Factors Influencing Sleep Time With Oxygen Saturation Below 90% in Sleep-Disordered Breathing
|
|
- Sabrina Hutchinson
- 6 years ago
- Views:
Transcription
1 The Laryngoscope VC 2014 The American Laryngological, Rhinological and Otological Society, Inc. Factors Influencing Sleep Time With Oxygen Saturation Below 90% in Sleep-Disordered Breathing Asli Bostanci, MD; Murat Turhan, MD; Selen Bozkurt, MSc Objectives/Hypothesis: To determine factors influencing sleep time with oxygen saturation below 90% (ST 90 ) in a population referred to a tertiary sleep center for assessment of possible sleep-disordered breathing (SDB). Study Design: Retrospective review of demographic and polysomnographic data of 731 consecutive patients with suspected SDB. Methods: Bivariate correlation analyses were performed, and Spearman rho coefficients were calculated. Variables with a marginal association with ST 90 (P <.05) in the bivariate analysis were included into the multiple regression analysis. Results: The distributions of SDB were as follows: normal/simple snoring, 18.2%; mild obstructive sleep apnea (OSA), 25.6%; moderate OSA, 17.4%; and severe OSA, 38.9%. The univariate analysis revealed a significant correlation between ST 90 and age (r ), body mass index (BMI) (r ), arousal index (r ), apnea-hypopnea index (AHI) (r ), mean oxygen saturation (SaO 2 )(r ), and mean O 2 desaturation (r ) (P <.001 for all parameters). In multiple regression analysis, age (P <.001), BMI (P 5.040), male gender (P 5.001), AHI (P <.001), mean SaO 2 (P <.001), and mean O 2 desaturation (P <.001) were found to be independent parameters influencing ST 90. Furthermore, these parameters explained a significant proportion of variance in ST 90 (R , F (6, 729) , P <.001). Although there was a strong correlation between AHI and ST 90 (r , P <.001), a large variation of ST 90 values was observed, especially within the severe OSA group. Conclusions: The study results provide supporting evidence that patients with similar AHI may have quite different values of ST 90, and thereby hypoxia. The stratification of patients with OSA according to AHI combined with ST 90 may allow better identification of prognostic information. Key Words: Obstructive sleep apnea, sleep time with oxygen saturation below 90%, hypoxia. Level of Evidence: 4 Laryngoscope, 125: , 2015 INTRODUCTION Obstructive sleep apnea (OSA) is a common syndrome characterized by repetitive episodic collapse of the upper airway and intermittent hypoxia during sleep. Disturbances in gas exchange lead to oxygen desaturation, hypercapnia, and sleep fragmentation, which contribute to the consequences of OSA including metabolic, neurocognitive, and cardiovascular effects. 1 The upper airway caliber is determined by afferent sensory input to the brainstem respiratory centers and efferent motor neural output to the upper airway structures. 2 Reestablishing airway patency in OSA is achieved due to arousal. The mucosal sensory receptor impairment in the upper airway might cause a delayed end-apneic arousal and extension of the apnea duration. 3 The longer the apnea duration is, the deeper the hypoxia becomes. The severity of OSA is stratified by the apneahypopnea index (AHI), which represents only the frequency of apneas and hypopneas per hour of sleep regardless of duration and morphology. 4 AHI does not completely reflect the pathophysiological characteristics or severity of hypoxia. 5 Moreover, patients with a similar AHI may have different clinical symptoms and outcomes. 6,7 Total sleep time with oxygen saturation below 90% (ST 90 ) is an objective parameter that can be easily obtained from polysomnography (PSG). In recent years, ST 90 has gained increasing attention in OSA research because of its direct relation to the duration and severity of hypoxia In the current study, we aimed to determine factors influencing ST 90 in the population referred to a tertiary sleep center for assessment of possible sleep-disordered breathing (SDB). From the Department of Otolaryngology Head and Neck Surgery (A.B., M.T.), and the Department of Biostatistics and Medical Informatics (S.B.), Akdeniz University School of Medicine, Antalya, Turkey. Editor s Note: This Manuscript was accepted for publication August 29, The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Asli Bostanci, MD, Akdeniz University Hospital, H Blok K: 1, 07070, Konyaalti, Antalya, Turkey. draslibostanci@gmail.com DOI: /lary MATERIALS AND METHODS Study Design and Patients From November 2011 to February 2014, a total of 731 consecutive patients with suspected SDB, who underwent complete polysomnographic evaluation at our accredited sleep disorders center, were included into this retrospective analysis. Demographic and polysomnographic data as well as information regarding age, gender, body mass index (BMI), total sleep time, supine sleep time, percentage of supine sleep position,
