Obstructive Sleep Apnea and COPD overlap syndrome. Financial Disclosures. Outline 11/1/2016
|
|
- Colleen Barton
- 6 years ago
- Views:
Transcription
1 Obstructive Sleep Apnea and COPD overlap syndrome Chitra Lal, MD, FCCP, FAASM Associate Professor of Medicine, Pulmonary, Critical Care, and Sleep, Medical University of South Carolina Financial Disclosures Grant support from Invado Pharmaceuticals, Jazz Pharmaceuticals and SCOR at MUSC Consultant for Ikaria Pharmaceuticals Outline Overview of Sleep Apnea Shared Symptoms of COPD and OSA Epidemiologic Data on COPD-OSA overlap Why OSA diagnosis matters in COPD Special Considerations for OSA treatment in COPD 1
2 Epidemiology of Obstructive Sleep Apnea Prevalence of moderate to severe Obstructive Sleep Apnea (OSA) is high and increases with age (1): - 10% in men and 3% in women between years of age - 17% in men and 9% in women between years of age OSA is seen in a large proportion of patients who have hypertension, coronary artery disease, neurocognitive deficits, stroke and atrial fibrillation (2) (1) Peppard PE et al, Am J Epidemiol 2013; May 1;177(9): (2) Lattimore JD et al, J Am Coll Cardiol 2003;41: Apnea: 90% in airflow for > 10 seconds Hypopnea (AASM definition): in airflow by 30% for 10 seconds with 3% desaturation or arousal RERA: in airflow with an arousal which does not met the definition of apnea/hypopnea Definitions Medicare definition of hypopnea: in airflow by 30% for 10 seconds with 4% desaturation AHI: apnea-hypopnea index (apneas + hypopneas/hour of sleep) RDI: respiratory disturbance index (apneas + hypopneas + RERA s/hour of sleep) Obstructive Apnea on Polysomnography Image courtesy emedecine.medscape.com 2
3 OSA in Adults Mild OSA: AHI/RDI 5 and <15/hour Moderate OSA: AHI/RDI 15 to 30/hour Severe OSA: AHI/RDI >30/hour Treatment for mild OSA with symptoms or moderate OSA with/without symptoms Patients at high risk for OSA (1): - Obesity (BMI > 35) - Congestive Heart Failure - Atrial Fibrillation - Refractory hypertension - Type 2 Diabetes - Nocturnal Dysrhythmias - Stroke - Pulmonary Hypertension - High-risk driving populations - Preoperative for bariatric surgery Physical exam findings consistent with OSA: - Mallampati score 3 or 4 - Macroglossia - BMI 30 - Tonsillar hypertrophy - Elongated uvula - High arched palate - Large neck circumference Screen for OSA Clinical features of OSA: - Daytime Sleepiness - Non-restorative sleep - Witnessed apneas - Snoring - Insomnia - Memory loss - Lack of concentration - Mood changes - Morning headaches - Polycythemia - Hypercapnia - Nocturia - Irritability - Decreased libido Sleep Study (1) LJ Epstein et al, JCSM, 2009 Cardinal symptoms of COPD and OSA Mieczkowski B et al, Int J Chron Obstruct Pulmon Dis
4 STOP-BANG questionnaire Snoring Tiredness Observed you stop breathing Blood Pressure BMI > 35 Age > 50 Neck Circumference > 40 cm Gender Male High Risk : Yes to 3 items Refer for sleep testing Chung F. et al, Anesthesiology, May 2008 Johns MW, Sleep 1991 Sleep Apnea Clinical Score Components: Neck Circumference, hypertension, habitual snoring and partner reports of nocturnal choking/gasping Sleep Apnea Clinical Score (SACS) of < 5 had a likelihood ratio of 0.25 ( 95% CI ) and a post-test probability of 17% for having OSA SACS of > 15 had a likelihood ratio of 5.17 (95% CI ) and a posttest probability of 81% for having OSA Flemons WW et al, AJRCCM
5 Sleep Apnea Clinical Score Flemons WW et al, AJRCCM 1994 Predictor of OSA in patients with COPD SACS outperformed Berlin Questionnaire and Epworth Sleepiness Score in predicting OSA in COPD patients in one study, with area under the curve 0.82, 95% CI , p = 0.02 Faria AC et al, Int J Gen Med 2015 Authors Chaouat 265 Resta 213 De Miguel 193 Number of patients Sanders 1132 Zamarrón 300 Bednarek 676 O Brien 120 Sample Group Prevalence Sleep Laboratory Sleep Laboratory Sleep Laboratory General population Sleep Laboratory General population Sleep Laboratory OSAS 11% OSAS 13.6% OSAS 28.5% COPD 14% OSAS 15.4% OSAS 9.2% OSAS 11.9% Prevalence of OSA-COPD Overlap Syndrome 5
6 McNicholas, WT, Impact of Sleep on Respiration, Chest 2000 A) Forces affecting thoracic function and FRC in supine sleep B) Limitation of diaphragm excursion with hyperinflation Mieczkowski B et al, Int J Chron Obstruct Pulmon Dis 2014 COPD McSharry DG et al, Sleep Quality in COPD, Respirology, July 2012 Daytime Hypoxemia REM sleep 6
7 Factors in COPD that influence OSA risk Promoting factors for OSA Oxygen desaturation Protective factors against OSA Low BMI Rostral fluid shift when supine Cigarette smoking Decreased REM sleep Medications such as theophylline Steroids Pathogenesis of COPD-OSA Overlap Syndrome Owens RL et al, Respir Care, 10/2010 Prognosis of COPD-OSA Overlap Syndrome Owens RL et al, Respir Care, 10/2010 7
