Precision Sleep Medicine
|
|
- Hilary Flowers
- 5 years ago
- Views:
Transcription
1 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
2 Conflict of Interest Part owner of a company that manufactures a sleep recorder (Sagatech) Part owner and Chief Medical Officer of a company that manufactures a dental titration device (Zephyr Sleep Technologies, Calgary, Alberta CANADA) 2
3 Objectives To understand the current balance of patient adherence to therapy versus therapeutic efficacy in outcomes with continuous positive airway pressure (CPAP) and oral appliance therapy (OAT) To be familiar with the role of wakefulness in permitting reflex compensation for the pharyngeal anatomic abnormality To understand the importance of patient selection in the management of OSA with OAT: what methods work and why To learn why mandibular protruding appliances produce a successful outcome in some patients but not others To be familiar with the possible role for emerging technologies in enhancing the accuracy of patient selection for OAT 3
4 Definition of Respiratory Disturbances Apnea absence of breathing for 10 seconds or more Hypopnea 50% reduction in breathing for 10 seconds followed by a 3% dip in O 2 sat or an arousal 4
5 Contraction of Inspiratory Muscles in OSA Negative luminal pressure 5
6 Pathophysiology of OSA: Two possibilities Neural Hypothesis (lazy tongue) Apneics have a sub-normal genioglossal activity during sleep Anatomic Hypothesis (small airway) Apneics have a structurally narrowed pharyngeal airway 6
7 The Passive Pharyngeal Airway General Anesthesia Complete Paralysis 7
8 Closing pressure is elevated in OSA 8
9 Maximal Area of the Passive Pharynx 9
10 Lazy Tongue Hypothesis Tantalizing but fragmentary evidence supports this hypothesis Currently, no hard evidence supports the lazy tongue In fact, the tongue seems to be working overtime while awake 10
11 Genioglossal EMG is elevated in OSA while awake 11
12 Here s the deal - OSA is caused by a structural narrowing of the pharynx This structural narrowing causes airway obstruction ONLY during sleep 12
13 While Awake - Neuromuscular Compensation NO Pharyngeal Obstruction Structural Narrowing 13
14 Non-REM Sleep Pharyngeal Obstruction Structural Narrowing 14
15 REM Sleep - Muscle Atonia Severe Pharyngeal Obstruction Pharyngeal Occlusion 15
16 Oral Appliance Therapy How Does it Work? Studies of the passive pharynx reveal that protruding the mandible acts mechanically to open the pharynx 16
17 Mandibular Protrusion Dilates the Passive Pharynx Note dependence of nasopharynx and oropharynx 17
18 Oral Appliance Therapy How Does it Work? OAT eliminates pharyngeal obstruction in OSA by dilating the velo-pharynx and oro-pharynx No evidence for muscle activation 18
19 Sleep Apnea & Comorbid Disease Depression 45% Stroke 63% Drug-Resistant Hypertension 83% Coronary Artery Disease 57% Heart Failure 76% A-fib 50% Severe Obesity Type 2 Diabetes 77% 72% 19
20 CV Effects Clearly sleep apnea is associated with CV disease Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365:
21 All Cause Mortality Wisconsin Sleep Cohort Young T; Finn L; Peppard PE; Szklo-Coxe M; Austin D; Nieto FJ; Stubbs R; Hla KM. Sleep disordered breathing and mortality: eighteen-year follow-up of the wisconsin sleep cohort. SLEEP 2008;31(8):
22 22
23 Does CPAP prevent CV disease? 3 recent clinical trials comparing CPAP with usual care Barbe et al. JAMA 2012 Peker et al. Am J Resp Crit Care Med 2016 McEvoy et al. New Eng J Med
24 McEvoy et al. (n=2687) SAVE Trial New Eng J Med 2016; 375: SAVE Trial (Sleep Apnea Cardiovascular Endpoints) 24
25 McEvoy et al. (n=2687) No significant difference in prevention of CV events comparing CPAP vs. controls New Eng J Med 2016; 375: SAVE Trial (Sleep Apnea Cardiovascular Endpoints) 25
26 Conclusions CPAP did not significantly reduce the occurrence of serious CV events in non-sleepy patients with moderate to severe OSA Why not? 26
27 Poor CPAP compliance 3.3 hours per night 27
28 This is why I m so concerned Prescribing CPAP with the sole purpose of reducing future CV events in asymptomatic patients with OSA and established CV disease cannot be recommended Need for novel treatment options Editorial. Mokhlesi B, Ayas N. New Eng J Med 2016; 375(10):