2 nonsupine (lateral and prone) sleep time, percentage of nonsupine sleep position, sleep efficiency, sleep latency, arousal index, AHI, AHI supine, AHI rapid eye movement (AHI REM ), AHI non rapid eye movement (AHI NREM ), severity of SDB, longest apnea duration, mean obstructive apnea duration, total apnea duration, lowest O 2 saturation (SaO 2 ), mean SaO 2, mean O 2 desaturation, oxygen desaturation index (ODI), ST 90, and percentage of cumulative time with oxygen saturation below 90% (CT 90 ) were all recorded following institutional review board approval. Patients were excluded if they had central sleep apnea syndrome, previous treatment for SDB by continuous positive airway pressure, surgery, and/or oral device, age <18 or >70 years, serious cardiovascular disease, chronic obstructive pulmonary disease, asthma, neuropathy or active neurological disease, medications known to affect peripheral nerves, or malignancy. PSG (Compumedics E Series Profusion; Compumedics, Abbotsford, Victoria, Australia) was scored manually based on American Academy of Sleep Medicine 2007 criteria. 4 Apnea was defined as cessation of airflow for at least 10 seconds with continued effort (obstructive) or lack of effort (central) to breathe. Hypopnea was defined as a >50% decrease in a valid measure of airflow without a requirement for associated oxygen desaturation or arousal, and with a lesser airflow reduction in association with oxygen desaturation of >3%, or an arousal for at least 10 seconds. AHI was defined as the number of apnea and hypopnea occurrences per hour. An AHI of <5 was considered as normal or simple snoring, 5 to 15 as mild OSA, 15 to 30 as moderate OSA, and >30 as severe OSA. Statistical Analysis The primary outcome was the determination of factors influencing the ST 90. We expressed data as mean, standard deviation, median, range, and interquartile range for continuous variables. We reported binary variables as counts and percentages. First, bivariate correlation analyses were performed to assess relationships between ST 90 and other variables. Because normal distribution assumptions were not met, Spearman rho coefficients were calculated. The Mann-Whitney U test was utilized to evaluate the statistical significance of differences of ST 90 between the gender groups. After checking for multicollinearity (variance inflation factor < 5) and autocorrelation (Durbin-Watson test), explanatory variables with a marginal association with the ST 90 (P <.05) in the bivariate analysis were included in the multiple regression analysis. Stepwise regression was used to select the model that best explained the relationship between trans-st 90 and the change in explanatory variables. All P values were two-sided, with the level of significance set at <.05. All statistical analyses were performed by a professional biostatistician using IBM SPSS Statistics 20 software (IBM Corp., Armonk, NY). RESULTS Table I presents the characteristics of the patients. The median age was 48 years (range, years), and most patients were male (78.4%). The distributions of severity of SDB were as follows: normal/simple snoring, 18.2%; mild OSA, 25.6%; moderate OSA, 17.4%; and severe OSA, 38.9%. The median AHI, AHI supine, AHI REM, AHI NREM, arousal index, and ODI were 19, 36.7, 20.2, 18.6, 22.1, and 14 events/hour, respectively. The median oxymetric values of patients were as follows: lowest SaO 2, 83%; mean SaO 2, 95%; mean O 2 desaturation, 6%; longest apnea duration, 41.8 seconds; total apnea duration, 26.7 minutes; ST 90, 7 minutes; and CT 90, 1.8%. Table II presents univariate and multivariate linear regression analysis of factors influencing ST 90. The univariate analysis revealed a significant correlation between ST 90 and age (r ), BMI (r ), arousal index (r ), AHI (r ), mean SaO 2 (r ), and mean O 2 desaturation (r ), (P <.001 for all parameters). Furthermore, there was a significant, but weak, positive correlation between supine sleep position and ST 90 (r , P 5.008), and a significant, but quite weak, negative correlation between nonsupine sleep position and ST 90 (r , P 5.009). However, in multiple linear regression analysis, age (P <.001), BMI (P 5.040), male gender (P 5.001), AHI (P <.001), mean SaO 2 (P <.001), and mean O 2 desaturation (P <.001) remained to be independent parameters influencing ST 90 after adjustment for other confounders. Furthermore, these parameters explained a significant proportion of variance in ST 90 (R , F (6, 729) , P <.001). In addition, although there was a strong correlation between AHI and ST 90, a great variation of ST 90 values was observed, especially within the severe OSA group (Fig. 1). DISCUSSION OSA is characterized by episodic obstructions of airflow during sleep, with repetitive oscillations in oxyhemoglobin saturation. Conventionally, it was considered to be an anatomical pathology, because patients with OSA mostly have a narrow upper airway due to either increased soft tissue surrounding the airway or restricted craniofacial bone structure. 