Case. Case. Case. Sleep Disorders: A Case-based Approach. LeRoy Essig, MD Rami Khayat, MD ROS:
|
|
- Adam Garrison
- 6 years ago
- Views:
Transcription
1 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 to primary doctor for annual examination Recently started on citalopram History of hypertension Family history of CAD Case Social history: School bus driver, 30 p/year Wife complains of husband snoring Meds: Lisinopril, atorvastatin, hydrochlorothiazide 1
2 Sleep History Struggling to stay awake during daytime 6 hours of sleep per night with a 1 hour nap in the early afternoon, 2-3 beers/night Watches TV in bed before sleep Physical Examination Exam: Weight 212, BMI 35, BP 147/87 Big uvula, nasal passages narrow, thick neck Lungs clear Heart regular, no gallop, clear lungs No peripheral edema Intact sensation and strength in LE s Sleep History Awakens 3-4 times at night to use rest room Persistent loud snoring Leg jerks and kicks, restless sleep Wife gradually sleeping in another room What problems did you identify in this patient? 2
3 Problems General: Poorly controlled HTN Cardiovascular risk factors Heartburn Arrange problems in order of Importance Problems Sleep Fatigue, depression Snoring, sleepiness Restless sleep/legs Dissatisfied spouse Problems in Order of Importance Sleepiness Professional driver Poorly controlled hypertension Smoking Obesity Depression Restless legs 3
4 Differential Diagnosis Inadequate sleep time Poor sleep hygiene Obstructive Sleep Apnea Periodic Limb Movement of Sleep/Restless Leg Syndrome Inadequately treated depression Medication side effects Daytime Sleepiness Sleep deprivation for 1 day or sleeping 2 hours less/day for a week resulted in the same driving impairment as a blood alcohol level of g/dl (Powell, 2001) NHTSA survey of 4010 adult drivers Of the 11% who admitted to nodding off while driving in the previous year, 2/3 stated they had 6 hours of sleep the previous night Daytime Sleepiness 16% of adults experience excessive sleepiness that impairs daily functioning (Young, 2004). More than 100,000 automobile accidents each year are due to drivers falling asleep (National Highway Traffic Safety Administration). 71,000 non-fatal injuries 1500 fatalities 12.5 billion dollars in annual all-cause monetary loss Assessment of Sleepiness The Epworth Sleepiness Scale SITUATION CHANCE OF DOZING 1-Sitting and reading 2-Watching TV 3-Sitting inactive in a public place (I.e. a theater or a meeting) 4- As a passenger in a car for an hour without break 5- Lying down to rest in the afternoon when circumstances permit 6-Sitting and talking to someone 7-Sitting quietly after lunch without alcohol 8 -In a car, while stopping for a few minutes in traffic 0 = Would never doze 1 = Slight chance of dozing 2 = Moderate chance of dozing 3 = High chance of dozing 4
5 What is the most effective next intervention? Prevalence of Obstructive Sleep Apnea Evaluate for OSA! Improved sleep hygiene and expanded sleep alone are unlikely to reduce sleepiness if OSA is untreated OSA is linked to hypertension, cardiovascular disease, periodic limb movement and depression The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults The Wisconsin Sleep Cohort, NEJM 1993 Obstructive Sleep Apnea OSA- why should I care? If I have to care, what should I do about it? Treatment of OSA and CSA in patients with heart disease is a waste of time! Symptoms of OSA Snoring Excessive daytime sleepiness Witnessed apneas Poor memory and concentration, irritability or personality changes Other: Dry throat, morning headache, and nocturia 5
6 Diagnosis History and physical examination Questionnaires Pulse oximetry Portable sleep studies Polysomnography Effects of Sleep on the Upper Airway Loss of tone in genioglossus, palatal, and pharyngeal constrictor muscles Supine position and reduced lung volumes OSA-Imbalance between Dilating and Constricting Forces of the Upper Airway Dilating forces: pharyngeal muscle tone Lung volumes Constricting forces: Negative inspiratory pressure Extra luminal fat Physical Examination in OSA Neck circumference > 17 inches in males > 16 inches in females Craniofacial anatomy Inferiorly positioned hyoid bone Mandibular insufficiency Increased mid-facial height Nasal obstruction 6
