders chronic or recurrent sleep disturbance due to misalignment between the environment and an individual's sleep wake cycle Parasomnias undesirable physical events (movements, behaviours) or experiences (emotions, perceptions, dreams) that occur during entry into sleep, within sleep, or during arousals from sleep Sleep related movement disorders simple, stereotypic movements that disturb sleep eg Restless Legs Syndrome Isolated symptoms and normal variants Other sleep disorders

7 A significant ifi public health h issue Explosion in both knowledge & its incidence id in the last 10 years Sleep creates a risky state

8 Physiological changes in Sleep In non REM sleep (75 85% sleep time) Parasympathetic tone increases and sympathetic decreases Decrease in HR, BP, systemic vascular resistance and cardiac output Increase in cardiac stability Decrease in airway size in REM sleep Decrease in parasympathetic tone and increase in sympathetic tone Rise in BP, HR

9 Health is adversely affected by Insufficient or excessive sleep Acute chronic Fragmentation of sleep Acute Chronic

10 The Upper Airway

11 Sleep apnoea recurrent, sleep induced, partial or complete collapse of the pharyngeal airway resulting in sleep fragmentation from arousals, daytime sleepiness, O2 desaturation, autonomic dysfunction and end organ damage Severity is quantified dby Apnoea Hypopnoea Index (AHI) Prevalence is high

12 Pathophysiological influence of OSA in cardiovascular disease Cycle of Sleep Apnoea Hypoxaemia Pleural pressure and intramural pressure change Sympathetic activation Arousal Ventilation Reoxygenation and restoration of mechanics

13 OSA Heart rate, BP and SaO 2 TACHYCARDIA ACUTE HYPERTENSION APNEA APNEA SaO2

14 Postulated mechanisms underlying the relationship between sleep apnoea and cardiac disease. Jaffe L M et al. Eur Heart J 2013;34: Published on behalf of the European Society of Cardiology. All rights reserved. The Author For permissions please journals.permissions@oup.com

15 Obstructive sleep apnoea in epidemic proportions now Prevalence depends on definition AHI > 5/h 26 % middle aged d men and 10 % middle aged d women. AHI 10/hr approximately 10 % of the middle aged population have OSA (1993) AHI >20 in 25% of adult males in North West Adelaide ( 2011) AHI >20 in 40 70% with end organ damage cardiac, renal, HT

16 Investigation i and therapy

17 Signs and symptoms of sleep apnea These are pointers to sleep apnea snoring choking/gasping i restless sleep waking unrefreshed daytime sleepiness nocturia Z Z Z Z Z Z

18 Cardiovascular Effects of Sleep Apnea

19 Home study

20 Sleep Study Report Normal Sleep Apnoea R W REM MOV AWK SpO2 SaO Cn.A Ob.A Mx.A Hyp Uns RERA Cn.A Ob.A Mx.A Hyp Uns Main indices Apnea Hypopnea Index (AHI) 02 desaturation index (ODI)

21 Sleep apneas go on and on, and on. 20 minute recording

22 An Australian Invention Prof. Colin Sullivan University of Sydney, 1981

23

24

25

26 The mechanisms of damage

27 Effects of obstructive sleep apnoea on pulmonary and nervous systems. Jaffe L M et al. Eur Heart J 2013;34: Published on behalf of the European Society of Cardiology. All rights reserved. The Author For permissions please journals.permissions@oup.com

28

29 Hypertension Cross sectional, longitudinal and prospective studies show strong rel between OSA & HT, independent of confounders Loss of nocturnal BP dipping Cycle of sleep disturbance causes sympathetic overdrive and HT Resistant HT correlated with hyper aldosteronism which promotes accumulation of fluid in the neck when supine and worsens OSA. Blocking this improves OSA and HT

30 Hypertension and OSA The Sleep Heart Health Study (Nieto et al., 2000) demonstrated: an association i between hypertension and OSA independent of age, obesity and other known confounding factors prevalence of hypertension increased with increasing AHI values.

31 OSA Circadian Rhythm of BP in Controls & OSA From: Davies: Thorax, Volume 55(9).September 1,

32 Hypertension and OSA and can actually lead to nocturnal hypertension.

33 Hypertension and OSA Ventura et al. (2004)found dhigher h risk of cardiovascular complications associated with non dipping independent of daytime BP.

34 Wisconsin Sleep Cohort Study BP increases linearly with increasing AHI (p =.003) At AHI 15 (vs 0): Systolic BP 3.6 mmhg higher (95% CI ) 6.0) Diastolic BP 1.2 mmhg higher (95% CI ) Risk of hypertension increases with increasing AHI: AHI 30 : OR 3.15 (95% CI ) AHI 15 : OR 1.78 (95% CI ) AHI 5: OR 1.21 (95% CI )

35

36 Coronary artery disease (CAD) & acute coronary syndrome (ACS) Correlation between CAD, ACS & OSA well established 65% admitted for MI have OSA and carry poor prognosis OSA when present with successful coronary intervention after ACS was associated with higher mortality (38% vs 9%), increased rate of stent restenosis (24%vs 5%) Refractory nocturnal angina has higher rate of OSA, occurs at the same time and is reduced with ncpap Whilst treatment of OSA has not been shown to reverse progression of CAD, it might retard it and can decrease new events OSA increases blood coagulability, viscosity and increased platelet aggregability, higher levels of clotting factors. This may contribute to CAD progression and in stent thrombus formation