12,13 However, OSA can be encountered in patients with a normal anatomy, but may not be observed in patients with a narrow upper airway. 14 Currently, there is increasing evidence supporting that respiratory instability, low lung volume, low arousal threshold, and impaired neural regulation of breathing are significant contributors to the pathogenesis of apneas and hypopneas. 1 Regardless of underlying etiology, episodic collapse of the upper airway leads to chronic intermittent hypoxia (CIH), a hallmark of OSA, which triggers oxidative stress and chronic inflammation. 15,16 Consequently, all these pathophysiological processes give rise to detrimental effects on cardiovascular, neurocognitive, and metabolic functions. 1 The gold standard test for the diagnosis of OSA is the overnight PSG, with the primary outcome measure of AHI, which only indicates the number of apneas and hypopneas per hour. 4 However, AHI is incapable of reflecting the actual duration and severity of hypoxia, and disease outcome. Patients with similar AHI could have different cessation of breathing and oxygen desaturation characteristics regarding the duration and depth of events. These differences mostly affect the symptoms and consequences of the disorder. Mediano et al. reported that patients with excessive daytime sleepiness (EDS) had worse nocturnal oxygenation indices and longer apnea duration than those without EDS, despite the 1009
3 TABLE I. Characteristics of Patients. Variables No. (%) Median [Range], {IQR} Mean 6 SD Age, yr 48 [20 70], {16} Body mass index, kg/m [ ], {5.9} Gender, no. (%) Male 573 (78.4) Female 158 (21.6) Total sleep time, min 393 [ ], {70} Sleep efficiency, % 88.2 [ ], {12.7} Sleep latency, min 17.5 [1 175], {20} Arousal index, events/hr 22.1 [ ], {35.9} AHI, events/hr 19.0 [0 115], {39.0} AHI supine, events/hr 36.7 [0 120], {55.3} AHI REM, events/hr 20.2 [0 112], {44.3} AHI NREM, events/hr 18.6 [0 115], {40.8} Severity of sleep-disordered breathing, no. (%) Normal/simple snoring 133 (18.2) Mild OSA 187 (25.6) Moderate OSA 127 (17.4) Severe OSA 284 (38.9) Longest apnea duration, s 41.8 [ ], {34.8} Mean obstructive apnea duration, s 19.6 [0 55.4], {9.5} Total apnea duration, min 26.7 [ ], {83.3} Lowest SaO 2,% 83 [38 96], {12} Mean SaO 2,% 95 [88 99], {2} Mean O 2 desaturation, % 6 [2 26], {4} ODI, events/hr 14.0 [ ], {27.0} ST 90, min 7.0 [0 427], {40} CT 90,% 1.8 [0 93], {10} AHI 5 apnea hypopnea index; CT 90 5 percentage of cumulative sleep time with oxygen saturation below 90%; IQR 5 interquartile range; NREM 5 non rapid eye movement; ODI 5 oxygen desaturation index; OSA 5 obstructive sleep apnea; REM 5 rapid eye movement; SaO 2 5 O 2 saturation; SD 5 standard deviation; ST 90 5 total sleep time with oxygen saturation below 90%. fact that neither the AHI, arousal indices, nor overall sleep architecture were significantly different between groups. 6 In a study evaluating the validity of a new index considering factors such as the duration and degree of hypoxia the so called integrated area of desaturation (IAD) Asano et al. reported that patients who experienced cardiovascular events had significantly higher IAD regardless of AHI. 7 Recently, in a similar TABLE II. Univariate and Multivariate Linear Regression Analysis of Factors Influencing Sleep Time With Oxygen Saturation Below 90%. Univariate Analysis Multiple Linear Regression Analysis Variables Median (IQR) r P Coefficients 95% CI P Age, yr 48 (16) < to <.001 Body mass index, kg/m (5.9) < to Gender, male/female, no. (%) 9 (49)/3 (17) < to Arousal index, events/hr 22.1 (35.9) < AHI, events/hr 19 (39) < to <.001 Mean SaO 2, % 95 (2) < to <.001 Mean O 2 desaturation, % 6 (4) < to <.001 Supine sleep position, % 43.7 (41.4) Nonsupine sleep position, % 56.4 (41.7) % CI 5 95% confidential interval; AHI 5 apnea-hypopnea index; IQR 5 interquartile range; SaO 2 5 O 2 saturation. 1010
4 Fig. 1. Distributions of sleep time with oxygen saturation below 90% (ST 90 ) values within different apnea-hypopnea index (AHI) severity categories. OSA 5 obstructive sleep apnea. study with a median follow-up time of 183 months, Kulkas et al. reported that despite there being no significant differences in AHI, patients with higher duration of obstruction and desaturation had increased mortality. 5 CIH is usually defined as repeated episodes of hypoxia interspersed with periodic reoxygenations. 17 Currently, there is no universally accepted quantitative clinical test to measure the intensity and/or severity of CIH due to the lack of a more precise definition. The ST 90 is an objective parameter that represents the duration of nocturnal hypoxia. Li et al. 8 first investigated the clinical value of ST 90 in the evaluation of CIH in patients with OSA and demonstrated that the correlation coefficients of ST 90 with AHI and with the Epworth Sleepiness Scale were both much higher than those of the lowest SaO 2. Later, Li and Jin noted that ST 90 was strongly correlated with AHI and total apnea duration (r and 0.776, respectively). 