7 LOC ROC Chin EMG C3-A2 O2-A1 EKG Nasal flow Chest Abdomen Sleep Study- Polysomnography SaO 2 Why should this patient be treated urgently? Professional driver with sleepiness Poorly controlled hypertension Cardiovascular risk Depression Quality of Life Case: Results of the Sleep Study Sleep Efficiency: 68% Wakefulness and arousal index: 37/hour Respiratory disturbance index: 42/hour Periodic Limb Movement Index: 32/hour Prospective Data From Wisconsin Sleep Cohort Study (N=913) (Young et al, Sleep 20:608, 1997) Any MVA in 5 years (n=165) Increased Relative Risk Men Women No SDB Reference category = 1.0 Snorer, RDI <5 3.4* 0.9 RDI * 0.8 RDI >15 3.4* 0.6 *Significant increase compared to reference category INCREASED RISK OF CRASHES EVEN WITH MILD OSA 7
8 Relationship Between Severity pf Sleep Apnea and Crash Risk (N=460, OSA) (George et al, Sleep 22:790, 1999) Crash Rate (Number/Year) Only increased risk RDI >40 p<0.01 Control RDI RDI RDI >40 Derivation of Patient Population Used in Study of CPAP and Crashes (George, Thorax 56:508, 2001) Confirmed OSA (n=740) Driving records available (n=582) CPAP treatment (n=317) Clinic follow-up for >3 years (n=210) Does Sleep Apnea Increase Crash Rates? Answer Yes Different data about relationship between crash risk and severity of illness Severe sleep apnea is a risk factor for crashes Is mild-to-moderate sleep apnea a risk factor for crashes Not clear Does treatment reduce crash risk? Yes Association of OSA and Depression Peppard, P. E. et al. Arch Intern Med 2006;166:
9 The Cardiovascular Consequences of Sleep Apnea Increased Sympathetic Nerve Activity in OSA (Somers et al J Clin Invest 1995; 96: ) Components of the Cardiovascular Response to Apnea Hypoxia Increased sympathetic activity Blood pressure surge Increased respiratory effort Arousal Increased Incidence of Coronary Artery Disease in OSA Pecker et al Eur Resir J
10 OSA Can Kill Patients with Coronary Disease Association of Hypertension and Sleep-Disordered Breathing -- Sleep Heart Health Study Respiratory Disturbance Index: an independent predictor of mortality in coronary artery disease Odds Ratio (OR) <1.5 (Ref) >30 RDI (episodes/hour) OR adjusted for age, sex, ethnicity OR adjusted for age, sex ethnicity, and BMI n=6440 p= for linear trend Pecker et al. AJRCC 2005 Nieto et al, JAMA 283:1829, 2000 OSA And Hypertension 40% of patients with OSA have hypertension 50% of patients with hypertension have OSA OSA patients were more likely to be nocturnal non-dippers Treatment of OSA reduces blood pressure Association Between Sleep Apnea and Incident Hypertension During 4 Year Follow Up Period Odds Ratio (OR) for Hypertension at Follow-up (Ref) >15 Baseline AHI OR adjusted for baseline hypertension status OR for above + age, gender, BMI, etc. Hypertension = BP of at least 140/90 or use of anti-hypertensive medications Peppard et al, NEJM 342: ,
11 Association of OSA and Type II Diabetes Reichmuth et al AJRCCM 2005 Obstructive Sleep Apnea and Stroke Young et al AJRCC 2005 Association of OSA and Type II Diabetes Reichmuth et al AJRCCM year odd ratio of physician diagnosed DM over 4 year of follow up Obstructive Sleep Apnea and Outcome of Stroke Mohsenin NEJM
12 OSA Can Cause Heart Failure OR I II III IV AHI Interquartile range CHF n=6,424 Association Between Severe OSA (AHI >30) and Arrhythmias in Sleep Heart Health Study (Mehra et al, AJRCCM, doi: /rccm oc) Arrhythmia Type Non-sustained ventricular tachycardia Complex ventricular ectopy Atrial fibrillation Unadjusted Odds Ratio 4.64 ( ) 1.96 ( ) 5.66 ( ) Odds Ratio* (95% CI) Adjusted for Age, Sex, BMI 3.72 ( ) 1.81 ( ) 3.85 ( ) Odds Ratio* (95% CI) Adjusted for Age, Sex, BMI, CHD 3.40 ( ) 1.74 ( ) 4.02 ( ) E Shahar, et al, AJRCCM, 2001 BMI=body mass index; CHD=coronary heart disease *Results of logistic regression analysis with SDB as the exposure; N=338 without SDB, N=228 with SDB Higher Prevalence of Predicted OSA in Patients Presenting with AF Compared to General Cardiology Patients (Gami et al, Circ 110:364, 2004) Sudden Cardiac Death in OSA N Engl J Med 2005;352:
13 OSA Increases Fatal and Non-fatal Cardiovascular Events (Marin et al, Lancet 365:1046, 2005) OSA Negative intrathoracic pressure Sympathetic activity Hypoxemia Systolic transmural pressure Venous return RV overload Afterload SVR Oxidative injury Endothelial dysfunction Pulmonary vasoconstriction LV afterload Impaired LV filling Arrhythmias HTN Platelet activation LV Hypertrophy RV afterload LV remodeling Atherosclerosis Worsening RV function Sudden death Diastolic dysfunction Ischemic heart disease Stroke Heart failure OSA is a Cardiovascular Risk Factor Hypertension Atherosclerosis OSA Heart Failure Arrhythmia Undiagnosed OSA Kills Patients with Cardiovascular Disease OSA causes sudden death OSA worsens atrial fibrillation OSA worsens Hypertension control OSA promotes stroke OSA worsens outcome of stroke OSA promotes arrhythmia 13
14 OSA is a Cardiovascular Risk Factor OSA is a cardiovascular risk factor just like high cholesterol and diabetes Certain cardiovascular risk factors are modifiable Case-Continued Patient is started on CPAP, returns after 6 weeks with: Complete resolution of snoring Remains restless in sleep Sleepiness is only partially improved Dry mouth in the morning OSA is a Cardiovascular Risk Factor Early identification and treatment of cardiovascular risk factors is the current focus of care Treatment of co-existent OSA in patients with established cardiovascular disease is critical Why didn t the treatment of OSA completely reverse sleepiness Is the patient adequately for OSA? Is the patient using CPAP long enough? Is the mask appropriately fitted? Is there mask leak? Are there other correctable causes of sleepiness? 14
15 CPAP Limitations Interface Mask issues, claustrophobia Mouth leaks Skin abrasion Pressure-related Intolerance of pressure, flow Rhinitis, sinusitis, headaches Assessment of Adequate treatment of OSA Hours of use per night: >4-5 hours Total Sleep time: 7-10 hours Mask fitting (noise, dry eyes, aerophagia) Number of awakening per night CPAP Limitations Equipment related Noise, smell, condensation Dryness, inadequate humidification Changes in optimal pressure within night/over time Weight gain Nasal congestion Positional Sleep stage Differential Diagnosis Inadequate sleep time Poor sleep hygiene Obstructive Sleep Apnea Periodic Limb Movement of Sleep/Restless Leg Syndrome Inadequately treated depression Medication side effects 15
16 Sleep Hygiene Interventions Increase sleep time Avoid Alcohol too close before bedtime Avoid TV in bed Exercise 4-5 hours before bedtime Conclusions Excessive Sleepiness is present in >16% of adults OSA is present in 5-15% middle age adults OSA increases risk of vehicle accidents OSA is a cardiovascular risk factor Case-Continued Interventions: Sleep Expansion Sleep hygiene Change Citalopram 16
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 informationSleep 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 informationSleep 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 informationManagement 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 informationSLEEP APNOEA DR TAN KAH LEONG ALVIN CO-DIRECTOR SLEEP LABORATORY SITE CHIEF SDDC (SLEEP) DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD & NECK SURGERY
SLEEP APNOEA DR TAN KAH LEONG ALVIN CO-DIRECTOR SLEEP LABORATORY SITE CHIEF SDDC (SLEEP) DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD & NECK SURGERY
More informationSleep Diordered Breathing (Part 1)
Sleep Diordered Breathing (Part 1) History (for more topics & presentations, visit ) Obstructive sleep apnea - first described by Charles Dickens in 1836 in Papers of the Pickwick Club, Dickens depicted
More informationSleep Apnea. Herbert A Berger, MD Pulmonary Division Department of Internal Medicine University of Iowa