8 When should COPD patients be screened for OSA? Waking hypercapnia out of proportion to the severity of airflow obstruction Moderate to severe nocturnal desaturation Pulmonary and systemic hypertension Heart Failure Lower tidal volume and higher respiratory rate seen in overlap syndrome patients (1) (1) Radwan L et al, Eur Respir J April 1995 Diagnosis of OSA in COPD patients Overnight oximetry: Assessment of the desaturation index can help to screen patients with a high pre-test probability of OSA (1) Utility of oximetry as a screening tool for OSA declines in moderate to severe COPD (2) Nocturnal end tidal/transcutaneous CO2 In-laboratory polysomnography is the gold standard (1) Bogdan M et al, Maedica Sept 2013 (2) Scott AS et al, Can Respir J 2014 Characteristics of nocturnal oxygen desaturation In COPD patients Occurs mainly in REM sleep Night to night variability Awake SO2 does not predict nocturnal oxygen desaturation Statistically significant correlation between nocturnal desaturation and daytime hypoxemia and hypercarbia In OSA patients Episodic intermittent oxygen desaturation which recovers with end of the apneic event More pronounced in REM sleep Nocturnal variability related to %REM and %supine sleep 8
9 Intermittent Hypoxemia pattern in OSA Bogdan M et al, Maedica Sept 2013 Nocturnal Oximetry and heart rate in COPD Overnight hypnogram showing continued oxygen desaturation in REM sleep despite positive airway pressure titration in COPD-OSA overlap syndrome Mieczkowski B et al, Int J Chron Obstruct Pulmon Dis
10 Types of Sleep Studies Type I: in-lab attended polysomnogram (gold standard, 7 channels) Type II: comprehensive portable unattended polysomnogram ( 7 channels) Type III: modified portable sleep apnea testing (cardiorespiratory sleep studies, 4-7 channels) Type IV: 1 or 2 channels, oximetry is 1 channel Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Sleep 1994 Types of sleep studies Diagnostic PSG Split PSG Titration PSG AHI 40/hour or 20-40/hour with low SO2 Physician specified AHI Indications for Portable Monitoring PM is done only in conjunction with a comprehensive sleep evaluation PM is only indicated in patients with a high pretest probability of moderate to severe OSA No PM in patients with co-morbid conditions or other sleep disorders PM is NOT for screening asymptomatic individuals PM measures AHI/total recording time, so underestimates AHI Collop, N. et al, JCSM, October
11 Treatment of OSA Positive Airway Pressure Oral appliances Upper airway surgery New treatments Adjunctive therapy -CPAP -BIPAP -BIPAP ST -APAP -Tongue retaining device - Mandibular repositioning device -UPPP -Adenotonsillectomy -Genioglossus advancement -Hyoid suspension -Mandibular advancement -Tongue reduction -Maxillomandibular advancement -Tracheostomy -Hypoglossal nerve stimulation -Provent -Bariatric surgery -Leukotriene inhibitors -Nasal steroids AASM guidelines on Positive Airway Pressure treatment CPAP is indicated for moderate to severe OSA and is optional for mild OSA BIPAP can be used where high pressure is needed with difficulty on exhalation and with coexisting central hypoventilation (1) Auto-titrating CPAP should not be used in patients with comorbidities such as COPD and congestive heart failure (2) (1) Kushida CA et al, Sleep 2006 (2) Morgenthaler TI et al, Sleep 2008 Nocturnal oxygen in Overlap Syndrome Oxygen (1): improves pulmonary hypertension Shortens sleep onset latency Increases REM and N3 sleep Decreases nocturnal arousals Careful titration of oxygen flow rate to avoid hypercapnia Recommended as adjunctive treatment to correct hypoxemia after optimal titration of positive airway pressure (1) C Zamarron et al, Int Journal of COPD,
12 Other treatment considerations Bronchodilators: theophylline, ipratropium, tiotropium Avoid hypnotics and alcohol Protriptyline as a REM suppressant Lung volume reduction surgery (1): improved total sleep time, sleep efficiency, mean and lowest nocturnal SO2 in the National Emphysema Treatment Trial (1) Krachman SL et al, Chest 2005 BIPAP in COPD-OSA Overlap Syndrome No evidence of survival benefit in the overlap syndrome BIPAP may improve gas exchange, dyspnea, quality of life, and decrease hospitalizations in chronic stable, hypercapnic COPD (1) (1) Duiverman ML et al, Respir Care, 2011 Treatment options for COPD-OSA overlap syndrome Jen R et al, Can Respir J
13 Conclusions Better epidemiologic studies are needed to determine the exact prevalence of COPD-OSA overlap syndrome COPD-OSA overlap syndrome is associated with significant adverse consequences and should be aggressively treated 13
Polysomnography (PSG) (Sleep Studies), Sleep Center
Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)