29 YOU have a treatment that will reduce heart attacks and strokes BUT only if you treat the patients who will respond! 29
30 Which ONES? 30
31 Selection Selection Selection 31
32 We need a validated method to prospectively select patients for OAT More efficient delivery of therapy Better outcomes 32
33 Available Methods for Selecting Patients for OAT Clinical features Imaging the pharynx Mandibular titration 33
34 Here s the deal - OSA is caused by a structural narrowing of the pharynx This structural narrowing is not apparent while awake because of neuromuscular compensations 34
35 Available Methods for Selecting Patients for OAT Clinical features Imaging the pharynx Mandibular titration during sleep 35
36 Mandibular Titration During Sleep in the Lab 36
37 MATRx Single-night, Attended Polysomnographic Test 1. Accurately selects patients who will respond to OAT and 2. Identifies an efficacious protrusive position for each responder Remmers J, Charkhandeh S, Grosse J, Topor Z, Brant R, Santosham P, Bruehlmann S. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. SLEEP 2013; 36(10):
38 Mandibular Titration During Sleep at Home Replacing the Tech with a Computer 38
39 MATRx plus Home Sleep Test 1. Accurately selects patients who will respond to OAT and 2. Identifies an efficacious protrusive position for each responder Note: This device is approved by Health Canada for sale in Canada. This device is pending 510(k) and 513(f)(2) clearance and is not available for sale in the United States. 39
40 The MATRx plus Difference Every other HST device only supports the diagnosis of OSA MATRx plus does it all 40
41 MATRx plus: A-MP Technology Auto-titrating mandibular positioner MATRx style dental trays Feedback signals: Oxyhemoglobin saturation Respiratory airflow Real-time detection of respiratory events Automated analysis of data 41
42 MATRx plus 42
43 43
44 44
45 MATRx plus Patient Information Portal 45
46 MATRx plus Titration: A two night study in the home Night 1 Dynamic interaction between respiratory events and mandibular movement Night 2 Refinement of mandibular position in response to respiratory events 46
47 Protrusive position (mm) MATRx plus Results: Responder Time (h) 47
48 Protrusive position (mm) MATRx plus Results: Non-Responder Time (h) 48
49 Case Study Obese Patient with Severe OSA Patient Profile 62 year old male Pre-study AHI = 40.2 BMI = 34.3 Tray Fitting Lower Limit (Resting Position) - 3.5mm Upper Limit (Maximum Protrusion) + 5.5mm 49
50 Night 1 - Dynamic Theragnostic Study 50
51 Night 2 - Static Theragnostic Study 51
52 Night 3 - Static Theragnostic Study 3.1mm 52
53 Theragnostic Study Summary 53
54 MATRx plus Clinical Investigation Objective To assess the ability of an auto-titrating mandibular positioner test in: Prospectively identifying therapeutic responders Determining an efficacious protrusive position 54
55 MATRx plus Trial Study Design All participants received: 2-night auto-titrating mandibular positioner test Custom oral appliance (SomnoMed G2, MicrO 2 ) 55
56 Inclusion Criteria Broad inclusion criteria: ODI > 10 hr -1 BMI < 45 kg/m 2 56
57 Distribution of Baseline ODI and BMI 57
58 Auto-titration + Machine Learning MATRx plus Machine Learning (Random Forest) Prediction of Outcome with OAT 58
59 Training and Validation of Predictive Model Phase 1: n = 131 Extract 266 feature s Training of Random Forest Machine Therapeutic Outcome Phase 2: n = 48 Extract 266 feature s Trained Random Forest Machine Responder or Non- Responder 59
60 Baseline and Outcome ODI n=48 60
61 Predictive Accuracy: Patient Selection Therapeutic success defined as ODI < 10hr -1 61
62 Efficacious Protrusion (%) Predictive Accuracy: Efficacious Protrusive Position PPV=86% Target Protrusion (%) 62
63 Why does MATRx work so well? Test Prediction Outcome Test circumstances mimic the outcome situation 63
64 Efficiency: Fewer Clinic Visits 64
65 Efficiency: Reduced Time-to-Treatment Days from OA Insertion to Therapeutic Success Prediction Mean±SD Range Predicted Success 29.3± Predicted Failure 76.9±
