ChanScore Predicts Presence And Severity Of Sleep Apnea-Hypopnea At The Bedside Before A Polysomnogram Sleep Test
|
|
|
- Bernard McBride
- 5 years ago
- Views:
Transcription
1 ChanScore Predicts Presence And Severity Of Sleep Apnea-Hypopnea At The Bedside Before A Polysomnogram Sleep Test Michael P. Chan, MD, MS, RPSGT Yale New Haven Hospital, Yale University School of Medicine Nicholas D. Ty Lim, Allyn Ly, B.S. Antonio Q. Chan, MD, MBA, FACC, FAHA, RPSGT, FAASM Chanwell Clinic Institute for Heart & Sleep Disorders Milpitas, California World Congress of Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013
2 ChanScore Predicts the Presence and Severity of Obstructive Sleep Apnea Hypopnea at the Bedside Before Polysomnogram Sleep Test Michael P. Chan, MD, MS, RPSGT, Yale University School of Medicine, Yale New Haven Hospital; Nicholas D. Lim; Allyn Ly, BS; Antonio Q. Chan, MD, MBA, FACC, FAHA, RPSGT, FAASM Chanwell Clinic Institute for Heart & Sleep Disorders, Milpitas, California Background: Obstructive sleep apnea-hypopnea (OSAH) increases the risk for metabolic syndrome, heart failure, myocardial infarction, stroke, sudden cardiac death, pulmonary arterial hypertension, vehicular accidents, cancer, depression etc.. In spite of the wide prevalence of OSAH estimated at 24% of the American adult s population and much higher rate among Asians, physicians often miss the signs and symptoms of OSAH, thus a large number of undiagnosed patients remain at great risks. Several bedside history-taking methodologies were developed to assess the daytime sleepiness of patients that come into the clinic. Both the Stanford Sleepiness Scale (SSS) and the Epworth Sleepiness Scale (ESS) were found to be lacking in predicting the presence and severity of OSAH. In the clinical population the Berlin Questionnaire (BQ) was found to have a low level of sensitivity and specificity for prediction of OSAH. Thus there is an urgent need to train physicians in accurate methodologies to screen patients that may suffer from OSAH. Given the scarcity of sleep specialists; primary care physicians and physician assistants (PAS) should be at the forefront of addressing the task of early detection of patients that may have OSAH. To date, there is no combined qualitative and quantitative measure that takes into account the history, age, body mass index (BMI), ESS score, and upper airway structure (Mallampati classification) of a patient. It is our contention that the preceding risk variables when taken individually are either weakly or not strongly correlated with the presence and severity of OSAH; however, when all these risk variables are weighted and measured collectively, the predictability at the bedside for the probable presence and severity of OSAH is further enhanced. Furthermore, most effective methods of diagnosing OSAH require an overnight in-sleep laboratory polysomnogram (SLPSG), and/or a portable home sleep-monitor which can be both costly and time consuming. To address the issue of the accuracy between bedside screening and actual diagnosis, we devised a method of predicting the presence and severity of OSAH by assigning weighted numerical values that consider a patient s age, history of snoring, Epworth Sleepiness Scale (ESS), body mass index (BMI), and upper airway structure (Mallampati classification).