37

38 Arrhythmia OSA associated with hypoxaemia, autonomic derangements and cardiac structural changes all which predispose to arrhythmia Cross sectional studies of SA show prevalence of 43 73% in those with AF, and excess CAD and CSA + In OSA > 25% greater risk of AF recurrence after ablation. Treatment with ncpap gives 8 fold improvement in lasting success of ablation SA esp with heart failure linked with other dysrhythmias y nocturnal asystole, brady arrhythmia, AV nodal block SVT and non sustained VT and malignant ventricular arrhythmias ncpap decreases rates of these arrhythmias

39 In patients with OSA and Arrhythmias Sinus arrhythmia is common, esp in REM sleep Abnormal rhythms are more common than with no OSA AF OR 4.02 Non sustained VT OR 3.40 Complex vent ectopics in severe OSA (bigeminy, trigeminy, quadrigeminy) even adjusting for other risk factors OR 1.74 There is a dose response relationship between increasing severity OSA and arrhythmia and CVE has stronger rel to OSA and hypoxaemia AF stronger rel with CSA, Cheyne Stokes breathing and underlying CVD Increase in nocturnal sudden death in OSA OR 2.57

40

41

42 Sleep Apnea in Heart Failure Contributory mechanisms hypoxaemia, hypercarbia, causing pulmonary vasoconstriction increase in intra thoracic pressure changes from upper airway obstruction Myocardial a wall stress, ess,atrial a size increase cease Impairment in ventricular function Increased venous return causing RV distension and compromise in LV filling Combined long term sympathetic overactivity from OSA and HF Myocyte y apoptosis, p B adrenoceptor down regulation, decreased HR variability, arrhythmias and increased mortality rate

43 Heart Failure OSA in 47 76% Complex mechanisms increase in sympathetic tone and heart rate in already failing heart can lead to myocyte injury, cardiac B adrenergic desensitisation and functional and structural abnormalities Heart failure can cause and exacerbate OSA and CSA CSR carries poor prognosis in HF Diastolic dysfunction is highly correlated with sleep disordered breathing 70% SA in HF with preserved ejection fraction, mainly OSA? why

44 Sleep Apnoea Central ( Cheyne Stokes Respiration ) Decreased ventilatory drive Heart failure, stroke, drugs Enhanced chemoreceptor sensitivity +/ prolonged circulation time

45 Cheyne-Stokes respiration

46 n=32 n=56 Javaheri 2007

47 In summary, although CSA has been associated with increased mortality in heart failure patients, a causal role for CSA in the morbidity and mortality of heart failure awaits more definitive evidence. A number of treatment strategies for CSA have been tested, but presently none is ideal with respect tto both efficacy and dtolerance, nor has any available therapy been demonstrated to improve survival.

48

49 Teschler H et. al; AJRCCM 2001

50

51

52 OSA better 3/12 after CVA Parra AMJRCC 2000

53 Cardiovascular Effects of Sleep Apnoea Severe OSA Mild-Mod OSA CPAP treated OSA Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet Mar 19-25;365(9464):

54 Linked epidemics Obesity, Metabolic Syndrome and Sleep Apnoea Incidence and prevalence of Sleep Apnoea is rising as we speak

55 The Weight of the Matter 10% increase in weight predicted 6- fold increase in odds of developing moderate to severe OSA (AHI 15) Peppard 2003

56

57 Therapy with ncpap is very cost effective CPAP for moderate-severe OSA $ /QALY gained Condition/Treatment Treatment for Erectile Dysfunction *Physician Counseling for Smoking Total Hip Replacement *Outreach for Flu and Pneumonia Treatment of Major Depression Gastric Bypass Surgery Treatment for Osteoporosis *Screening For Colon Cancer Implantable Cardioverter Defibrillator Lung-Volume Reduction Surgery Tight Control of Diabetes *Treating Elevated Cholesterol ( + 1 risk factor) Resuscitation After Cardiac Arrest Left Ventricular Assist Device Cost per QALY $6,400/QALY $7,200/QALY $9,900/QALY900/QALY $13,000/QALY $20,000/QALY $20,000/QALY000/QALY $38,000/QALY $40,000/QALY $75,000/QALY $98,000/QALY $154,000/QALY $200,000/QALY000/QALY $270,000/QALY $900,000/QALY

58 Evidence for a causal link between OSA and cardiovascular disease remains circumstantial Studies of intermediate markers small subject numbers, short follow up (months) Population and clinic studies positive associations between OSA and CV disease NO large, long term RCTs exploring link between OSA and hard cardiovascular endpoints

59 The SAVE trial Multicentre RCT (n=5000) CPAP versus usual care ( ) Pti Patients t with documented d CV disease PLUS moderatesevere OSA Hard CV outcomes myocardial infarction stroke Hard CV outcomes myocardial infarction, stroke, sudden death, hospital admission for TIA or unstable angina

60 SITES 1site 5 sites, 3 initiated 2 patients t 1 site initiated 15 sites 8 sites, 67 patients 46 sites, 1164 patients 12 sites, 184 patients 5 sites, 87 patients

61 Summary Sleep quality and quantity is fundamental to health Sleep disordered breathing is common. It causes substantial morbidity and mortality OSA is one of the important risk factors to the cardiovascular system That risk is reduced by its control with ncpap Definitive RCT awaited in a number of areas

62 Recent reviews Importance and management of chronic sleep apnoea in Cardiology, Jaffe et al, European Heart Journal 2013, 34, Obstructive Sleep Apnoea in adults, Usmani et al Post Grad Medicine 2013, 89:

Circadian Variations Influential in Circulatory & Vascular Phenomena

Circadian Variations Influential in Circulatory & Vascular Phenomena SLEEP & STROKE 1 Circadian Variations Influential in Circulatory & Vascular Phenomena Endocrine secretions Thermo regulations Renal Functions Respiratory control Heart Rhythm Hematologic parameters Immune

More information

Mario Kinsella MD FAASM 10/5/2016

Mario Kinsella MD FAASM 10/5/2016 Mario Kinsella MD FAASM 10/5/2016 Repetitive episodes of apnea or reduced airflow Due to upper airway obstruction during sleep Patients often obese Often have hypertension or DM 1 Obstructive apneas, hypopneas,

More information

Heart Failure and Sleep Disordered Breathing (SDB) Unhappy Bedfellows

Heart Failure and Sleep Disordered Breathing (SDB) Unhappy Bedfellows Question Heart Failure and Sleep Disordered Breathing (SDB) Unhappy Bedfellows 1 ResMed 2012 07 2 ResMed 2012 07 Open Airway 3 ResMed 2012 07 Flow Limitation Snore 4 ResMed 2012 07 Apnoea 5 ResMed 2012

More information

The Effect of Sleep Disordered Breathing on Cardiovascular Disease

The Effect of Sleep Disordered Breathing on Cardiovascular Disease The Effect of Sleep Disordered Breathing on Cardiovascular Disease Juan G. Flores MD Pulmonary, Critical Care and Sleep Medicine Dupage Medical Group Director of Edward Sleep Lab Disclaimers or Conflicts

More information

Sleep and the Heart. Sleep Stages. Sleep and the Heart: non REM 8/31/2016

Sleep and the Heart. Sleep Stages. Sleep and the Heart: non REM 8/31/2016 Sleep and the Heart Overview of sleep Hypertension Arrhythmias Ischemic events CHF Pulmonary Hypertension Cardiac Meds and Sleep Sleep Stages Non-REM sleep(75-80%) Stage 1(5%) Stage 2(50%) Stage 3-4*(15-20%)

More information

Sleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK

Sleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK Sleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK Sleep Disordered Breathing in CHF Erratic breathing during sleep known for years e.g.

More information

3/10/2014. Pearls to Remember. 1) Consequences of OSA related to both arousals and hypoxia. 2) Arousals provoke increased

3/10/2014. Pearls to Remember. 1) Consequences of OSA related to both arousals and hypoxia. 2) Arousals provoke increased Cardiovascular disease and Sleep Disorders Timothy L. Grant, M.D.,F.A.A.S.M. Medical Director Baptist Sleep Center at Sunset Medical Director Baptist Sleep Education Series Medical Director Sleep Division

More information

Sleep and the Heart. Physiologic Changes in Cardiovascular Parameters during Sleep

Sleep and the Heart. Physiologic Changes in Cardiovascular Parameters during Sleep Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University

More information

Sleep and the Heart. Rami N. Khayat, MD

Sleep and the Heart. Rami N. Khayat, MD Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University

More information

Apnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing. Alan S Maisel MD

Apnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing. Alan S Maisel MD Apnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing Alan S Maisel MD Triumvirate of Health-public awareness 1.8% Sleep Physical Fitness Nutrition 91.3% 99.9% Sleep is important to

More information

Observations on Sleep Apnoea and Cardiac disease

Observations on Sleep Apnoea and Cardiac disease Observations on Sleep Apnoea and Cardiac disease Tim Sutton, Cardiologist Middlemore Hospital What is sleep? a naturally recurring state of relatively suspended sensory and motor activity, characterized

More information

Σύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών;

Σύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών; Σύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών; E.N. Σημανηηράκης MD, FESC Επίκ. Καθηγηηής Καρδιολογίας Πανεπιζηημιακό Νοζοκομείο Ηρακλείοσ Epidemiology 4% 2% 24%

More information

Sleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease

Sleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease 1 Sleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease Rami Khayat, MD Professor of Internal Medicine Director, OSU Sleep Heart Program Medical Director, Department of

More information

AHA Sleep Apnea and Cardiovascular Disease. Slide Set

AHA Sleep Apnea and Cardiovascular Disease. Slide Set AHA 2008 Sleep Apnea and Cardiovascular Disease Slide Set Based on the AHA 2008 Scientific Statement Sleep Apnea and Cardiovascular Disease Virend K. Somers, MD, DPhil, FAHA, FACC Mayo Clinic and Mayo

More information

Sleep Apnea: Vascular and Metabolic Complications

Sleep Apnea: Vascular and Metabolic Complications Sleep Apnea: Vascular and Metabolic Complications Vahid Mohsenin, M.D. Professor of Medicine Yale University School of Medicine Director, Yale Center for Sleep Medicine Definitions Apnea: Cessation of

More information

A Deadly Combination: Central Sleep Apnea & Heart Failure

A Deadly Combination: Central Sleep Apnea & Heart Failure A Deadly Combination: Central Sleep Apnea & Heart Failure Sanjaya Gupta, MD FACC FHRS Ohio State University Symposium May 10 th, 2018 Disclosures Boston Scientific: fellowship support, speaking honoraria