66 Conclusions CPAP is still standard treatment for OSA but it has clay feet OAT is great treatment for OSA BUT it must incorporate patient selection The at-home sleep test, MATRx plus, provides accurate patient selection for OAT 66
67 MATRx plus Empowering the Sleep Dentist Know, in advance, OSA patients who will be effectively treated with an oral appliance Improve your efficiency of appliance fitting at target Decrease the time-to-therapy Minimize the risk of over-titration 67
68 Acknowledgements National Research Council Canada Industrial Research Assistance Program Alberta Innovates Technology Futures SomnoMed MicroDental Laboratories Zephyr Sleep Technologies 68
Selecting the Right Patients for Oral Appliance Therapy
Selecting the Right Patients for Oral Appliance Therapy AN OVERVIEW OF THE IN-LAB MATRx TITRATION SYSTEM Oral Appliance Titration Made Simple Confidently Prescribe Oral Appliance Therapy The ONLY validated
More informationTHE ROLE OF THE MATRx IN PREDICTING WHICH PATIENTS CAN BE TREATED SUCCESSFULLY WITH ORAL APPLIANCES
THE ROLE OF THE MATRx IN PREDICTING WHICH PATIENTS CAN BE TREATED SUCCESSFULLY WITH ORAL APPLIANCES Brock Rondeau, D.D.S. I.B.O., D.A.B.C.P., D-A.C.S.D.D., D.A.B.D.S.M., D.A.B.C.D.S.M. Oral appliance therapy
More informationORAL APPLIANCE THERAPY
ORAL APPLIANCE THERAPY IN AND OUT OF LAB Todd Wyatt, DMD Background in Sleep Tim C Duke DDS Respironics SomnoMed Elite Somcenter Sleep Centers of Arkansas WCMC (Unity Health) Baptist Health ResMed American
More informationIn-Lab Titration. The New Standard of Care in Oral Appliance Therapy
In-Lab Titration The New Standard of Care in Oral Appliance Therapy Dr. Jonathan S. Lown, MD Clinical Director Delta Sleep Center of Long Island Certified in the areas of Sleep, Internal Medicine and Lipidology
More informationPerformance of Remotely Controlled Mandibular Protrusion Sleep Studies for Prediction of Oral Appliance Treatment Response
pii: jc-00327-16 http://dx.doi.org/10.5664/jcsm.6492 SCIENTIFIC INVESTIGATIONS Performance of Remotely Controlled Mandibular Protrusion Sleep Studies for Prediction of Oral Appliance Treatment Response
More informationBefore & After your MATRx Study
Before & After your MATRx Study A MATRx study is a highly accurate sleep test ordered by a sleep physician. This overnight study is done in a local sleep lab to find out if your obstructive sleep apnea
More informationRemotely Controlled Mandibular Protrusion during Sleep Predicts Therapeutic Success with Oral Appliances in Patients with Obstructive Sleep Apnea
REMOTELY CONTROLLED MANDIBULAR PROTRUSION IN OSA PATIENTS http://dx.doi.org/.5665/sleep.348 Remotely Controlled Mandibular Protrusion during Sleep Predicts Therapeutic Success with Oral Appliances in Patients
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 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 informationSleep Apnea in Women: How Is It Different?
Sleep Apnea in Women: How Is It Different? Grace Pien, MD, MSCE Division of Pulmonary and Critical Care Department of Medicine Johns Hopkins School of Medicine 16 February 2018 Outline Prevalence Clinical
More informationRESEARCH 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 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 informationEXPLORE NEW POSSIBILITIES
EXPLORE NEW POSSIBILITIES TREATING SNORING AND SLEEP APNOEA HAS CHANGED FOREVER Introducing the Oventus O 2 Vent, a custom made, comfortable oral appliance with a unique airway design for the treatment
More informationUpdate 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 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 informationManagement of OSA. saurabh maji
Management of OSA saurabh maji INTRODUCTION Obstructive sleep apnea is a major public health problem Prevalence of OSAS in INDIA is 2.4% to 4.96% in men and 1% to 2 % in women In the rest of the world
More informationEmerging 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 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 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 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 informationTired of being tired?