Sleep Apnea Herbert A Berger, MD Pulmonary Division Department of Internal Medicine University of Iowa Disclosures No Relevant Financial Interests to Report Objectives Learn the history and physical examination
More informationSNORING AND OBSTRUCTIVE SLEEP APNOEA WAYS TO DEAL WITH THESE PROBLEMS
SNORING AND OBSTRUCTIVE SLEEP APNOEA WAYS TO DEAL WITH THESE PROBLEMS Laugh and the world laughs with you; snore and you sleep alone. These words by novelist Anthony Vergess ring true with all too many
More informationWHAT 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 informationSleep 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 informationEmergency Contact Information Name: Phone: Address: Employer Information Employer Name: Address/Street: City: Zip: Phone: Fax:
SUNSET SLEEP LABS PATIENT INFORMATION FORM Patient Information Name: Sex: M F Date of Birth: Address/Street: City: Zip: Phone: Alt Phone: Parent/Guardian: Phone: Social Security Number: Drivers License:
More informationI 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 informationIntake Questionnaire
Intake Questionnaire In order to make the best use of your appointment time, please complete this form prior to your initial appointment. What is your name? (Who filled in this form?) (Y= yes N=no DK=
More informationSurgical 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 informationObstructive 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 informationDECLARATION 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 informationThe 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 informationSleep History Questionnaire B/P / Pulse: Neck Circum Wgt: Pulse Ox
2700 Campus Drive, Ste 100 2412 E 117 th Street Plymouth, MN 55441 Burnsville, MN 55337 P 763.519.0634 F 763.519.0636 P 952.431.5011 F 952.431.5013 www.whitneysleepcenter.com Sleep History Questionnaire
More informationPATIENT DEMOGRAPHICS
PATIENT DEMOGRAPHICS NPSG CPAP CPAP Retitration Split Night PATIENT INFORMATION: Name: Last First Middle Initial Address: City: State: Zip: Social Security #: DOB: Gender: Age: Phone Number: Cell: Work:
More informationPULMONARY & CRITICAL CARE CONSULTANTS OF AUSTIN 1305 West 34 th Street, Suite 400, Austin, TX Phone: Fax:
Name: Sex: Age: Date: Date of Birth Height Weight Neck size Referring Physician: Primary Care MD: Main Sleep Complaint(s) trouble falling asleep trouble remaining asleep excessive sleepiness during the
More informationMCOEM 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 informationBaptist Health Floyd 1850 State Street New Albany, IN Sleep Disorders Center Lung & Sleep Specialists. Date of Birth: Age:
Page 1 of 7 GENERAL INFORMATION Name: Date of Birth: Age: Social Security #: Sex: Height: Weight: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: Employer s Name: Marital Status: Married
More informationSleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address
Patient Label For office use only Appt date: Clinician: Sleep Center Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 Leading
More informationSleep Medicine Questionnaire
Please bring this completed questionnaire with you to your sleep medicine appointment. Our sleep medicine staff strives to understand your sleep symptoms, which may be complex in nature. Thank you for
More informationWELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS
WELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS Prior to your office visit, we request that you complete this questionnaire. It asks questions not only about your sleeping habits and behavior
More informationPolysomnography (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 informationPATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID (208)
PATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID 83704 (208)884-2922 ***Questionnaire MUST be completed PRIOR to arrival for appointment*** Today s Date / / / / Last First MI DOB Referring
More informationThe 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 informationSleep Medicine Associates
Date: Patient Name: DOB: Patient Height: _ Weight: _ lbs Referring Physician: Neck Size: Main Sleep Problems: 1. My main sleep complaint is: Trouble Sleeping at night Sleepy during the day Unusual behavior