More information

PVDOMICS. Sleep Core. Cleveland Clinic Cleveland, Ohio

PVDOMICS. Sleep Core. Cleveland Clinic Cleveland, Ohio PVDOMICS Sleep Core Rawan Nawabit, Research Coordinator and Polysomnologist Joan Aylor, Research Coordinator Dr. Reena Mehra, Co-Investigator, Sleep Core Lead Cleveland Clinic Cleveland, Ohio 1 Obstructive

More information

How We Breathe During Sleep Affects Health, Wellness and Longevity

How We Breathe During Sleep Affects Health, Wellness and Longevity How We Breathe During Sleep Affects Health, Wellness and Longevity Susan Redline, MD, MPH Peter C. Farrell Professor of Sleep Medicine Program Director- Sleep Medicine Epidemiology Harvard Medical School

More information

Sleep Apnea and chronic Heart Failure

Sleep Apnea and chronic Heart Failure ESC CONGRESS 2012 Sleep Apnea and chronic Heart Failure Prof. Dr. med. Michael Arzt Schlafmedizinisches Zentrum Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg michael.arzt@klinik.uni-regensburg.de

More information

Obstructive Sleep Apnea

Obstructive Sleep Apnea Obstructive Sleep Apnea Definition: Repetitive episodes of upper airway obstruction (complete or partial) that occur during sleep and are associated with arousals or desaturations +/or daytime sleepiness.

More information

OSA and cardiovascular disease what is the evidence? Mohan Edupuganti, MD, FACC. Baptist Health Cardiology. Disclosures: None

OSA and cardiovascular disease what is the evidence? Mohan Edupuganti, MD, FACC. Baptist Health Cardiology. Disclosures: None OSA and cardiovascular disease what is the evidence? Mohan Edupuganti, MD, FACC. Baptist Health Cardiology. Disclosures: None 1 OSA basics Affects 20-30% of males and 10-15% of females in North America

More information

Treatment of sleep apnea in heart failure patients after SERVE-HF results

Treatment of sleep apnea in heart failure patients after SERVE-HF results Treatment of sleep apnea in heart failure patients after SERVE-HF results Martin R Cowie Professor of Cardiology National Heart & Lung Institute Imperial College London (Royal Brompton Hospital Campus)

More information

MCOEM Spring Chapter Meeting April 5, Sleep Apnea An Overview with Emphasis on Cardiovascular Correlations Jacques Conaway, MD

MCOEM Spring Chapter Meeting April 5, Sleep Apnea An Overview with Emphasis on Cardiovascular Correlations Jacques Conaway, MD MCOEM Spring Chapter Meeting April 5, 2014 Sleep Apnea An Overview with Emphasis on Cardiovascular Correlations Jacques Conaway, MD Case Presentation History of Present Illness 57 year old man with ihh/

More information

Chronic NIV in heart failure patients: ASV, NIV and CPAP

Chronic NIV in heart failure patients: ASV, NIV and CPAP Chronic NIV in heart failure patients: ASV, NIV and CPAP João C. Winck, Marta Drummond, Miguel Gonçalves and Tiago Pinto Sleep disordered breathing (SDB), including OSA and central sleep apnoea (CSA),

More information

BTS sleep Course. Module 10 Therapies I: Mechanical Intervention Devices (Prepared by Debby Nicoll and Debbie Smith)

BTS sleep Course. Module 10 Therapies I: Mechanical Intervention Devices (Prepared by Debby Nicoll and Debbie Smith) BTS sleep Course Module 10 Therapies I: Mechanical Intervention Devices (Prepared by Debby Nicoll and Debbie Smith) S1: Overview of OSA Definition History Prevalence Pathophysiology Causes Consequences

More information

6/5/2017. Mellar P Davis MD FCCP FAAHPM Geisinger Medical Center Danville, PA

6/5/2017. Mellar P Davis MD FCCP FAAHPM Geisinger Medical Center Danville, PA Mellar P Davis MD FCCP FAAHPM Geisinger Medical Center Danville, PA Opioids adversely influence respiration in five distinct ways Opioids cause complex sleep disordered breathing consisting of central

More information

Edoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica

Edoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica Convegno Pneumologia 2016 Milano 16-18 giugno 2016 Centro Congressi Palazzo delle Stelline Edoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica Central apnea 10 second

More information

Sleep Apnea and Heart Failure

Sleep Apnea and Heart Failure Sleep Apnea and Heart Failure Micha T. Maeder, MD Cardiology Division Kantonsspital St. Gallen Switzerland micha.maeder@kssg.ch Sleep Disordered Breathing (SDB) in HFrEF 700 HFrEF patients (LVEF

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

2/19/2013. Cardiovascular Disease Prevention International Symposium. Cardiovascular Disease and Sleep Apnea. Still Controversial?