Tired of being tired? Narval CC MRD ResMed.com/Narval Sleepiness and snoring are possible symptoms of sleep apnea. Did you know that one in every four adults has some form of sleep disordered-breathing
More informationAdvancements in the Field of Dental Sleep Medicine
Advancements in the Field of Dental Sleep Medicine An update for sleep specialists & technologists Daniel Burton, DDS, D.ABDSM Dentist / Owner at Michigan Sleep Network, PC MASM Annual Meeting October
More informationPositive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea
Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea Policy Number: Original Effective Date: MM.01.009 11/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO
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 information11/13/2017. Jeremy Tabak MD, FAASM Medical Director Baptist Hospital Sleep Lab Medical Director Baptist Sleep Lab at Galloway
Jeremy Tabak MD, FAASM Medical Director Baptist Hospital Sleep Lab Medical Director Baptist Sleep Lab at Galloway HypnoLaus study: OSA effect on mortality US Preventive Services Task Force recommendations
More informationPositive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea
Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea Policy Number: Original Effective Date: MM.01.009 11/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO;
More informationIncreased Tongue Space. Option 1: Short Hook Single Point Midline Adjustment. turns the dsm world upside down! DDS TO MD COMMUNICATION
Insider MAGAZINE DENTAL SLEEP MEDICINE MARCH 2016 Issue 10 the new dreamtap Greater Adjustment Range Increased Tongue Space Custom-formed Soft Liners Superior Retention Option 1: Short Hook Single Point
More information(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 informationPrefabricated Oral Appliances for Obstructive Sleep Apnea
Medical Policy Manual Allied Health, Policy No. 36 Prefabricated Oral Appliances for Obstructive Sleep Apnea Next Review: May 2019 Last Review: April 2018 Effective: May 1, 2018 IMPORTANT REMINDER Medical
More informationA Winning Combination
The Physiologic Sleep Bite and the Micr0 2 Sleep Device A Winning Combination There is no doubt that using the best bite technique available will improve overall treatment success, but how important is
More informationSleep Medicine. Paul Fredrickson, MD Director. Mayo Sleep Center Jacksonville, Florida.
Sleep Medicine Paul Fredrickson, MD Director Mayo Sleep Center Jacksonville, Florida Fredrickson.Paul@mayo.edu DISCLOSURES No relevant conflicts to report. Obstructive Sleep Apnea The most common sleep
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 informationDr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012
Dr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012 Why screen of OSA prior to surgery? What factors increase the risk? When due to anticipate problems?