More informationSleep 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 informationNew Patient Sleep Intake
New Patient Sleep Intake Name: Date of Birth: Primary Care Physician: Date of Visit: Referring Physician and/or Other Physicians: Retail Pharmacy: Mail Order Pharmacy: Address: Mail Order Phone #: Phone
More informationSleep Symptoms & History
Sleep Symptoms & History In your own words, please tell us what brings you to the sleep clinic today? How long have you been experiencing your sleep problems? yrs. mos. To give us a precise understanding
More informationPatient Adult Information History
Patient Adult Information History Patient name: Age: Date: What is the main reason for today s evaluation? Infant History Birth delivery: Normal C-section Delayed Epidural Premature: No Yes If yes, how
More informationSLEEP HISTORY QUESTIONNAIRE
Date of birth: Today s date: Dear Patient: SLEEP HISTORY QUESTIONNAIRE Thank you for taking the time to fill out a sleep history questionnaire. This will help our healthcare team to provide the best possible
More informationSleep 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 information130 Preston Executive Drive Cary, NC Ph(919) Fax(919) Page 1 of 6. Patient History
130 Preston Executive Drive Cary, NC 27513 Ph(919)462-8081 Fax(919)462-8082 www.parkwaysleep.com Page 1 of 6 Patient History *Please fill out in dark BLACK INK only. General Information Name Sex: Male
More informationPATIENT NAME: M.R. #: ACCT #: HOME TEL: WORK TEL: AGE: D.O.B.: OCCUPATION: HEIGHT: WEIGHT: NECK SIZE: GENDER EMERGENCY CONTACT: RELATIONSHIP: TEL:
SLEEP DISORDERS INSTITUTE HOSPITAL: DePaul Building Street Address City, State Zip Tel: (202) 555-1212 Fax: (202) 555-1212 SLEEP QUESTIONNAIRE PATIENT NAME: M.R. #: ACCT #: STREET ADDRESS: CITY: STATE:
More informationGOALS. 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 informationLittleton, CO Welcome Packet 8151 Southpark Lane, Suite 200 Littleton, CO 80120
Littleton, CO Welcome Packet For any after-hours questions, please call (303) 956-5145 Dear Mountain Sleep Patient, You have been scheduled for a sleep study at 8151 Southpark Lane, Suite 200, Littleton,
More informationAssociated Neurological Specialties and Sleep Disorder Center
Sleep Center Questionnaire Name: Sex: Age: Date: Date of Birth: Height: Weight: Neck Size: Primary Care Physician: Referring Physician: Main Sleep Issues/Complaints Trouble falling asleep Trouble staying
More informationSLEEP SCREENING QUESTIONNAIRE
Patient Information 433 W. University Dr. Rochester, MI 48307 www.rochesteradvanceddentistry.com +1 248 656-2020 SLEEP SCREENING QUESTIONNAIRE Name: DOB: Age: Address: Employer: SS# Home Phone: Work Phone:
More informationCircadian 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 informationSleep 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 informationSleep 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 informationDenver, CO Welcome Packet
Fax: (303) 957-5414 or 720-542-8699 For any after-hours questions, please call (303) 956-5145 Dear Mountain Sleep Patient, You have been scheduled for a sleep study at 1210 S Parker Road, Suite 101, Denver,
More information3/10/2014. 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 informationSleep Screening Questionnaire
Version: SLPQV1 Sleep Screening Questionnaire OFFICE USE Patient ID: NAME: CURRENT DATE: / / DATE OF BIRTH: / / MALE FEMALE Referring Physician: Contact ID: Number Number #1 = the most severe symptom #1
More informationHeart 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 informationOccupation: Usual Work Hours/Days: Referring Physician: Family Physician (PCP): Marital status: Single Married Divorced Widowed
Name Social Security No. Last First MI Address Phone No. ( ) City State Zip Secondary No. ( ) Date of Birth Sex (M/F) Race Email County Primary Care Marital Status Single Divorced Married Widowed Employer
More informationBalboa Island Dentistry (949)