3 Purpose To predict the presence and severity of OSAH (in the form of an AHI category) with a multilateral bedside scoring system wherein physicians or PAS with no training in sleep medicine may be able to enhance the awareness of OSAH, weed out unnecessary referral of low probability OSAH to SLPSG, and expedite referrals to sleep medicine specialists and SLPSG for those at high probability for mild moderate, moderate to severe OSAH. Methods: Given known correlations of age, snoring, body mass index (BMI), Epworth Sleepiness Scale (ESS), and Mallampati classification with OSAH, we assigned simplified weighted values to the listed variables. The total ChanScore (0 to 10) is the sum of the weighted values that corresponds to each variable. Analyses of 315 patients (Male: Female 175:140), picked at random with scored SLPSG, were retrospectively correlated to individual variables and used to optimize the weighting of the ChanScore. Ordinal regression analyses were executed using AHI-categories as defined by the following: 1 AHI <5, 2 AHI , 3 AHI , 4 AHI , 5 AHI 50. Findings We found that age, snoring, body mass index (BMI), Epworth Sleepiness Scale (ESS), and Mallampati classification when analyzed individually proved to have lesser statistical significance in ordinal regression using AHI-Categories (Age: p-value <.00001, Snoring: p-value.02, BMI: p-value <.00001, ESS: p-value.10, Mallampati: p-value.007) than the multilateral ChanScore (p-value < ) which accurately diagnosed over 80% of the population s OSAH (AHI 5 threshold for OSAH as defined by the American Academy of Sleep Medicine). Conclusion Our scoring system, ChanScore, predicts the presence and severity of OSAH at the bedside and correlated remarkably well with SLPSG results. It is a simple, valuable clinical tool for physicians, or PA's who may have no training in Sleep Medicine, to quickly identify patients who may have OSAH and predict its severity. World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
4 ChanScore Background Obstructive sleep apnea-hypopnea (OSAH) increases the risk for: Metabolic syndrome Heart failure Myocardial infarction (up to 300%) Stroke (up to 300%) Sudden cardiac death (up to 300%) Pulmonary arterial hypertension Vehicular accidents (up to 700%) Cancer Depression
5 ChanScore Background Prevalence of OSAH, estimated at 24% of the American adult s population Much higher rate among Asians, physicians often miss the signs and symptoms of OSAH, thus a large number of undiagnosed patents remain at great risks World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
6 ChanScore Background Diagnosing OSAH: The observation of a sleep technician An overnight in-lab polysomnogram (PSG) A portable home sleep-monitor All of the above can be time-consuming and costly & may not be available in the community World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
7 ChanScore Background Assess the daytime sleepiness of patients: Stanford Sleepiness Scale (SSS) Epworth Sleepiness Scale (ESS) Berlin Questionnaire (BQ) Limitation: SSS, ESS, BQ are exclusively subjective and may result in error. Insomnia + OSAH = may have low ESS, hence ESS is not reliable World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
8 ChanScore Background Stanford Sleepiness Scale (SSS) Epworth Sleepiness Scale (ESS) Degree of Sleepiness Scale Rating Situation Chance of Dozing Feeling active, vital, alert, or wide awake 1 Functioning at high levels, but not at peak; able to concentrate Awake, but relaxed; responsive but not 3 fully alert Somewhat foggy, let down 4 Foggy, losing interest in remaining awake, slowed down Sleepy, woozy, fighting sleep; prefer to lie down Sitting and Reading Watching TV Sitting inactive in a public place As a passenger in a car for one hour without a break Lying down to rest in the afternoon Sitting and talking to someone No longer fighting sleep, sleep onset soon; having dream-like thoughts Asleep Rate your alertness at different times during the day. If you go below a three when you should be feeling alert, this is an indication that you have a serious sleep debt 7 X Sitting quietly after lunch (without alcohol) In a car, stopped for a few minutes in traffic Total Score
9 ChanScore Background Berlin Questionnaire (BQ) considered other factors of OSAH besides general sleepiness such as: BMI Blood pressure Snoring history Limitation: BQ approach considers single threshold based interpretations of qualitative information World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
10 ChanScore Background Berlin Questionnaire (BQ) Annals of Internal Medicine 1999
11 ChanScore Background Current history-taking methodologies (ESS, SSS, BQ) lack quantitative multi-threshold (non-binary) consideration and apnea-hypopnea related factors (besides snoring) Given these limitations, Chanwell Clinic devised a method of predicting OSAH & its severity by assigning a score that considers a patient s age, history of snoring, ESS score, BMI, and upper airway structure (Mallampati classification) World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
12 Physical Exam Examine the Upper Airway! World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
13 World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct Mallampati Score
14 Children & Young Adults World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