More informationMario 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 information18/06/2009 NZ Respiratory & Sleep Institute
Sleep Disorders in Primary Care - a personal view 18/06/2009 Andrew G Veale NZ Respiratory & Sleep Institute Abnormal Sleep Disorders of the initiation & maintenance of sleep (DIMS) Insomnia 1 o or 2 o
More informationNew Government O2 Criteria and Expert Panel. Jennifer Despain, RPSGT, RST, AS
New Government O2 Criteria and Expert Panel Jennifer Despain, RPSGT, RST, AS Lead Sleep Technologist, Central Utah Clinic Sleep Disorders Center; Provo, Utah Objectives: Review new government O2 criteria
More informationREVIEW ARTICLES INTRODUCTION
pii: jc-00111-16 http://dx.doi.org/10.5664/jcsm.6202 REVIEW ARTICLES The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients
More informationEffect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea
European Journal of Orthodontics 20 (1998) 293 297 1998 European Orthodontic Society Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea J. Lamont*, D. R. Baldwin**,
More informationUpper Airway Stimulation for Obstructive Sleep Apnea
Upper Airway Stimulation for Obstructive Sleep Apnea Background, Mechanism and Clinical Data Overview Seth Hollen RPSGT 21 May 2016 1 Conflicts of Interest Therapy Support Specialist, Inspire Medical Systems
More informationDental Sleep Medicine Basics
Dental Sleep Medicine Basics Written By: Patrick Tessier 2018 www.tap.wiki/ Page 1 of 8 INTRODUCTION Here are some basic aspect of Dental Sleep Medicine. This viewpoint is from an industry participant,
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 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 informationA First Line Treatment for Sleep Disordered Breathing
A First Line Treatment for Sleep Disordered Breathing Sleep Disordered Breathing Snoring & Obstructive Sleep Apnoea Snoring and Obstructive Sleep Apnoea (OSA) are caused by the airway narrowing or even
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 informationUPDATES IN SLEEP APNEA:
UPDATES IN SLEEP APNEA: CPAP,CPAP COMPLIANCE, & ALTERNATIVES MICHELLE ZETOONY, DO, FCCP, FACOI BOARD CERTIFIED PULMONARY, CRITICAL CARE, SLEEP & INTERNAL MEDICINE CLEARWATER, FL DISCLOSURE I have no conflicts
More informationUpdate on Obstructive Sleep Apnea (OSA) With Oral Appliance Therapy (OAT) for the Health Care Professional
Update on Obstructive Sleep Apnea (OSA) With Oral Appliance Therapy (OAT) for the Health Care Professional By Dr. Steven E. Todd, DMD, MaCSD, ABOI/ID Introduction and Objectives Discuss the impact of OSA
More informationSleep 101. Kathleen Feeney RPSGT, RST, CSE Business Development Specialist
Sleep 101 Kathleen Feeney RPSGT, RST, CSE Business Development Specialist 2016 Why is Sleep Important More than one-third of the population has trouble sleeping (Gallup) Obstructive Sleep Apnea Untreated
More informationUpper Airway Muscle Stimulation for Obstructive Sleep Apnea
Upper Airway Muscle Stimulation for Obstructive Sleep Apnea M. Safwan Badr, MD, MBA Chair, Department of Medicine, Wayne State University School of Medicine. Staff Physician, John D. Dingell VA Medical
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 informationShyamala 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 informationWAKE UP AND TAKE SNORING SERIOUSLY. TAP SCREENING TM SNORING VS. OBSTRUCTIVE SLEEP APNEA FACTS TO SLEEP ON. tapintosleep.com
TAP SYSTEM TM AN INTRODUCTION TO MODERN SLEEP CARE. TAP METHOD TM CPAP DOES NOT FIT ALL. Just like people, no two sleep experiences are the same. For a From predictor appliance to custom solutions, the
More informationLearning Objectives. And it s getting worse. The Big Picture. Dr. Roger Roubal
Learning Objectives How to screen for sleep apnea; questions to ask your patients Industry treatment guidelines; when to consider an oral appliance vs. a CPAP What goals/thresholds to set for successful
More informationTreatment of Obstructive Sleep Apnea (OSA)
MP9239 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes as shown below None Prevea360 Health Plan Medical Policy: 1.0 A continuous positive airway
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 informationSleep disordered breathing (SDB)
Update on Sleep Medicine II Sleep-disordered breathing Dirk Pevernagie Sleep Medicine Centre, Kempenhaeghe Foundation, Nl Dpt. Internal Medicine, Ghent University, Be ESRS Congress Tallinn Sleep disordered
More informationDid you know more than a million Australians suffer from severe sleep apnoea?