2/19/2013. Cardiovascular Disease Prevention International Symposium. Cardiovascular Disease and Sleep Apnea. Still Controversial? Cardiovascular Disease Prevention International Symposium Cardiovascular Disease and Sleep Apnea February 16, 2013 Jonathan A. Fialkow, M.D., FACC, FAHA Medical Director, Clinical Cardiology, Baptist Cardiac

More information

Co-Morbidities Associated with OSA

Co-Morbidities Associated with OSA Co-Morbidities Associated with OSA Dr VK Vijayan MD (Med), PhD (Med), DSc, FCCP, FICC, FAPSR, FAMS Advisor to Director General, ICMR Bhopal Memorial Hospital and Research Centre & National Institute for

More information

DRS ed Aritmie Cardiache Iper ed Ipocinetiche: la clinica

DRS ed Aritmie Cardiache Iper ed Ipocinetiche: la clinica Corso Multidisciplinare di Aggiornamento La Sindrome delle Apnee Notturne: una sfida diagnostico terapeutica DRS ed Aritmie Cardiache Iper ed Ipocinetiche: la clinica FRANCESCO PERNA, MD, PhD Laboratorio

More information

GOALS. Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) FINANCIAL DISCLOSURE 2/1/2017

GOALS. Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) FINANCIAL DISCLOSURE 2/1/2017 Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) 19th Annual Topics in Cardiovascular Care Steven Khov, DO, FAAP Pulmonary Associates of Lancaster, Ltd February 3, 2017 skhov2@lghealth.org

More information

Precision Sleep Medicine

Precision Sleep Medicine Precision Sleep Medicine Picking Winners Improves Outcomes and Avoids Side-Effects North American Dental Sleep Medicine Conference February 17-18, 2017 Clearwater Beach, FL John E. Remmers, MD Conflict

More information

National Sleep Disorders Research Plan

National Sleep Disorders Research Plan Research Plan Home Foreword Preface Introduction Executive Summary Contents Contact Us National Sleep Disorders Research Plan Return to Table of Contents SECTION 5 - SLEEP DISORDERS SLEEP-DISORDERED BREATHING

More information

The Sleep-Stroke Connection: An Under-recognized Entity. Simin Khavandgar MD UPMC Neurology Department

The Sleep-Stroke Connection: An Under-recognized Entity. Simin Khavandgar MD UPMC Neurology Department The Sleep-Stroke Connection: An Under-recognized Entity Simin Khavandgar MD UPMC Neurology Department Sleep Disordered Breathing (SDB) Obstructive Sleep Apnea (OSA): -Transient cessation of airflow, duration

More information

Diabetes & Obstructive Sleep Apnoea risk. Jaynie Pateraki MSc RGN

Diabetes & Obstructive Sleep Apnoea risk. Jaynie Pateraki MSc RGN Diabetes & Obstructive Sleep Apnoea risk Jaynie Pateraki MSc RGN Non-REM - REM - Both - Unrelated - Common disorders of Sleep Sleep Walking Night terrors Periodic leg movements Sleep automatism Nightmares

More information

Obstructive Sleep Apnoea. Dr William Man Thoracic and Sleep Medicine, Harefield Hospital

Obstructive Sleep Apnoea. Dr William Man Thoracic and Sleep Medicine, Harefield Hospital Obstructive Sleep Apnoea Dr William Man Thoracic and Sleep Medicine, Harefield Hospital Obstructive Sleep Apnoea Common Condition (Syndrome) 3 7% of adult males, 2 5% females Prevalence expected to rise

More information

In-Patient Sleep Testing/Management Boaz Markewitz, MD

In-Patient Sleep Testing/Management Boaz Markewitz, MD In-Patient Sleep Testing/Management Boaz Markewitz, MD Objectives: Discuss inpatient sleep programs and if they provide a benefit to patients and sleep centers Identify things needed to be considered when

More information

Sleep apnea as a risk factor for cardiovascular disease

Sleep apnea as a risk factor for cardiovascular disease Sleep apnea as a risk factor for cardiovascular disease Malcolm Kohler Chair Respiratory Medicine, Clinical Director, Department of Pulmonology, University Hospital Zurich Incidence of fatal cardiovascular

More information

Association of Nocturnal Cardiac Arrhythmias with Sleep- Disordered Breathing

Association of Nocturnal Cardiac Arrhythmias with Sleep- Disordered Breathing Association of Nocturnal Cardiac Arrhythmias with Sleep- Disordered Breathing 1 ARIC Manuscript Proposal #918S PC Reviewed: 01/10/03 Status: A Priority: 2 SC Reviewed: 01/15/03 Status: A Priority: 2 SHHS

More information

Martin R Cowie Professor of Cardiology, National Heart & Lung Institute Imperial College London (Royal Brompton Hospital)

Martin R Cowie Professor of Cardiology, National Heart & Lung Institute Imperial College London (Royal Brompton Hospital) Treatment of Sleep-Disordered Breathing With Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients With Heart Failure and Reduced Ejection Fraction (SERVE-HF) Martin R Cowie Professor

More information

The most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome

The most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome The most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome Natsios Georgios University Hospital of Larissa, Greece Definitions Obstructive Sleep Apnea (OSA)

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

DECLARATION OF CONFLICT OF INTEREST

DECLARATION OF CONFLICT OF INTEREST DECLARATION OF CONFLICT OF INTEREST Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential

More information

Obstructive sleep apnoea How to identify?