9 Recently, Zhang et al. demonstrated that after adjustment for BMI and other cardiovascular risk factors, the ST 90 was the strongest independent predictor of high-sensitivity C- reactive protein elevation, which is known to be associated with the severity of OSA. 10 They concluded that the severity of OSA should be stratified by combining AHI and nocturnal CIH variables, such as ST 90 and ODI, instead of AHI alone. Furthermore, in a study of 119 OSA patients who underwent velopharyngeal surgery, including uvulopharyngopalatoplasty with transpalatal advancement pharyngoplasty, the ST 90 rather than AHI was reported to be one of the independent predictors of surgical success. 11 The current study is the largest sample to date that examines the relationship between various polysomnographic variables and ST 90 in a population with suspected SDB. Our results demonstrated that ST 90 is independently influenced by age, BMI, male gender, AHI, mean SaO 2, and mean O 2 desaturation, each explaining a significant proportion of variance. The study results also provide supporting evidence that patients with similar AHI may have very different values of ST 90, and thereby hypoxia. Potential limitations of our study include its retrospective nature, with inherent problems of selection bias, an that it is a single-institution analysis, which could lead to referral bias. A lack of follow-up data and lack of analysis of other potential confounders, such as anthropometric measurements, comorbidities, smoking, and inflammatory markers, could also be considered potential limitations. CONCLUSION The current study contributes to increased concerns regarding failure of AHI in reflecting the actual severity of OSA. Based on our results and available data in the literature, the stratification of patients with OSA according to the AHI combined with ST 90 may allow better identification of prognostic information and selection of individualized patient-tailored treatment modalities. Future randomized controlled trials with longer followup are needed to confirm these findings. BIBLIOGRAPHY 1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014;383: Guilleminault C, Ramar K. Neurologic aspects of sleep apnea: is obstructive sleep apnea a neurologic disorder? Semin Neurol 2009;29: Kimoff RJ, Sforza E, Champagne V, Ofiara L, Gendron D. Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med 2001;164: Iber C, Ancoli-Israel S, Chesson A, Quan S. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine; Kulkas A, Tiihonen P, Julkunen P, Mervaala E, T oyr as J. Novel parameters indicate significant differences in severity of obstructive sleep apnea with patients having similar apnea-hypopnea index. Med Biol Eng Comput 2013;51:
5 6. Mediano O, Barcelo A, de la Pe~na M, Gozal D, Agustı A, Barbe F. Daytime sleepiness and polysomnographic variables in sleep apnoea patients. Eur Respir J 2007;30: Asano K, Takata Y, Usui Y, et al. New index for analysis of polysomnography, integrated area of desaturation, is associated with high cardiovascular risk in patients with mild to moderate obstructive sleep apnea. Respiration 2009;78: Li JR, Sun JJ, Zhang R, Li CF, Hu Y, Sun YM. Clinical value of TS90% in evaluation of hypoxemia in patients with obstructive sleep apnea/hypoventilation syndrome [in Chinese]. Zhonghua Yi Xue Za Zhi 2005;85: Li Q, Jin XJ. Correlations between the duration and frequency of sleep apnea episode and hypoxemia in patients with obstructive sleep apnea syndrome [in Chinese]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009;44: Zhang XB, Zen HQ, Lin QC, Chen GP, Chen LD, Chen H. TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 2014;271: Zhang J, Li Y, Cao X, et al. The combination of anatomy and physiology in predicting the outcomes of velopharyngeal surgery. Laryngoscope 2014; 124: Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 1995;152(5 pt 1): Sutherland K, Lee RW, Cistulli PA. Obesity and craniofacial structure as risk factors for obstructive sleep apnoea: impact of ethnicity. Respirology 2012;17: Wellman A, Jordan AS, Malhotra A, et al. Ventilatory control and airway anatomy in obstructive sleep apnea. Am J Respir Crit Care Med 2004; 170: Lavie L. Obstructive sleep apnoea syndrome an oxidative stress disorder. Sleep Med Rev 2003;7: Prabhakar NR, Kumar GK. Oxidative stress in the systemic and cellular responses to intermittent hypoxia. Biol Chem 2004;385: Neubauer J. Invited review: physiological and pathophysiological responses to intermittent hypoxia. J Appl Physiol 2001;90:
Does AHI Value Enough for Evaluating the Obstructive Sleep Apnea Severity?