More 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 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 informationEvaluation, Management and Long-Term Care of OSA in Adults
Evaluation, Management and Long-Term Care of OSA in Adults AUGUST 2015 Providing diagnostic tools and therapies that are evidence-based is a key part of a successful sleep practice. This resource outlines
More informationSleep 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 information11/19/2012 ก! " Varies 5-86% in men 2-57% in women. Thailand 26.4% (Neruntarut et al, Sleep Breath (2011) 15: )
Snoring ก Respiratory sound generated in the upper airway during sleep that typically occurs during inspiration but may occur during expiration ICSD-2, 2005..... ก ก! Prevalence of snoring Varies 5-86%
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 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 informationOSA and COPD: What happens when the two OVERLAP?
2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine
More information(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 informationIEHP considers the treatment of obstructive sleep apnea (OSA) medically necessary according to the criteria outlined below:
: Positive Airway Pressure, Oral Appliances, and Surgical Interventions Policy: Obstructive sleep apnea (OSA) is characterized by an interruption of breathing during sleep most commonly due to extra or
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: 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 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 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 information(HST) (95806, G0398, G0399)
95800 Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory analysis (e.g. by airflow or peripheral arterial tone), and sleep time 95801 Sleep study, unattended,
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 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 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 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 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 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 informationPORTABLE OR HOME SLEEP STUDIES FOR ADULT PATIENTS:
Sleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing MP9132 Covered Service: Prior Authorization Required: Additional
More 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 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 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 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 DISORDERED BREATHING AND CHRONIC LUNG DISEASE: UPDATE ON OVERLAP SYNDROMES
SLEEP DISORDERED BREATHING AND CHRONIC LUNG DISEASE: UPDATE ON OVERLAP SYNDROMES ROBERT OWENS, MD ASSISTANT CLINICAL PROFESSOR OF MEDICINE UNIVERSITY OF CALIFORNIA AT SAN DIEGO LA JOLLA, CA Robert L. Owens,
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 informationObstructive Sleep Apnea: Effective Intervention & Care
Obstructive Sleep Apnea: Effective Intervention & Care Provider Training Modules Jonathan Freudman, MD 2016 Resonea Inc. 2016 Resonea Inc. Module II: Confirming the Clinical Diagnosis of OSA Module II:
More informationBasics of Polysomnography. Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC
Basics of Polysomnography Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC Basics of Polysomnography Continuous and simultaneous recording
More informationSleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing
Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing MP9132 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes as indicated
More 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 informationPolysomnography and Sleep Studies
Polysomnography and Sleep Studies Policy Number: Original Effective Date: MM.02.016 09/14/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 05/01/2014 Section: Medicine Place(s)
More 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 informationDr. Karan Madan Senior Resident
SLEEP DISORDERED BREATHING DIAGNOSIS & MANAGEMENT Dr. Karan Madan Senior Resident Department of Pulmonary medicine Sleep disordered breathing (SDB) Definition- Sleep-disordered breathing (SDB) is present
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 informationDiagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome Policy Number: 2.01.18 Last Review: 9/2018 Origination: 1/2006 Next Review: 1/2019 Policy Blue Cross and Blue Shield of Kansas City
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 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 informationPEDIATRIC SLEEP GUIDELINES Version 1.0; Effective
MedSolutions, Inc. Clinical Decision Support Tool Diagnostic Strategies This tool addresses common symptoms and symptom complexes. Requests for patients with atypical symptoms or clinical presentations