Did you know more than a million Australians suffer from severe sleep apnoea? Your comprehensive guide to curing sleep apnoea www.futuredental.com.au 1 Contents What is Obstructive Sleep Apnoea? 2 What
More informationYear 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 informationOventus: Innovators in Sleep Apnoea Treatment Investor lunch presentation Tattersall s Club, Brisbane
Oventus: Innovators in Sleep Apnoea Treatment Investor lunch presentation Tattersall s Club, Brisbane February 2018 Twitter: @OventusLtd About Oventus (ASX: OVN) Oventus is commercialising its Airway Technology
More informationBrian Palmer, D.D.S, Kansas City, Missouri, USA. April, 2001
Brian Palmer, D.D.S, Kansas City, Missouri, USA A1 April, 2001 Disclaimer The information in this presentation is for basic information only and is not to be construed as a diagnosis or treatment for any
More informationClinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015
SPECIAL ARTICLES JDSM http://dx.doi.org/10.15331/jdsm.4868 Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015 An American
More informationEffect of Three Different Mandibular Advancement Devices and Two Different Bite Techniques on the Resultant Sleep Metrics
Effect of Three Different Mandibular Advancement Devices and Two Different Bite Techniques on the Resultant Sleep Metrics Shamshudin (Sam) Kherani, DDS, FAGD, MICCMO Background It has been documented in
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 informationCan we do it? Yes we can! Managing Obstructive Sleep Apnea in Primary Care. Dr Andrea Loewen MD, FRCPC, DABIM (Sleep)
Can we do it? Yes we can! Managing Obstructive Sleep Apnea in Primary Care Dr Andrea Loewen MD, FRCPC, DABIM (Sleep) Financial disclosures No conflict of interest Objectives When and how to order home
More informationPre-Operative Services Teaching Rounds 11 March 2011
Pre-Operative Services Teaching Rounds 11 March 2011 Deborah Richman MBChB FFA(SA) Director Pre-Operative Services Department of Anesthesia Stony Brook University Medical Center, NY drichman@notes.cc.sunysb.edu
More informationQuestions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI?
Pediatric Obstructive Sleep Apnea Case Study : Margaret-Ann Carno PhD, CPNP, D,ABSM for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee April 2014. Facilitator s guide Part
More informationHealthy Sleep. Frederick Tolle, M.D., dabsm Community Health Network
Healthy Sleep Frederick Tolle, M.D., dabsm Community Health Network Adults should sleep 7 or more hours per night on a regular basis to promote optimal health. Getting less than 7 hours of sleep on average
More informationObstructive 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 informationTEST. SELECT. TREAT. Titration Tray Manual
TEST. SELECT. TREAT. Titration Tray Manual Manufacturer s Information Zephyr Sleep Technologies #102, 701 64th Ave. S.E. Calgary, Alberta, Canada T2H 2C3 Toll Free: 1.877.341.8814 Technical Support: 1.877.227.9832
More informationMedical Affairs Policy
Medical Affairs Policy Service: Sleep Disorder Treatment: Positive Airway Pressure Devices and Oral Appliances (CPAP, BPAP, BiPAP, BiPAP ST, BiPAP with backup, BiPAP -Auto SV, VPAP, VPAP Adapt, VPAP adapt
More informationInspire Therapy for Sleep Apnea
Inspire Therapy for Sleep Apnea Patient Guide Giving You the FREEDOM TO SLEEP Like Everyone Else Take Comfort. Inspire therapy can help. Inspire therapy is a breakthrough implantable treatment option for
More 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 informationMandibular repositioning appliance (MRA) therapy for snoring
Scientific investigations Effect of a Titration Polysomnogram on Treatment Success with a Mandibular Repositioning Appliance Fernanda R. Almeida, D.D.S. 1 ; Jonathan A. Parker, D.D.S. 2 ; James S. Hodges,
More informationASX Investor Presentation
ASX Investor Presentation Sydney, Australia Dr Peter Neustadt Executive Chairman and CEO November 2014 Copyright and registered trademark notice ASX Investor Presentation Page 0 Who we are SomnoMed Limited
More informationCauses 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 informationSnoring and Its Outcomes
Disclosures None Snoring and Its Outcomes Jolie Chang, MD Otolaryngology, Head and Neck Surgery University of California, San Francisco February 14, 2014 Otolaryngology Head Outline Snoring and OSA Acoustics
More informationPhysician Dentist Collaboration
Physician Dentist Collaboration Ronald S. Prehn, ThM, DDS Legal Perspective MD CAN LEGALLY MAKE PROPER DIAGNOSIS DDS CAN LEGALLY FABRICATE DENTAL SLEEP APPLIANCES Legal Perspective TWO PROFESSIONS WORK