15 ChanScorePurpose To Predict the Presence and Severity of OSAH with a Multilateral Bedside Scoring System Before Polysomnogram Sleep Test. Provide simplified tool for healthcare workers to identify patients who may have OSAH World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
16 ChanScorePurpose Weed out unnecessary referral of low probability OSAH to sleep lab PSG Expedite referrals to sleep medicine specialistsand sleep lab PSG for those at high probability for mild moderate, moderate to severe OSAH World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
17 ChanScore Study Patient Population Characteristics Overall (n = 315) <5 (n = 44) (n = 75) (n = 73) (n = 67) 50 (n = 56) P Value* Male, % Snorer, % Age <70 y, % Ethnicity, % Caucasian African-American Middle Eastern Asian Hispanic Other BMI, kg/m^2, % < <.001 > Epworth, % < > Mallampati, % Class I Class II Class III Class IV ChanScore, % <
18 ChanScore Breakdown Mallampati Classification: Class I 0 Class II 1 Class III 2 Class IV 3 Age (Years): < BMI (kgm -2 ) < Epworth Sleepiness Scale: < >15 2 Snoring: No 0 Yes 1 Minimum ChanScore: 0; Maximum ChanScore: 10 Total Weighted Value
19 ChanScore Breakdown Given the known correlations of snoring, BMI, ESS score, Mallampati classification, and age with OSAH, we assigned simplified values to the listed factors as shown above In essence, the ChanScore combines quantitative assessment with qualitative historybased methodologies and craniofacial structure to generate a more precise prediction of the presence and severity of Sleep Disordered Breathing (SDB)
20 ChanScore Methods Probabilities were generated using ordinal regression analysis chiefly executed using the apnea hypopnea index (AHI)-Categories as follows: 1 AHI <5 2 AHI AHI AHI AHI 50 Regression model used was: ln(py/(1-py)) = Constant + ( ) * ChanScore Py represents the probability of event Y occurring, the constant is different for each Y(AHI- Category)
21 ChanScore Methods During the initial analyses of the smaller data sample, ordinal regression and retrospective usage of the regression model (with solved constants) displayed a low percentage (below 30%) of correctly predicted AHI-Categories (1-5) This phenomenon likely occurred given the distinction created in non-binary probabilities between a plurality (highest probability) and majority (over 50% probability and naturally indicative of plurality)
22 ChanScore Methods Binary Logistic Regression Model: ln(py/(1-py)) = (-4.537) + ( ) * TOTAL Logit Link Response Summary: SEVERE(>30) Value Count Proportion Event X Total 145 Py represents the probability of event Y occurring, the constant is different for each Y(AHI-Category)
23 ChanScore Methods Parameter Estimate Term Coefficie nt SE Coefficient Z P Odds Ratio Lower 95% Odds Ratio Upper 95% Odds Ratio Constant TOTAL World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
24 Model Summary of Goodness Fit Statistics Log-Likelihood Test that all slope coefficients are equal to zero: Likelihood Ratio Chi-Square (G) DF 1 P-Value McFadden's Pseudo R-Square 9.49% (P-Value <.05 indicates Lack-of-Fit): Pearson Residuals Chi-Square DF 6 P-Value Deviance Residuals Chi-Square DF 6 P-Value Hosmer-Lemeshow Chi-Square DF 4 P-Value Measures of Association Concordant 3062 Discordant 1074 Ties 988 Total 5124 Concordant Percent Discordant Percent Ties Percent Goodman-Kruskal Gamma Somers' D Kendall's Tau-a
25 Initial Observed & Predicted Outcome Observed Outcome Predicted Outcome Row Total Ŷ = 0 Ŷ = 1 Y = Y = Column Total Percent Correctly Predicte 68.28%
26 ChanScore Methods 315 patients (M:F 175:140), picked at random with scored in-lab PSGs, were retrospectively correlated to individual factors and used to optimize the weighting of the ChanScore The data generated from the analyses of the study base were used to generate equations to predict the likelihood of each patient falling into a specific apnea hypopnea index(ahi) Category. World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
27 ChanScore Methods Calculating a more precise ChanScore methodology: Version 1: Range: 0-8; Mallampati classification worth maximum of 2 points (Class <2 0, Class 3 1, Class 4 2); Snoring not considered Version 2: Range: 0-9; Mallampati classification worth maximum of 3 points (Class 1 0, Class 2 1, Class 3 2, Class 4 3); Snoring not considered Version 3: Range: 0-10; Mallampati classification worth maximum of 3 points (Class 1 0, Class 2 1, Class 3 2, Class 4 3); Snoring considered
28 ChanScore Methods Consider a multi-party first-past-the-post election There are 5 parties in total sharing 100 votes To win a minority government, a party must only obtain the most votes among the other parties this is a plurality To win a majority government, a party must obtain more votes than all other parties combined this is a majority To create a coalition government, two or more parties may combine their votes to form a majority
29 ChanScore Methods In a majority event, the probability (associated with said event) must overweigh the sum of the probabilities of all other events In a plurality event, the probability (associated with said event) need only overweigh each of the other probabilities individually In a coalition event, the probabilities of two or more separate events can be combined to form a unified majority event.