Do You Snore? Are you always tired? Snoring is no laughing matter! It may be more than an annoying habit. It may be a sign of. How well do you sleep? Just about everyone snores occasionally. Even a baby
More information1960 FP CENTER FOR SLEEP DISORDERS
1960 FP CENTER FOR SLEEP DISORDERS Sleep Questionnaire Name: Date: Date of Birth: / / Age: Gender: Height: Weight: lbs. Referring Physician: Occupation: Please give a brief description of your sleep problem
More informationObservations 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 informationTallahassee Memorial Sleep Center Patient Questionnaire
Tallahassee Memorial Sleep Center Patient Questionnaire Name _ Age Date Date of Birth Sex Height ft in Weight lbs Neck size inches (If known) Body Mass Index (BMI) (If known) Phone(s) (home) (work) (cell)
More informationSleep apnea. What is sleep apnea? What are the symptoms of sleep apnea? Symptoms during the day. Symptoms during sleep
Sleep apnea Your doctor thinks you may have sleep apnea. The purpose of this fact sheet is to inform you about this disease. It also gives you details about the tests done to diagnose it and possible treatments.
More informationROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA
ROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA A Person is physically qualified to drive a motor vehicle if that person; -(5) has no established medical history or clinical diagnosis
More informationSLEEP DISORDERS CENTER QUESTIONNAIRE
Carteret Health Care Patient's name DOB Gender: M F Date of Visit _ Referring physicians: Primary care providers: Please complete the following questionnaire by filling in the blanks and placing a check
More informationPatient History & Sleep Questionnaire
Patient History & Sleep Questionnaire Patient Full Name: Nick Name: Birth date: Age: Sex: Height: Current Weight: Weight Five Years Ago: Peak Lifetime Weight: Marital Status: Single Married Divorced Widowed
More informationObstructive 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 informationThe following questions are about your sleep. Please consider both what others have told you about your sleep and what you know yourself.
Sleep History Form FORM CODE: SLE VERSION A 1/29/2009 PARTICIPANT ID NUMBER: CONTACT YEAR: 0 9 LAST NAME: INITIALS: INSTRUCTIONS: This form should be completed during the participant's clinic visit. ID
More informationSleep Disordered Breathing
Sleep Disordered Breathing SDB SDB Is an Umbrella Term for Many Disorders characterized by a lack of drive to breathe Results n repetitive pauses in breathing with no effort Occurs for a minimum of 10
More informationSection of Pediatric Sleep Medicine
Section of Pediatric Sleep Medicine David Gozal, MD Hari Bandla, MD Date: Dear Parent or Caregiver; Thank you for your interest in the Sleep Disorders Program. The sleep clinic s standard assessment procedure
More informationOBSTRUCTIVE 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 informationArizona Grand Medical Center 3777 Crossings Drive Prescott, AZ 86305
Patient Information Arizona Grand Medical Center 3777 Crossings Drive Prescott, AZ 86305 Home Phone: Cell Phone: Last Name: First Name: MI Mailing Address: APT City/State/Zip Sex: Male Female Birthdate:
More informationNot Sleepy HO Q1 D2 Q3 Q4 ]5 D6 j7 Q8 Q9 Q10 Extremely Sleepy
Health Benefits Employee Services HBE Preventive Health - Sleep Assessment Form Please bring your completed assessment form to your appointment. To schedule an appointment please call 505 844-HBES (4237).
More informationYour physician has ordered a sleep study for you on. Your arrival time is scheduled for.
Dear Patient: Your physician has ordered a sleep study for you on. Your arrival time is scheduled for. The Texas State Sleep Lab is located in the Health Professions Building on the Texas State University
More informationSleep 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 informationWhat 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 informationDiabetes & 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 informationHelp I Have Problems with My Sleep!