Obstructive sleep apnoea How to identify? Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential conflict of interest None Obstructive

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

Best Match. Non-Invasive Ventilation. WSS Fall Objectives. BiPAP AVAPS Patient Types 9/10/2018. Advanced Algorithms - Clinical Applications

Best Match. Non-Invasive Ventilation. WSS Fall Objectives. BiPAP AVAPS Patient Types 9/10/2018. Advanced Algorithms - Clinical Applications WSS Fall 2018 Advanced Algorithms - Clinical Applications Average Volume Assured Ventilation (AVAPS) Auto Servo Ventilation (SV) Hank Hart BS, LPN Objectives Differentiate between BiPAP AVAPS and BiPAP

More information

Sleep Apnea and Cardiovascular Risk. Presented by Akshay Mahadevia, M.D. Diplomate American Board of Sleep Medicine

Sleep Apnea and Cardiovascular Risk. Presented by Akshay Mahadevia, M.D. Diplomate American Board of Sleep Medicine Sleep Apnea and Cardiovascular Risk Presented by Akshay Mahadevia, M.D. Diplomate American Board of Sleep Medicine Objectives Pathogenesis of obstructive sleep apnea, central sleep apnea and Cheyne-Stokes

More information

Sleep and Heart Health: Consequences of OSA

Sleep and Heart Health: Consequences of OSA Sleep and Heart Health: Consequences of OSA Michelle Zetoony, DO, FCCP, FACOI Sleep Medicine Specialist Board Certified Pulmonary, Critical Care, Sleep and Internal Medicine 2014 Objectives Explain the

More information

Emerging Nursing Roles in Collaborative Management of Sleep Disordered Breathing and Obstructive Sleep Apnoea

Emerging Nursing Roles in Collaborative Management of Sleep Disordered Breathing and Obstructive Sleep Apnoea Emerging Nursing Roles in Collaborative Management of Sleep Disordered Breathing and Obstructive Sleep Apnoea Sigma Theta Tau International 28th International Nursing Research Congress 27-31 July 2017

More information

Sleep Disorders and the Metabolic Syndrome

Sleep Disorders and the Metabolic Syndrome Sleep Disorders and the Metabolic Syndrome Tom V. Cloward, M.D. Intermountain Sleep Disorders Center LDS Hospital Objectives Describe how sleep disorders impact your daily medical practice Don Don t do

More information

Sleep-disordered breathing in the elderly: is it distinct from that in the younger or middle-aged populations?

Sleep-disordered breathing in the elderly: is it distinct from that in the younger or middle-aged populations? Editorial Sleep-disordered breathing in the elderly: is it distinct from that in the younger or middle-aged populations? Hiroki Kitakata, Takashi Kohno, Keiichi Fukuda Division of Cardiology, Department

More information

Sleep Apnea and CardioMetabolic Syndrome in women

Sleep Apnea and CardioMetabolic Syndrome in women Sleep Apnea and CardioMetabolic Syndrome in women 신원철 강동경희대병원신경과, 수면센터 1 Today s Talks 폐쇄성수면무호흡증의정의와발생기전 수면무호흡증의합병증 : 고혈압, 관상동맥질환, 부정맥, 뇌졸중, 돌연사, 당뇨, 대사증후군 여성에서의폐쇄성수면무호흡증 폐쇄성수면무호흡증 (Obstructive Sleep Apnea:

More information

Sleep Apnoea : its impact outside the chest. Dr Tom Mackay Consultant Respiratory Physician Royal Infirmary Edinburgh

Sleep Apnoea : its impact outside the chest. Dr Tom Mackay Consultant Respiratory Physician Royal Infirmary Edinburgh Sleep Apnoea : its impact outside the chest Dr Tom Mackay Consultant Respiratory Physician Royal Infirmary Edinburgh Body Mass Index < 20 kg/m 2 20-25 kg/m 2 25-30 kg/m 2 > 30 kg/m 2 underweight normal

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

Cardiovascular disease and obstructive sleep apnoea

Cardiovascular disease and obstructive sleep apnoea Cardiovascular disease and obstructive sleep apnoea Dr. Raymond J.B. Massay M.B.B.S., F.R.C.P(London)., F.E.S.C., F.A.C.C Four basic drives in life 1. Eat 2. Drink 3. Reproduce 4. Sleep Sleep is the biggest

More information

Prof. Samir Morcos Rafla Alexandria Univ. Cardiology Dept.

Prof. Samir Morcos Rafla Alexandria Univ. Cardiology Dept. Obesity as a risk factor for Atrial Fibrillation Prof. Samir Morcos Rafla Alexandria Univ. Cardiology Dept. CardioAlex 2010 smrafla@hotmail.com 1 Obesity has reached epidemic proportions in the United

More information

Sleep Disorders and Cardiac Consequences

Sleep Disorders and Cardiac Consequences Virginia Commonwealth University VCU Scholars Compass Case Studies from Age in Action Virginia Center on Aging 2015 Sleep Disorders and Cardiac Consequences Robert D. Vorona Eastern Virginia Medical School

More information

Novel pathophysiological concepts for the development and impact of sleep apnea in CHF.

Novel pathophysiological concepts for the development and impact of sleep apnea in CHF. Olaf Oldenburg Novel pathophysiological concepts for the development and impact of sleep apnea in CHF. Sleep apnea the need to synchronize the heart, the lung and the brain. Heart Failure 2011 Gothenburg,

More information

Simple diagnostic tools for the Screening of Sleep Apnea in subjects with high risk of cardiovascular disease

Simple diagnostic tools for the Screening of Sleep Apnea in subjects with high risk of cardiovascular disease Cardiovascular diseases remain the number one cause of death worldwide Simple diagnostic tools for the Screening of Sleep Apnea in subjects with high risk of cardiovascular disease Shaoguang Huang MD Department

More information

The ACC Heart Failure Guidelines

The ACC Heart Failure Guidelines The ACC Heart Failure Guidelines Fakhr Alayoubi, Msc,R Ph President of SCCP Cardiology Clinical Pharmacist Assistant Professor At King Saud University King Khalid University Hospital Riyadh-KSA 2017 ACC/AHA/HFSA

More information

Adaptive servo ventilation improves cardiac pre and after load in heart failure patients with Cheyne-Stokes respiration