30 ChanScore Methods Applying the coalition principle, the predictions were recalculated to include the two most likely AHI-Categories (in this case with any ChanScore, the two highest scores in a plurality generated a likelihood of over 50%) Note: this system was only applied in the case where there was no majority present Successful implementation resulted in over 50% correctly predicted AHI-Categories (final study, n = 315) & over 80% accuracy in predicted presence of OSAH.
31 ChanScore Methods Upon further examination of the ordinal logistic study, it was found that over 50% of the error was constituted by predictions that correctly diagnosed the presence of OSAH (AHI >5), but ended up under-predicting the severity This discovery then prompted the usage of binary logistic regression to predict a Y/N situation based on the AHI being greater than certain values (>5, >15, >30) All 3 models resulted in over 65% accuracy with Version 3 over 86% accuracy.
32 ChanScore Methods ChanScore was eventually optimized to Version 3 based on analyses of the PSG data With the same data selection and ordinal logistic regression, Version 3 had the lowest p-value or most statistical significance (p < ) compared to Version 1 (p <.00004) and Version 2 (p <.00001) World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
33 Observed and Predicted Outcomes Observed Outcome Predicted Outcome Column1 Row Total Ŷ = 0 Ŷ = 1 Y = Y = Column Total Percent Correctly Predicte 86.98%
34 Fig 1.2: ChanScoreInterval Correlation with Severity Obstructive Sleep Apnea-Hypopnea % Distributions ChanScore Interval Apnea-Hypopnea Index CaOverall (n=315)0-2 (n=0) 3-4 (n=19) 5-6 (n=108) 7-8 (n=162) 9-10 (n <5 (n=44) (n=75) (n=73) (n=67) (n=56) World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
35 Fig 1.3: ChanScoreAHI Category Probability Ordinal Logistic Regression with Retrospective Study Apnea Hypopnea Index Category, % ChanScore <
36 ChanScore 1- Predicted OSAH Severity Outcome World Congress on Sleep Medicine Valencia, Sp Enter Predicted Event Predictors Settings: Probability Journal TOTAL 1 2% 2% probability of OSAH World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
37 ChanScore 5- Predicted OSAH Severity Outcome Predicted Predictors Enter Settings: Event Probability TOTAL 5 17% 17% probability of OSAH World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
38 ChanScore 10- Predicted OSAH Severity Outcome Predicted Enter Event Predictors Settings: Probability TOTAL 10 80% 80% probability of OSAH World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
39 AHI Category Distribution ChanScore Range 100% 0 90% 80% Percentage Distribu ution 70% 60% 50% 40% 30% 20% 10% 0% Overall (n=315) 3-4 (n=19) 5-6 (n=108) 7-8 (n=162) 9-10 (n=26) ChanScore Range 50 (n=56) (n=67) (n=73) (n=75)
40 ChanScore ChanScore RangeProbability Probability of AHI Categories < % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Probability
41 PSG Decision Tree Based on ChanScore When to refer to Sleep Lab? World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
42 ChanScore AHI Probability Decision 0 80% probability no OSAH. No need to do anything. 1 74% probability no OSAH. Overnight sleep pulse oximetry If 4% DE is <10, do nothing, reevaluate in 1 year If 4% DE is >10, may recommend PSG sleep test 2 63% probability no OSAH May recommend PSG 18% mild OSAH 3 41% probability no OSAH PSG sleep test 25% mild OSAH 4 37% probability no OSAH PSG sleep test 31% mild OSAH 11% moderate OSAH 5 26% probability no OSAH PSG sleep test 34% mild OSAH 16% moderate OSAH 8% severe OSAH
43 ChanScore AHI Probability Decision 6 34% mild OSAH PSG sleep test 21% moderate OSAH 13% severe OSAH 11% unusually severe OSAH 7 11% probability no OSAH PSG sleep test 23% mild OSAH 25% moderate OSAH 23% severe OSAH 18% unusually severe OSAH 8 7% probability no OSAH PSG sleep test 17% mild OSAH 23% moderate OSAH 28% severe OSAH 26% unusually severe OSAH 9 4% probability no OSAH PSG sleep test 11% mild OSAH 18% moderate OSAH 29% severe OSAH 38% unusually severe OSAH MP Chan, AQ Chan et al ChanScore Predicts Presence & Severity of Sleep Apnea Hypopnea Journal of Sleep Supplement October % probability no OSAH PSG sleep test 7% mild OSAH 13% moderate OSAH 26% severe OSAH 51% unusually severe OSAH
44 ChanScore Conclusions ChanScorepredicts the presence and severity of OSAH at the bedside and correlated remarkably well with sleep lab PSG results. World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