DOI 10.1007/s12070-014-0722-6 ORIGINAL ARTICLE Does AHI Value Enough for Evaluating the Obstructive Sleep Apnea Severity? Yusuf Dündar Güleser Saylam Emel Çadallı Tatar Ali Özdek Hakan Korkmaz Hikmet Fırat
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 informationDiagnostic Accuracy of the Multivariable Apnea Prediction (MAP) Index as a Screening Tool for Obstructive Sleep Apnea
Original Article Diagnostic Accuracy of the Multivariable Apnea Prediction (MAP) Index as a Screening Tool for Obstructive Sleep Apnea Ahmad Khajeh-Mehrizi 1,2 and Omid Aminian 1 1. Occupational Sleep
More informationAssociation of Palatine Tonsil Size and Obstructive Sleep Apnea in Adults
The Laryngoscope VC 2017 The American Laryngological, Rhinological and Otological Society, Inc. Association of Palatine Tonsil Size and Obstructive Sleep Apnea in Adults Sebastian M. Jara, MD ; Edward
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 informationEfremidis George, Varela Katerina, Spyropoulou Maria, Beroukas Lambros, Nikoloutsou Konstantina, and Georgopoulos Dimitrios
Sleep Disorders Volume 2012, Article ID 324635, 5 pages doi:10.1155/2012/324635 Clinical Study Clinical Features and Polysomnographic Findings in Greek Male Patients with Obstructive Sleep Apnea Syndrome:
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 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 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 information1/27/2017 RECOGNITION AND MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA: STRATEGIES TO PREVENT POST-OPERATIVE RESPIRATORY FAILURE DEFINITION PATHOPHYSIOLOGY
RECOGNITION AND MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA: STRATEGIES TO PREVENT POST-OPERATIVE RESPIRATORY FAILURE Peggy Hollis MSN, RN, ACNS-BC March 9, 2017 DEFINITION Obstructive sleep apnea is a disorder
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 informationChristopher D. Turnbull 1,2, Daniel J. Bratton 3, Sonya E. Craig 1, Malcolm Kohler 3, John R. Stradling 1,2. Original Article
Original Article In patients with minimally symptomatic OSA can baseline characteristics and early patterns of CPAP usage predict those who are likely to be longer-term users of CPAP Christopher D. Turnbull
More informationGeneral Outline. General Outline. Pathogenesis of Metabolic Dysfunction in Sleep Apnea: The Role of Sleep Fragmentation and Intermittent Hypoxemia
Pathogenesis of Metabolic in Sleep Apnea: The Role of Sleep Fragmentation and Intermittent Hypoxemia Naresh M. Punjabi, MD, PhD Associate Professor of Medicine and Epidemiology Johns Hopkins University,
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 informationPrediction of sleep-disordered breathing by unattended overnight oximetry
J. Sleep Res. (1999) 8, 51 55 Prediction of sleep-disordered breathing by unattended overnight oximetry L. G. OLSON, A. AMBROGETTI ands. G. GYULAY Discipline of Medicine, University of Newcastle and Sleep
More informationOvernight fluid shifts in subjects with and without obstructive sleep apnea
Original Article Overnight fluid shifts in subjects with and without obstructive sleep apnea Ning Ding 1 *, Wei Lin 2 *, Xi-Long Zhang 1, Wen-Xiao Ding 1, Bing Gu 3, Bu-Qing Ni 4, Wei Zhang 4, Shi-Jiang
More informationEFFECT OF WEIGHT CHANGE ON SEVERITY OF OBSTRUCTIVE SLEEP APNEA IN CHILDHOOD OBESITY
EFFECT OF WEIGHT CHANGE ON SEVERITY OF OBSTRUCTIVE SLEEP APNEA IN CHILDHOOD OBESITY Weerapong Lilitwat 1, Wattanachai Chotinaiwattarakul 2, and Kanokporn Udomittipong 3 1 Division of Critical Care, University
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 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 informationPVDOMICS. Sleep Core. Cleveland Clinic Cleveland, Ohio
PVDOMICS Sleep Core Rawan Nawabit, Research Coordinator and Polysomnologist Joan Aylor, Research Coordinator Dr. Reena Mehra, Co-Investigator, Sleep Core Lead Cleveland Clinic Cleveland, Ohio 1 Obstructive
More 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 informationThe Role of Bariatric Surgery in Obstructive Sleep Apnea Syndrome
DOI: 10.5152/ttd.2014.4211 ORIGINAL INVESTIGATION The Role of Bariatric Surgery in Obstructive Sleep Apnea Syndrome Fatmanur Karaköse 1, Süleyman Bozkurt 2, Muhammed Emin Akkoyunlu 1, Halil Coşkun 2, Fatih
More informationComparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty: A Single University Experience
771395AORXXX10.1177/0003489418771395Annals of Otology, Rhinology & LaryngologyHuntley et al research-article2018 Original Article Comparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty:
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 informationInternational 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
More informationSleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016
Sleep Apnea and ifficulty in Extubation Jean Louis BOURGAIN May 15, 2016 Introduction Repetitive collapse of the upper airway > sleep fragmentation, > hypoxemia, hypercapnia, > marked variations in intrathoracic
More informationThe Ignored Parameter in the Diagnosis of Obstructive Sleep Apnea Syndrome: The Oxygen Desaturation Index
1 Turk Arch Otorhinolaryngol 2018; 56: 1-6 Turkish Archives of Otorhinolaryngology The Ignored Parameter in the Diagnosis of Obstructive Sleep Apnea Syndrome: The Oxygen Desaturation Index Original Investigation
More informationNational Sleep Disorders Research Plan
Research Plan Home Foreword Preface Introduction Executive Summary Contents Contact Us National Sleep Disorders Research Plan Return to Table of Contents SECTION 5 - SLEEP DISORDERS SLEEP-DISORDERED BREATHING
More 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 informationJMSCR Vol 05 Issue 01 Page January 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i1.161 Risk of Failure of Adenotonsillectomy
More informationAssociation between Depression and Severity of Obstructive Sleep Apnea Syndrome
Original Article Association between Depression and Severity of Obstructive Sleep Apnea Syndrome Mojahede Salmani Nodoushan 1,2 and Farzaneh Chavoshi 3 1. Department of Occupational Medicine, Medical School,
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 informationPolycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners. M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017
Polycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017 Case of S.R. S.R. is a 39 year old female referred for suspected obstructive
More informationA new beginning in therapy for women
A new beginning in therapy for women OSA in women Tailored solutions for Her AutoSet for Her algorithm ResMed.com Women and OSA OSA has traditionally been considered to be a male disease. However, recent
More 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 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 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 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 informationLateral Pharyngoplasty Reduces Nocturnal Blood Pressure in Patients With Obstructive Sleep Apnea
The Laryngoscope VC 2013 The American Laryngological, Rhinological and Otological Society, Inc. Lateral Pharyngoplasty Reduces Nocturnal Blood Pressure in Patients With Obstructive Sleep Apnea Carolina
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 informationNasal Mass Presenting as Obstructive Sleep Apnea Syndrome
ORIGINAL ARTICLE pissn 2093-9175 / eissn 2233-8853 http://dx.doi.org/10.17241/smr.2015.6.2.54 Nasal Mass Presenting as Obstructive Sleep Apnea Syndrome Seung Hoon Lee, MD, PhD, In Sik Song, MD, Jae Woo
More informationJosé Haba-Rubio, MD; Jean-Paul Janssens, MD; Thierry Rochat, MD, PhD; and Emilia Sforza, MD, PhD
Rapid Eye Movement-Related Disordered Breathing* Clinical and Polysomnographic Features José Haba-Rubio, MD; Jean-Paul Janssens, MD; Thierry Rochat, MD, PhD; and Emilia Sforza, MD, PhD Objective: The existence
More informationΣύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών;
Σύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών; E.N. Σημανηηράκης MD, FESC Επίκ. Καθηγηηής Καρδιολογίας Πανεπιζηημιακό Νοζοκομείο Ηρακλείοσ Epidemiology 4% 2% 24%
More information( ) 28 kg/ m 2, OSAHS, BMI < 24 kg/ m 2 10
2013 9 12 5 http: / / www. cjrccm. com 435 ;, ( sleep apneahypopnea syndrome, SAHS) 20 80,, SAHS /, SAHS, [ 1 ] SAHS ( obstructive sleep apnea-hypopnea syndrome, OSAHS) OSAHS [ 2-4 ], 50% 92% OSAHS, 30%