Help I Have Problems with My Sleep! Over An 85 Year Lifespan Sleep 31% Work 21% Exercise 1% Food and Drink 11% Sleep Is Important! You can survive without food for up to 2 months Without water 3-5 days
More informationNarendra Kumar, M.D. PC Board Certified ENT Board Certified Sleep Medicine
Narendra Kumar, M.D. PC Board Certified ENT Board Certified Sleep Medicine PATIENT DEMOGRAPHICS Who is the Physician that referred you to us? Who is the primary care Physician? Date: Do you want this report
More informationSleep History Questionnaire
Sleep History Questionnaire Name: DOB: Phone: Date of Consultation: Consultation is requested by: Primary care provider: _ Preferred pharmacy: Chief complaint: Please tell us why you are here: How long
More informationTHE PERMANENTE MEDICAL GROUP
Patient label here THE PERMANENTE MEDICAL GROUP Division of Sleep Medicine COMPLETED BY: PARENT/GUARDIAN CHILD/ADOLESCENT Age: Height: Weight: PEDIATRIC SLEEP QUESTIONNAIRE Thank you completing this questionnaire.
More informationSleep Questionnaire Name: Sex: Age: Da te: Da te of birth: Height: Weight: Neck siz e: Ref erring Physician: Primary Car e MD:
www.myvcmf.com 1133 E. Stanley Blvd., Suite 101 Livermore, CA 94550 925 454-4280 5725 W. Las Positas Blvd., Suite 110 Pleasanton, CA 94588 925-416-6767 Sleep Questionnaire Name: Sex: Age: Da te: Da te
More informationUP 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 informationSleep Center New Patient Questionnaire
For office use only Appt date: Sleep Center Clinician: Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 #1 respiratory hospital
More informationBMI: Family physician : Neck circumference (cm) Hypertension + 4 cm Snoring + 3 cm Witnessed apnea + 3cm Total
Last and first names: F M Date: Date of birth: / / YYYY MM DD Weight: kg /lbs Profession/job: Height: _ cm /ft.in. BMI:_ Family physician : ANC (adjusted neck circumference) : Neck circumference (cm) Hypertension
More informationIn-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 informationHuron Medical Sleep Center Saad S. Ahmad, MD
Authorization and Consent for Sleep Testing I authorize the release of any medical information necessary to the durable medical equipment company for therapy, if applicable. I authorize the use of audio
More informationObstructive Sleep Apnea
Obstructive Sleep Apnea Introduction Obstructive sleep apnea is an interruption in breathing during sleep. It is caused by throat and tongue muscles collapsing and relaxing. This blocks, or obstructs,
More informationBTS 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 informationSLEEP STUDY - PATIENT QUESTIONNAIRE
NOTE: You cannot fill out this form on Mozilla Firefox, please try another browser. You have two options for completing a questionnaire: - Enter the information on the fillable PDF and click Print at the
More informationSleep 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 informationPEDIATRIC HISTORY FORM
Lehigh Valley Health Network Pediatric Sleep Center PEDIATRIC HISTORY FORM Please answer the following questions frankly and accurately by filling in the blank or checking/circling the appropriate answer.