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 informationPolysomnography - Sleep Studies
Polysomnography - Sleep Studies Policy Number: Original Effective Date: MM.02.016 09/14/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST 12/21/2012 Section: Medicine Place(s) of Service:
More informationObstructive Sleep Apnea In The Perioperative Setting. Christopher Karcher, MD Diplomate, ABPN Medical Director The Neuroscience Sleep Center
Obstructive Sleep Apnea In The Perioperative Setting Christopher Karcher, MD Diplomate, ABPN Medical Director The Neuroscience Sleep Center Obstructive Sleep Apnea Cyclic collapse of upper airway tissues
More informationQUESTIONS FOR DELIBERATION
New England Comparative Effectiveness Public Advisory Council Public Meeting Hartford, Connecticut Diagnosis and Treatment of Obstructive Sleep Apnea in Adults December 6, 2012 UPDATED: November 28, 2012
More 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 informationCHANGING 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
More informationPEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA)
PEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA) DEFINITION OSA Inspiratory airflow is either partly (hypopnea) or completely (apnea) occluded during sleep. The combination of sleep-disordered breathing with daytime
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 informationDiagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively
More informationSleep Management Solutions, Inc. A CareCentrix Company
Sleep Management Solutions, Inc. A CareCentrix Company Criteria for Determining the Medical Necessity for the Diagnosis and Treatment of Sleep Disordered Breathing in Adults and Children Date: 06/21/2017
More informationOSA OBSTRUCTIVE SLEEP APNEA
OSA OBSTRUCTIVE SLEEP APNEA Anna-Marie Wellins DNP, ANP-C Objectives Describe consequences of Obstructive Sleep Apnea Outline sleep facts/stages Define OSA and clinical symptoms Describe Pathophysiology
More 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 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 Disclosres: None Chronic Sleep Deprivation (0 v 4 v 6 v 8 hrs)
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 informationAlaska Sleep Education Center
Alaska Sleep Education Center The 3 Types of Sleep Apnea Explained: Obstructive, Central, & Mixed Posted by Kevin Phillips on Jan 28, 2015 6:53:00 PM Sleep apnea is a very common sleep disorder, affecting
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 informationIs CPAP helpful in severe Asthma?
Is CPAP helpful in severe Asthma? P RAP UN KI TTIVORAVITKUL, M.D. PULMONARY AND CRITICAL CARE DIVISION DEPARTMENT OF MEDICINE, PHRAMONGKUTKLAO HOSPITAL Outlines o Obstructive sleep apnea syndrome (OSAS)
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 informationEvaluation of the Brussells Questionnaire as a screening tool
ORIGINAL PAPERs Borgis New Med 2017; 21(1): 3-7 DOI: 10.5604/01.3001.0009.7834 Evaluation of the Brussells Questionnaire as a screening tool for obstructive sleep apnea syndrome Nóra Pető 1, *Terézia Seres
More informationAHA Sleep Apnea and Cardiovascular Disease. Slide Set
AHA 2008 Sleep Apnea and Cardiovascular Disease Slide Set Based on the AHA 2008 Scientific Statement Sleep Apnea and Cardiovascular Disease Virend K. Somers, MD, DPhil, FAHA, FACC Mayo Clinic and Mayo
More informationObstructive 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
More informationAn update on childhood sleep-disordered breathing
An update on childhood sleep-disordered breathing แพทย หญ งวนพร อน นตเสร ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร มหาว ทยาล ยสงขลานคร นทร Sleep-disordered breathing Primary snoring Upper airway resistance syndrome
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 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 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 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 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 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 informationObstructive sleep apnea (OSA) is a common disorder affecting
SPECIAL ARTICLE Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine
More informationMEDICAL POLICY. SUBJECT: POSITIVE AIRWAY PRESSURE DEVICES: CPAP, BiPAP, APAP AND NONINVASIVE POSITIVE PRESSURE VENTILATORS
MEDICAL POLICY SUBJECT: POSITIVE AIRWAY PRESSURE DEVICES: CPAP, BiPAP, APAP AND (DELETED: 07/16/09-04/28/11) PAGE: 1 OF: 9 If a product excludes coverage for a service, it is not covered, and medical policy
More informationObstructive sleep apnea (OSA) is the periodic reduction
Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis 1 Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto,