45 ChanScore Conclusions ChanScoreis a simple, valuable clinical tool for physicians, or Physician Assistant's or Nurses who may have no training in Sleep Medicine, to quickly identify patients who may have OSAH and predict its severity. World Congress on Sleep Medicine Valencia, Spain Sept 28 Oct 2, 2013 Journal of Sleep Supplement Oct. 2013
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
Balboa 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
Types 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
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
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
Sleep 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:
The 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
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
Home 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
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
493 Blackwell Road, Suite 317-A, Warrenton, VA
493 Blackwell Road, Suite 317-A, Warrenton, VA. 20186 Dear Sleep Study Patient, Attached is the patient questionnaire for your sleep study. Please complete and mail or fax the enclosed forms as soon as
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
Welcome to the Koala Center for Sleep Disorders
Welcome to the Koala Center for Sleep Disorders Your health is very important. We are honored to have the opportunity to join you on your wellness journey. In order to provide you with the comprehensive
Assessment of Sleep Disorders DR HUGH SELSICK
Assessment of Sleep Disorders DR HUGH SELSICK Goals Understand the importance of history taking Be able to take a basic sleep history Be aware the technology used to assess sleep disorders. Understand
The Implications of a Hospital Break Policy: A Comparison of Two Regional Hospitals Using Survey Data
The Implications of a Hospital Break Policy: A Comparison of Two Regional Hospitals Using Survey Data Samantha M. Riedy, BS, RPSGT Experimental Psychology Doctoral Program Sleep and Performance Research
Sleep 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
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
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
Sleep 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
Sleep. 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
MESA EXAM 5 ANCILLARY STUDY 113 SLEEP QUESTIONNAIRE DATA SET VARIABLE GUIDE
MESA EXAM 5 ANCILLARY STUDY 113 SLEEP QUESTIONNAIRE DATA SET VARIABLE GUIDE Data Set name : Principal Investigator : Contact Information : MESAe5_SleepQ_20140617 Susan Redline sredline1@rics.bwh.harvard.edu
SLEEP 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
ANNUAL FOLLOW-UP QUESTIONNAIRE
SLEEP HEART HEALTH STUDY - TUCSON ANNUAL FOLLOW-UP QUESTIONNAIRE - 2003 Dear Sleep Heart Health Study participant: Today s Date: / / Month Day Year Please take the time to complete and return this short
Help 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
Brunswick Pulmonary and Sleep Medicine Lawrence Davanzo, DO, FCCP 49 Veronica Ave, Somerset, NJ Phone# Fax#
REGISTRATION FORM (Please Print) Today s date: PCP: PATIENT INFORMATION Patient s last name: First: Middle: Mr. Mrs. Miss Ms. Marital status (circle one) Single / Mar / Div / Sep / Wid If not, what is
SLEEP 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
Sleep 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
Sleep 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
SLEEP SCREENING QUESTIONNAIRE
SLEEP SCREENING QUESTIONNAIRE Please answer each question accurately and to the best of your knowledge, to help us obtain an accurate picture of your health and sleep issues, only this way will we be able
New 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
WELCOME 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
SNORING 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
Telephone: Fax:
PATIENT AUTHORIZATION TO RELEASE MEDICAL RECORDS AND DEMOGRAPHIC INFORMATION DATE: SS #: PATIENT NAME: BIRTHDATE: / / PATIENT ADDRESS: CITY: STATE: ZIP CODE: HOME PHONE #: CELL PHONE #: REFERRING PHYSICIAN
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)
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
DESERT CENTER FOR ALLERGY AND CHEST DISEASES HEALTH QUESTIONAIRE NAME. PAST MEDICAL PROBLEMS- Check mark if you have any of the following
DESERT CENTER FOR ALLERGY AND CHEST DISEASES Pulmonary Medicine, Allergy/Immunology, Sleep Disorders Pulmonary Rehabilitation, Pulmonary Function Laboratory HEALTH QUESTIONAIRE NAME What is your presenting
Baptist 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
SLEEP 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
Arizona 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:
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
What s the name of your position?