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 informationEdoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica
Convegno Pneumologia 2016 Milano 16-18 giugno 2016 Centro Congressi Palazzo delle Stelline Edoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica Central apnea 10 second
More informationThe 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
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 informationHigh Flow Nasal Cannula in Children During Sleep. Brian McGinley M.D. Associate Professor of Pediatrics University of Utah
High Flow Nasal Cannula in Children During Sleep Brian McGinley M.D. Associate Professor of Pediatrics University of Utah Disclosures Conflicts of Interest: None Will discuss a product that is commercially
More informationFeatures of REM-related Sleep Disordered Breathing in the Japanese Population
ORIGINAL ARTICLE Features of Sleep Disordered Breathing in the Japanese Population Seiichiro Sakao, Takayuki Sakurai, Misuzu Yahaba, Yoriko Sakurai, Jiro Terada, Nobuhiro Tanabe and Koichiro Tatsumi Abstract
More informationLipolysis and Metabolic Impairment in Community-Based Sample with Obstructive Sleep Apnea
Lipolysis and Metabolic Impairment in Community-Based Sample with Obstructive Sleep Apnea R. Nisha Aurora, MD Assistant Professor of Medicine Division of Pulmonary & Critical Care Medicine Group 4 Obstructive
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 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 informationMonitoring: gas exchange, poly(somno)graphy or device in-built software?
Monitoring: gas exchange, poly(somno)graphy or device in-built software? Alessandro Amaddeo Noninvasive ventilation and Sleep Unit & Inserm U 955 Necker Hospital, Paris, France Inserm Institut national
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 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 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 informationSleep Apnea induced Endothelial Dysfunction: could it be reversible?
Orofacial Pain and Oral Medicine Course: OFPM #723 Motor/Sleep Disorders and Oral Physiology in OFPOM Lecture #3a Dr. Glenn Clark Professor of Diagnostic Sciences Assistant Dean of Distance Education Director
More informationPatients with upper airway resistance syndrome
Two-Point Palatal Discrimination in Patients With Upper Airway Resistance Syndrome, Obstructive Sleep Apnea Syndrome, and Normal Control Subjects* Christian Guilleminault, MD, BiolD; Kasey Li, MD, DDS;
More informationRespiratory/Sleep Disorder Breathing (SDB) SDB is highly prevalent, under recognized, under reported and under treated
Respiratory/Sleep Disorder Breathing (SDB) Definitions SDB is highly prevalent, under recognized, under reported and under treated Central 1. Central sleep apnea (CSA) is defined by the cessation of air
More informationStep (2) Looked for correlations between baseline surrogates and postoperative AHI.
Development of the PSG PLUS PHYIOLOGY model Step (1) Picked possible surrogates of the physiological traits (See Table 1 in the main text). Step (2) Looked for correlations between baseline surrogates
More informationSleepiness in Patients with Moderate to Severe Sleep-Disordered Breathing
Sleepiness in Patients with Moderate to Severe Sleep-Disordered Breathing Vishesh K. Kapur, MD, MPH 1 ; Carol M. Baldwin, RN, PhD, HNC 2 ; Helaine E. Resnick, PhD, MPH 3 ; Daniel J. Gottlieb, MD, MPH 4
More informationInfluence of upper airways section area on oxygen blood saturation level in patients with obesity and sleep apnea syndrome
Influence of upper airways section area on oxygen blood saturation level in patients with obesity and sleep apnea syndrome Poster No.: P-0028 Congress: ESCR 2015 Type: Scientific Poster Authors: E. Butorova,
More informationPrecision Sleep Medicine
Precision Sleep Medicine Picking Winners Improves Outcomes and Avoids Side-Effects North American Dental Sleep Medicine Conference February 17-18, 2017 Clearwater Beach, FL John E. Remmers, MD Conflict
More informationHHS Public Access Author manuscript Respirology. Author manuscript; available in PMC 2017 October 01.