More informationInspire. therapy for sleep apnea. Giving you the freedom to sleep like everyone else
Inspire therapy for sleep apnea Giving you the freedom to sleep like everyone else Take Comfort. Take Action. Inspire therapy can help. Here are some reasons people like you have chosen Inspire therapy
More informationToday, according to the American Academy of Sleep Medicine,
Precision Medicine in a Dental Sleep Practice Importance of better screening, more efficient clinical workflow and patient selection in dental sleep medicine by Dr. Shouresh Charkhandeh Today, according
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 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 informationCoding 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 informationAdvances in the Evaluation and Management of Adult OSA
Advances in the Evaluation and Management of Adult OSA Michelle Cao, DO Clinical Associate Professor Pulmonary, Critical Care, and Sleep Medicine Stanford University Conflict of Interest Disclosure I declare
More informationTongue Protrusion Strength in Arousal State Is Predictive of the Airway Patency in Obstructive Sleep Apnea
Tohoku J. Exp. Med., 2015, 236, 241-245 Tongue Protrusion Strength in Obstructive Sleep Apnea 241 Tongue Protrusion Strength in Arousal State Is Predictive of the Airway Patency in Obstructive Sleep Apnea
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 informationTOPIC: Continuing Coverage of CPAP Machines and Supplies for the Treatment of Obstructive Sleep Apnea
These documents are not used to determine benefits or reimbursement. Please reference the appropriate certificate or contract for benefit information. BLUE CROSS BLUE SHIELD of MI MEDICAL POLICY Enterprise:
More information3/13/2014. Home Sweet Home? New Trends in Testing for Obstructive Sleep Apnea. Disclosures. No relevant financial disclosures
2014 Big Sky Pulmonary Conference Home Sweet Home? New Trends in Testing for Obstructive Sleep Apnea Eric Olson, MD Associate Professor of Medicine Co-Director, Center for Sleep Medicine Mayo Clinic olson.eric@mayo.edu
More informationIndex. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acquired central hypoventilation syndrome, NPPV in children with, 475 Acute cardiogenic pulmonary edema, PAP therapy in, 394 395 Adaptive
More informationPremier Health Plan considers Oral Appliances for Obstructive Sleep Apnea (OSA) medically necessary for the following indications:
Premier Health Plan POLICY AND PROCEDURE MANUAL MP.063.PH - al Appliances for Obstructive Sleep Apnea This policy applies to the following lines of business: Premier Commercial Premier Employee Premier
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process
Quality ID #277: Sleep Apnea: Severity Assessment at Initial Diagnosis National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Management of Chronic Conditions 2019 COLLECTION
More informationBRUXISM ASSOCIATED WITH AIRWAY COMPROMISE. Night 1: Baseline Night 2: ResMed APAP Night 3: Occlusal Guard
The purpose of these case studies are to provide guidance on how to interpret the data included in the GEMPro reports. CASE STUDY 1: Bruxism Associated with Airway Compromise CASE STUDY # 1 BRUXISM ASSOCIATED
More informationJoel Reiter*, Bashar Zleik, Mihaela Bazalakova, Pankaj Mehta, Robert Joseph Thomas
Joel Reiter*, Bashar Zleik, Mihaela Bazalakova, Pankaj Mehta, Robert Joseph Thomas Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA *ומעבדת השינה הדסה עין כרם, ירושלים חיפפ ירושלים,
More informationPerioperative Management of Obstructive Sleep Apnea
Perioperative Management of Obstructive Sleep Apnea Charles W. Atwood Jr, MD, FCCP, FAASM Associate Professor of Medicine Director, Sleep Medicine Program, VA Pittsburgh Healthcare System; Sleep Medicine
More informationin China Shanghai Office Beijing Office (+86) (+86)
SLEEP Apnea in China Guide 2018-2019 Shanghai Office (+86) 21 2426 6400 Beijing Office (+86) 010 6464 0611 www.pacificprime.cn Follow us on WeChat t A comprehensive overview of sleep apnea Perhaps you
More informationSimple 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 informationA 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 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 informationIndex SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type.
549 SLEEP MEDICINE CLINICS Sleep Med Clin 1 (2007) 549 553 Note: Page numbers of article titles are in boldface type. A Abdominal motion, in assessment of sleep-related breathing disorders, 452 454 Adherence,
More information