What s the name of your position? What are some basic work responsibilities (e.g primarily front desk/administration, light lifting or heavy liftingplease indicate pounds)? CONSENT FORM FOR USE AND DISCLOSURE
Patient 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
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
PATIENT 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
Sleep 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
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
PULMONARY & 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
PHYSICIAN EVALUATION AMONG DENTAL PATIENTS WHO SCREEN HIGH-RISK FOR SLEEP APNEA. Kristin D. Dillow
PHYSICIAN EVALUATION AMONG DENTAL PATIENTS WHO SCREEN HIGH-RISK FOR SLEEP APNEA Kristin D. Dillow A thesis submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment
Emergency 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:
The STOP-Bang Equivalent Model and Prediction of Severity
DOI:.5664/JCSM.36 The STOP-Bang Equivalent Model and Prediction of Severity of Obstructive Sleep Apnea: Relation to Polysomnographic Measurements of the Apnea/Hypopnea Index Robert J. Farney, M.D. ; Brandon
EPWORTH SLEEPINESS SCALE
EPWORTH SLEEPINESS SCALE Name: Sponsors last 4 of SSN#: DOB: Today s Date: Age (years): Gender (circle): MALE FEMALE How likely are you to doze off or fall asleep in the following situation, in contrast
Patient 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:
Sleep 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
130 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
Obstructive 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,
HOW S YOUR HEART? GET A FREE HEART HEALTH CHECK ASK YOUR AMCAL PHARMACIST TODAY FREE. 10 minutes. No appointment needed
HOW S YOUR HEART? GET A FREE HEART HEALTH CHECK FREE 10 minutes No appointment needed ASK YOUR AMCAL PHARMACIST TODAY START YOUR HEART HEALTH ASSESSMENT TODAY Name: Date: Your Amcal pharmacist: HEART HEALTH
PATIENT 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
THN. Sleep Therapy Study. ImThera. Information for Participants. Caution: Investigational device. Limited by United States law to investigational use.
THN Sleep Therapy Study Information for Participants Caution: Investigational device. Limited by United States law to investigational use. ImThera Obstructive sleep apnea (OSA) is a very serious condition.
Sleep 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
Tracy Carbone, MD System Medical Director of Sleep Medicine Lee Health Golisano Children s Hospital of Southwest Florida Fort Myers, FL
Tracy Carbone, MD System Medical Director of Sleep Medicine Lee Health Golisano Children s Hospital of Southwest Florida Fort Myers, FL Background Factors Which Increase the Risks for OSA in Pregnancy
Your 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
Occupation: 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
Maintenance for Wakefulness Testing (MWT)
Maintenance for Wakefulness Testing (MWT) Dear, Your Maintenance for Wakefulness Testing (MWT) will begin on the morning of at 7 a.m. and will end at 5 p.m. ARRIVAL TIME: If you are not able to arrive
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
Please complete this questionnaire before your appointment.
Date completed: Please complete this questionnaire before your appointment. Name: Occupation: Age: Birth date: Gender: M / F Height: Weight: Weight in High School: Neck Size: in. Ethnicity: Hispanic or
The Epworth Sleepiness Scale (ESS), which asks an individual
Scientific investigations The Epworth Score in African American Populations Amanda L. Hayes, B.S. 1 ; James C. Spilsbury, Ph.D., M.P.H. 2 ; Sanjay R. Patel, M.D., M.S. 1,2 1 Division of Pulmonary, Critical
SLEEP 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:
Narendra 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
Associated 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
Maintenance for Wakefulness Testing (MWT)
SLEEP DISORDERS CENTER St. Joseph Mercy Ann Arbor 5305 Elliott Drive, Ypsilanti, MI 48197 734-712-2276 / Fax 734-712-2967 Maintenance for Wakefulness Testing (MWT) Dear, Your Maintenance for Wakefulness
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
Sleep 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
An Introduction to Identifying and Treating Sleep Disorders in Adults
An Introduction to Identifying and Treating Sleep Disorders in Adults REFERENCES/RESOURCES TOOLS & MEASURES: SLEEP DIARY: Carney, C., et al. (2012). The Consensus Sleep Diary: Standardizing prospective
THE 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
Please complete the following questionnaire by filling in the blanks and placing a check in appropriate areas. For how many months/years?
St. Louis Heart and Vascular - McKelvey Office May 28, 2018 (Page 1) Please complete the following questionnaire by filling in the blanks and placing a check in appropriate areas. Today s Date: My Main
BMI: 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
Not Sleepy HO Q1 D2 Q3 Q4 ]5 D6 j7 Q8 Q9 Q10 Extremely Sleepy
![Not Sleepy HO Q1 D2 Q3 Q4 ]5 D6 j7 Q8 Q9 Q10 Extremely Sleepy](/thumbs/96/127246551.jpg "Not 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).