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 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 informationMEDICAL POLICY. SUBJECT: POSITIVE AIRWAY PRESSURE DEVICES: CPAP, BiPAP, APAP AND NONINVASIVE POSITIVE PRESSURE VENTILATORS
MEDICAL POLICY SUBJECT: POSITIVE AIRWAY PRESSURE DEVICES: CPAP, BiPAP, APAP AND (DELETED: 07/16/09-04/28/11) PAGE: 1 OF: 10 If a product excludes coverage for a service, it is not covered, and medical
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 informationPolicy Specific Section: October 1, 2010 January 21, 2013
Medical Policy Bi-level Positive Airway Pressure (BPAP/NPPV) Type: Medical Necessity/Not Medical Necessity Policy Specific Section: Durable Medical Equipment Original Policy Date: Effective Date: October
More informationPediatric Sleep-Disordered Breathing
Pediatric Sleep-Disordered Breathing OSA in infants and young children is generally characterized by partial, persistent obstruction of the upper airway Continuum Benign primary snoring Upper-airway resistance
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 informationBi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients
Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific
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 informationMedicare C/D Medical Coverage Policy. Respiratory Assist Devices for Obstructive Sleep Apnea and Breathing Related Sleep Disorders
Medicare C/D Medical Coverage Policy Respiratory Assist Devices for Obstructive Sleep Apnea and Breathing Related Sleep Disorders Origination: June 26, 2000 Review Date: January 18, 2017 Next Review January,
More informationObstructive sleep apnea : recent advances and future trends. Ajay Handa Dept of Pulmonary Medicine
Obstructive sleep apnea : recent advances and future trends Ajay Handa Dept of Pulmonary Medicine Sleep physiology Historical aspects Clinical profile Polysomnography Management Recent advances Future
More informationCLINICAL GUIDELINES. Sleep Apnea And Treatment. Version Effective May 1, 2018
CLINICAL GUIDELINES Sleep Apnea And Treatment Version 6.0.2018 Effective May 1, 2018 evicore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom
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 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 informationCommon Pulmonary Problems. Diana Coffa, MD Residency Program Director UCSF Department of Family and Community Medicine
Common Pulmonary Problems Diana Coffa, MD Residency Program Director UCSF Department of Family and Community Medicine Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist Obstructive
More informationMedical Affairs Policy
Medical Affairs Policy Service: Sleep Disorder Testing (Polysomnogram, Split Night Polysomnogram, Sleep Study, Multiple Sleep Latency Test (MSLT), Maintenance of Wakefulness Testing (MWT), Home Sleep Apnea
More informationJill D. Marshall. Professor Boye. MPH 510: Applied Epidemiology. Section 01 Summer A June 28, 2013
1 Obstructive Sleep Apnea: Capstone Screening Project By Jill D. Marshall Professor Boye MPH 510: Applied Epidemiology Section 01 Summer A 2013 June 28, 2013 2 Sufficient sleep should be considered a vital
More 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 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 information2/24/2016. Disclosures. OSA: Common, Increasing, and Underrecognized!
Management of Documented or Suspected Obstructive sleep apnea (OSA) in Patients Undergoing n-cardiac Surgery Eric J. Olson, MD Center for Sleep Medicine, Mayo Clinic Rochester 2016 Big Sky Pulmonary Conference
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Diagnosis and Medical Management of OSA Syndrome Page 1 of 37 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Diagnosis and Medical Management of Obstructive Sleep
More informationCLINICAL GUIDELINES. Sleep Apnea and Treatment. Version Effective February 15, 2019
CLINICAL GUIDELINES Sleep Apnea and Treatment Version 1.0.2019 Effective February 15, 2019 evicore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and
More informationSuchada Sritippayawan, MD Div. Pulmonology & Critical Care Dept. Pediatrics, Faculty of Medicine
Management of pediatric OSA Suchada Sritippayawan, MD Div. Pulmonology & Critical Care Dept. Pediatrics, Faculty of Medicine Chulalongkorn University Treatment modalities Surgery Medications NIV during
More informationSLEEP UPDATE 2008 SLEEP HYPNOGRAM. David Claman, MD UCSF Sleep Disorders Center
SLEEP UPDATE 2008 SLEEP HYPNOGRAM David Claman, MD UCSF Sleep Disorders Center Insomnia Case A 40 year old man c/o insomnia at sleep onset. He worries about sleep at night, and takes 2-3 hrs to fall asleep.
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 information