Adaptive servo ventilation improves cardiac pre and after load in heart failure patients with Cheyne-Stokes respiration Adaptive servo ventilation improves cardiac pre and after load in heart failure patients with Cheyne-Stokes respiration Makiko Miyata, Akiomi Yoshihisa, Takamasa Sato, Satoshi Suzuki, Koichi Sugimoto,

More information

(To be filled by the treating physician)

(To be filled by the treating physician) CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type

More information

C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders

C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders GENERAL ISSUES REGARDING MEDICAL FITNESS-FOR-DUTY 1. These medical standards apply to Union Pacific Railroad (UPRR) employees

More information

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac

More information

Obstructive sleep apnoea (OSA) is a common. Effects of obstructive sleep apnoea on heart rhythm REVIEW

Obstructive sleep apnoea (OSA) is a common. Effects of obstructive sleep apnoea on heart rhythm REVIEW Eur Respir J 2013; 41: 1439 1451 DOI: 10.1183/09031936.00128412 CopyrightßERS 2013 REVIEW Effects of obstructive sleep apnoea on heart rhythm Valentina A. Rossi*, John R. Stradling # and Malcolm Kohler*,"

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

BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT

BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides

More information

6/2/18 SLEEP APNEA AND ITS CARDIOVASCULAR CONSEQUENCE. Salim Surani, MD, MPH, MSHM, FACP, FCCP, FAASM

6/2/18 SLEEP APNEA AND ITS CARDIOVASCULAR CONSEQUENCE. Salim Surani, MD, MPH, MSHM, FACP, FCCP, FAASM SLEEP APNEA AND ITS CARDIOVASCULAR CONSEQUENCE Salim Surani, MD, MPH, MSHM, FACP, FCCP, FAASM 1 2 SNORING PATIENT Sleep and wakefulness, both of them when immoderate constitutes disease hippocrates SRS

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

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

Case. Case. Case. Sleep Disorders: A Case-based Approach. LeRoy Essig, MD Rami Khayat, MD ROS:

Case. Case. Case. Sleep Disorders: A Case-based Approach. LeRoy Essig, MD Rami Khayat, MD ROS: Sleep Disorders: A Case-based Approach LeRoy Essig, MD Rami Khayat, MD Case ROS: 30 Lbs wt gain/1year Fatigue Heart burn Nasal congestion, dry mouth Reduced concentration/memory Case 47 y/o male presents

More information

Chapter 4: Cardiovascular Disease in Patients With CKD

Chapter 4: Cardiovascular Disease in Patients With CKD Chapter 4: Cardiovascular Disease in Patients With CKD Introduction Cardiovascular disease is an important comorbidity for patients with chronic kidney disease (CKD). CKD patients are at high-risk for

More information

A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation

A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation 1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation The following 3 minute polysomnogram (PSG) tracing was recorded in a 74-year-old man with severe ischemic cardiomyopathy

More information

What s new in 2016 Guidelines of the European Society of Cardiology? HEART FAILURE. Marc Ferrini (Lyon Fr)

What s new in 2016 Guidelines of the European Society of Cardiology? HEART FAILURE. Marc Ferrini (Lyon Fr) What s new in 2016 Guidelines of the European Society of Cardiology? HEART FAILURE Marc Ferrini (Lyon Fr) Palermo (I) 1 04 2017 Consulting Fees, Honoraria: BAYER PHARMA BOEHRINGER INGELHEIM BRISTOL MEYERS

More information

FA et Apnée du Sommeil

FA et Apnée du Sommeil FA et Apnée du Sommeil La Réunion Octobre 2017 Pascal Defaye CHU Grenoble-Alpes Obstructive Sleep Apnea and AF Incidence of atrial fibrillation (AF), based on presence or absence of OSA. Cumulative frequency

More information

Heart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output

Heart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover

More information

Cardiac Arrhythmias in Sleep

Cardiac Arrhythmias in Sleep Cardiac Arrhythmias in Sleep Only 53 Slides! Gauresh H Kashyap, MD, FACP, FCCP, FAASM 1 2 Cardiac Arrhythmias in Sleep Out of 400 Patients with OSA, 48% had some Arrhythmias 20% - 2 PVCs/min 7% - Bradycardia

More information

UP TO 25% SLEEP DISORDERED BREATHING AND STROKE OSA. Prevalence 11/12/2015. Young et al. NEJM 1993

UP TO 25% SLEEP DISORDERED BREATHING AND STROKE OSA. Prevalence 11/12/2015. Young et al. NEJM 1993 SLEEP DISORDERED BREATHING AND STROKE Daniel Shade, Jr., MD FCCP, ABSM, D Medical Director, AHN Sleep Medicine OSA Prevalence Young et al. NEJM 1993 Middle aged cohort (30-60years) Diagnosed by PSG, in

More information

Diastolic Heart Failure. Edwin Tulloch-Reid MBBS FACC Consultant Cardiologist Heart Institute of the Caribbean December 2012

Diastolic Heart Failure. Edwin Tulloch-Reid MBBS FACC Consultant Cardiologist Heart Institute of the Caribbean December 2012 Diastolic Heart Failure Edwin Tulloch-Reid MBBS FACC Consultant Cardiologist Heart Institute of the Caribbean December 2012 Disclosures Have spoken for Merck, Sharpe and Dohme Sat on a physician advisory