More informationTypes of Sleep Studies 8/28/2018. Ronald S. Prehn, ThM, DDS. Type 1 Attended in-lab polysomnography (PSG) 18 leads
Ronald S. Prehn, ThM, DDS rprehn@tmjtexas.com Board Certified in Dental Sleep Medicine Board Certified in Orofacial Pain Types of Sleep Studies Type 1 Attended in-lab polysomnography (PSG) 18 leads Type
More informationSLEEP DISORDERED BREATHING The Clinical Conditions
SLEEP DISORDERED BREATHING The Clinical Conditions Robert G. Hooper, M.D. In the previous portion of this paper, the definitions of the respiratory events that are the hallmarks of problems with breathing
More informationPATIENT REGISTRATION PERSON TO NOTIFY IN CASE OF EMERGENCY. Name: Relationship: Phone:
PATIENT REGISTRATION Patient's Name (Last, First, MI): Date of Birth: Age: Sex: M / F Social Security Number: Address: Apt. # City: State: Zip: Home Number: Mobile Number: Work Number: Employment Status:
More informationSleep. Anil Rama, MD Medical Director, Division of Sleep Medicine The Permanente Medical Group
Sleep Anil Rama, MD Medical Director, Division of Sleep Medicine The Permanente Medical Group Assistant Adjunct Clinical Faculty Stanford School of Medicine Circadian Rhythm of Sleep Body temperature 7
More informationSleep History Questionnaire. Sleep Disorders Center Duke University Medical Center. General Information. Age: Sex: F M (select one)
Sleep History Questionnaire Sleep Disorders Center Duke University Medical Center Part I: General Information Name: Address: Date: Phone: Age: Sex: F M (select one) Education (years of school): Occupation:
More informationTHE SLEEP DISORDERS CLINIC Medical Director: Dr Raymond Gottschalk PATIENT QUESTIONNAIRE
THE SLEEP DISORDERS CLINIC Medical Director: Dr Raymond Gottschalk 55 Frid Street, Unit 7, Hamilton, Ontario L8P 4M3 Phone:905-529-2259 Fax: 905-529-2262 282 Linwell Road, Suite 118, St. Catharines, Ontario
More information*521634* Sleep History Questionnaire. Name of primary care doctor:
*521634* Today s Date: Sleep History Questionnaire Appointment Date: Please answer the following questions before coming to your appointment. Please arrive 15 minutes early with this packet filled out.
More informationApnea-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 informationPATIENT QUESTIONNAIRE Salem Sleep Medicine Please fill out completely
PATIENT QUESTIONNAIRE Salem Sleep Medicine Please fill out completely Date: email address: First name: Middle: Last: Nickname: Ethnicity/Race (please circle): Black or African American Caucasian Hispanic
More informationPATIENT REGISTRATION PERSON TO NOTIFY IN CASE OF EMERGENCY. Name: Relationship: Phone:
PATIENT REGISTRATION Patient's Name (Last, First, MI): Date Date of Birth: Age: Sex: M / F Social Security Number: Address: Apt. # City: State: Zip: Home Number: Mobile Number: Work Number: PERSON TO NOTIFY
More informationCo-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 informationHome Sleep Testing Questionnaire
Home Sleep Testing Questionnaire Patient Name: DOB: / / Gender: Male Female Study Date: / / Marital Status: Married Cohabitate Single Divorced Widow/Widower Email: Phone: Height: Weight: Neck Size: What
More informationPatient Information. Name: Date of Birth: Address: Number & Street City State Zip Code. Home Number: ( ) Cell Number: ( )
Patient Information Name: Date of Birth: Age: Address: Number & Street City State Zip Code Home Number: ( ) Cell Number: ( ) Social Security Number: Marital Status: Religion: Race: Height: Weight: Sex:
More informationThe Agony or the Ecstasy. Familiar?
The Agony or the Ecstasy Familiar? Snoring Related Complaints Drives wife from bedroom Girlfriend won t marry me Shakes entire house Ask me to leave movies and church Has had to leave boat so friends could
More informationOSA 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 informationOutline. Major variables contributing to airway patency/collapse. OSA- Definition
Outline Alicia Gruber Kalamas, MD Associate Clinical Professor of Anesthesia & Perioperative Care University of California, San Francisco September 2011 Definition Pathophysiology Patient Risk Factors
More information604 NORTH ACADIA ROAD, Suite 210 THIBODAUX, LA SLEEP HISTORY QUESTIONNAIRE
604 NORTH ACADIA ROAD, Suite 210 THIBODAUX, LA 70301 985-493-4759 SLEEP HISTORY QUESTIONNAIRE DATE: / / NAME: AGE (First) (Middle) (Last) ADDRESS: (Street) (City) (State) (Zip) PHONE: Home( ) Work:( )
More information