PATIENT 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:
PEDIATRIC 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.
Outline. 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
CHANGING SHAPE OF SLEEP STUDIES
CHANGING SHAPE OF SLEEP STUDIES JAMES C. O BRIEN MD FCCP, FAASM MEDICAL DIRECTOR, PROHEALTH PHYSICIANS SLEEP CENTERS 10/19/2107 GOALS OF MY TALK-- Review the types of sleep studies Provide clinical information
The Effect of Patient Neighbourhood Income Level on the Purchase of Continuous Positive Airway
Online Data Supplement The Effect of Patient Neighbourhood Income Level on the Purchase of Continuous Positive Airway Pressure Treatment among Sleep Apnea Patients Tetyana Kendzerska, MD, PhD, Andrea S.
1960 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
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
Case A Review: Checkpoint A Contents
June 2011 Case A Review: Checkpoint A Contents Patient Name: Jonathan Sandman Case Investigation #: 587291 Dear Investigators, Thank you for agreeing to take a look at this patient s file. After the initial
PATIENT 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:
ANNUAL FOLLOW-UP QUESTIONNAIRE
SLEEP HEART HEALTH STUDY - TUCSON ANNUAL FOLLOW-UP QUESTIONNAIRE - 2004 Dear Sleep Heart Health Study participant: Today s Date: / / Month Day Year Please take the time to complete and return this short
Sleep 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
Intake 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=
Prevalent Sleep Disordered Breathing & Obstructive Sleep Apnea in Spite of Treatment for Acromegaly
Prevalent Sleep Disordered Breathing & Obstructive Sleep Apnea in Spite of Treatment for Acromegaly Chris Yedinak DNP,MN,FNP Assistant Professor Oregon Health & Sciences University Portland. Oregon. USA
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
Sleep & Wakefulness Disorders in Parkinson s Disease: The Challenge of Getting a Good Night s Sleep
Sleep & Wakefulness Disorders in Parkinson s Disease: The Challenge of Getting a Good Night s Sleep Helene A. Emsellem, MD March 25, 2017 The Center for Sleep & Wake Disorders PFNCA Symposium Sleep is
International Journal of Scientific & Engineering Research Volume 9, Issue 1, January ISSN
International Journal of Scientific & Engineering Research Volume 9, Issue 1, January-2018 342 The difference of sleep quality between 2-channel ambulatory monitor and diagnostic polysomnography Tengchin
Humble Dreams Sleep Center. Humble, TX 77339
Humble Dreams Sleep Center 8901 FM 1960 Bypass West, Ste. 306 Humble, TX 77339 Dear Humble Dreams Sleep Study Patient, Thank you for allowing Humble Dreams Sleep Center to provide your sleep study as requested
Obstructive Sleep Apnea
Obstructive Sleep Apnea by Barbara Phillips MD MSPH and Matthew T Naughton MD FRACP Epidemiology and risk factors 7 Clinical presentation 13 Medical complications 22 Diagnosis 40 Medical management 50
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
Instructions. If you make a mistake, put an "X" over the checkmark. Then put a checkmark in the correct box and draw a circle around that box.
SLEEP HEART HEALTH STUDY SLEEP HABITS AND LIFESTYLE QUESTIONNAIRE Instructions Thank you for taking time to fill out the enclosed Sleep Habits Questionnaire. Please fill out the form completely. You may
General Information. Name Age Date of Birth. Address Apt. # City State Zip. Home Phone Work Phone. Social Security Number Marital Status
Accredited Member Center of The American Academy of Sleep Medicine 400 Riverside Drive, Suite 1500, Bourbonnais, IL 60914 Phone (815) 933-2874 Fax (815) 939-9413 www.riversidemc.net/sleep General Information
Patient Scheduled Letter Thunderbird Internal Medicine Sleep Center 5620 W. Thunderbird Rd., Suite C-1 Glendale, AZ (602)
Patient Scheduled Letter Thunderbird Internal Medicine Sleep Center 5620 W. Thunderbird Rd., Suite C-1 Glendale, AZ 85306 (602) 938 6960 Dear Patient, Your Doctor has requested you be scheduled for a sleep
SLEEP 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