More information

Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital

Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment

More information

Obstructive Sleep Apnoea

Obstructive Sleep Apnoea Obstructive Sleep Apnoea Adam Whittle Respiratory Medicine Bristol Royal Infirmary Sleep Service 1990: Bristol respiratory sleep service Drs Catterall & Kendrick, Bristol General ATW since 2001 2008: NICE

More information

Sleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016

Sleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016 Sleep Apnea and ifficulty in Extubation Jean Louis BOURGAIN May 15, 2016 Introduction Repetitive collapse of the upper airway > sleep fragmentation, > hypoxemia, hypercapnia, > marked variations in intrathoracic

More information

Atrial fibrillation (AF) is a disorder seen

Atrial fibrillation (AF) is a disorder seen This Just In... An Update on Arrhythmia What do recent studies reveal about arrhythmia? In this article, the authors provide an update on atrial fibrillation and ventricular arrhythmia. Beth L. Abramson,

More information

Obstructive sleep apnea and hypertension: why treatment does not consistently improve blood pressure?

Obstructive sleep apnea and hypertension: why treatment does not consistently improve blood pressure? Martino F. Pengo MD, PhD 7 & 8 décembre 2018, Berlin Obstructive sleep apnea and hypertension: why treatment does not consistently improve blood pressure? Sleep Disorder Center Department of Cardiovascular,

More information

Slide 1. Slide 2 Declaration of Interests. Slide 3. Case study #1. Heart Failure and Sleep Apnoea. 47 year old BMI 32 Treated HBP Type 2 DM

Slide 1. Slide 2 Declaration of Interests. Slide 3. Case study #1. Heart Failure and Sleep Apnoea. 47 year old BMI 32 Treated HBP Type 2 DM Slide 1 Heart Failure and Sleep Apnoea Martin R Cowie MD MSc FRCP FRCP (Ed) FESC Professor of Cardiology, Imperial College London m.cowie@imperial.ac.uk @ProfMartinCowie Slide 2 Declaration of Interests

More information

Year in Review. Outline of Lecture

Year in Review. Outline of Lecture Year in Review Allan I. Pack, M.B.Ch.B., Ph.D. John Miclot Professor of Medicine Director, Center for Sleep and Circadian Neurobiology University of Pennsylvania Perelman School of Medicine Philadelphia,

More information

A new beginning in therapy for women

A new beginning in therapy for women A new beginning in therapy for women OSA in women Tailored solutions for Her AutoSet for Her algorithm ResMed.com Women and OSA OSA has traditionally been considered to be a male disease. However, recent

More information

Sleep Disordered Breathing and HH with Preserved Ejection Fraction:

Sleep Disordered Breathing and HH with Preserved Ejection Fraction: Sleep Disordered Breathing and HH with Preserved Ejection Fraction: Pr Thibaud DAMY Heart Failure Unit Department of Cardiology CHU Mondor, Créteil, France Definition of HF-PEF The diagnosis of HF-PEF

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

OSA and Hypertension Scope of the Problem

OSA and Hypertension Scope of the Problem OSA and Hypertension Scope of the Problem Dr Ahmad Izuanuddin Ismail Senior Lecturer & Respiratory Physician Faculty of Medicine, Universiti Teknologi MARA izuanuddin@salam.uitm.edu.my http://respiratoryuitm.com

More information

Managing Sleep Disorders in Primary Care. Objectives. Disclosures. Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center

Managing Sleep Disorders in Primary Care. Objectives. Disclosures. Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center Managing Sleep Disorders in Primary Care Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center www.sleeplessinidaho.com 1 Objectives 1) Identify stages and behaviors for normal

More information

Sleep and Stroke. M.V. Padma Srivastava Department of Neurology All-India Institute of Medical Sciences, New Delhi ABSTRACT

Sleep and Stroke. M.V. Padma Srivastava Department of Neurology All-India Institute of Medical Sciences, New Delhi ABSTRACT Ann Natl Acad Med Sci (India), 49(3&4): 169-176, 2013 Sleep and Stroke M.V. Padma Srivastava Department of Neurology All-India Institute of Medical Sciences, New Delhi Circadian variations in conjunction

More information

UPDATES IN MANAGEMENT OF HF

UPDATES IN MANAGEMENT OF HF UPDATES IN MANAGEMENT OF HF Jennifer R Brown MD, MS Heart Failure Specialist Medstar Cardiology Associates DC ACP Meeting Fall 2017 Disclosures: speaker bureau for novartis speaker bureau for actelion

More information

"Sleeping with the Enemy Link to Cognitive and Cardiovascular Disease

Sleeping with the Enemy Link to Cognitive and Cardiovascular Disease "Sleeping with the Enemy Link to Cognitive and Cardiovascular Disease 1 Bill Davies PAC BS RRT Confluence Health Division of Pulmonary Sleep Medicine 2 3 Don t ever go to sleep, Too many people die there

More information

The great practical guide to sleep medicine

The great practical guide to sleep medicine Kompendium Schlafmedizin Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM German Sleep Society) / H. Schulz (editor), A. Rodenbeck, P. Geisler (coeditors) Compendium Sleep Medicine Loose

More information

Causes and Consequences of Respiratory Centre Depression and Hypoventilation

Causes and Consequences of Respiratory Centre Depression and Hypoventilation Causes and Consequences of Respiratory Centre Depression and Hypoventilation Lou Irving Director Respiratory and Sleep Medicine, RMH louis.irving@mh.org.au Capacity of the Respiratory System At rest During

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