Connecting insomnia, sleep apnoea and depression Michael A. Grandner, PhD, MTR 1 and Atul Malhotra, MD 2 1 Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of
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 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 informationObstructive Sleep Apnoea in Singapore: Polysomnography Data From a Tertiary Sleep Disorders Unit
Original Article 629 Obstructive Sleep Apnoea in Singapore: Polysomnography Data From a Tertiary Sleep Disorders Unit Li Ling Lim, 1,2 MBBS, MRCP (UK), ABSM (Sleep Medicine) (USA), Kwang Wei Tham, 3,4
More informationThe 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.
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: October 15, 2018 Related Policies: 2.01.18 Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome Polysomnography for Non-Respiratory Sleep Disorders
More informationTreatment-related changes in sleep apnea syndrome in patients with acromegaly: a prospective study
Treatment-related changes in sleep apnea syndrome in patients with acromegaly: a prospective study Thalijn Wolters 1 *, Sean Roerink 1 *, Linda Drenthen 1, Jolanda van Haren- Willems 2, Guido van den Broek
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 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 informationPrevalence of Cardiac Arrhythmias in Asian Patients With Obstructive Sleep Apnea: A Singapore Sleep Center Experience
pii: jc-17-00275 http://dx.doi.org/10.5664/jcsm.6794 SCIENTIFIC INVESTIGATIONS Prevalence of Cardiac Arrhythmias in Asian Patients With Obstructive Sleep Apnea: A Singapore Sleep Center Experience Wei
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 informationPROGRESSION OF SNORING AND OBSTRUCTIVE SLEEP APNEA: THE ROLE OF INCREASING WEIGHT AND TIME
ERJ Express. Published on November 14, 2008 as doi: 10.1183/09031936.00075408 1 PROGRESSION OF SNORING AND OBSTRUCTIVE SLEEP APNEA: THE ROLE OF INCREASING WEIGHT AND TIME Gilead Berger MD 1, Rachel Berger
More informationUsing Questionnaire Tools to Predict Pediatric OSA outcomes. Vidya T. Raman, MD Nationwide Children s Hospital October 201
Using Questionnaire Tools to Predict Pediatric OSA outcomes Vidya T. Raman, MD Nationwide Children s Hospital October 201 NCH Conflict of Interest SASM $10,000 Grant NCH intramural/interdepartmental $38,000
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 informationEvaluation of a 2-Channel Portable Device and a Predictive Model to Screen for Obstructive Sleep Apnea in a Laboratory Environment
Evaluation of a 2-Channel Portable Device and a Predictive Model to Screen for Obstructive Sleep Apnea in a Laboratory Environment Jianyin Zou, Lili Meng MD, Yupu Liu MSc, Xiaoxi Xu, Suru Liu PhD, Jian
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 informationEszopiclone and Zolpidem Do Not Affect the Prevalence of the Low Arousal Threshold Phenotype
pii: jc-00125-16 http://dx.doi.org/10.5664/jcsm.6402 SCIENTIFIC INVESTIGATIONS Eszopiclone and Zolpidem Do Not Affect the Prevalence of the Low Arousal Threshold Phenotype Patrick R. Smith, DO 1 ; Karen
More informationObstructive Sleep Apnea and COPD overlap syndrome. Financial Disclosures. Outline 11/1/2016
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
More informationHow We Breathe During Sleep Affects Health, Wellness and Longevity
How We Breathe During Sleep Affects Health, Wellness and Longevity Susan Redline, MD, MPH Peter C. Farrell Professor of Sleep Medicine Program Director- Sleep Medicine Epidemiology Harvard Medical School
More informationOutcome Measures in OSA Defining Our Treatment Goal. Defining common outcome metrics in OSA Al-Shawwa Sleep Med Rev 2008
Outcome Measures in OSA Defining Our Treatment Goal Disclosures Apnicure Minor stock holder sleep apnea device Siesta Medical Minor stock holder sleep apnea device Patent Pending 61/624,105 Sinus diagnostics
More informationORIGINAL ARTICLES. Adaptation to Nocturnal Intermittent Hypoxia in Sleep-Disordered Breathing: 2,3 Diphosphoglycerate Levels: A Preliminary Study
ORIGINAL ARTICLES Adaptation to Nocturnal Intermittent Hypoxia in Sleep-Disordered Breathing: 2,3 Diphosphoglycerate Levels: A Preliminary Study Levent Öztürk, M.D., Banu Mansour, M.D., Zerrin Pelin, M.D.,
More informationInterrelationships between Body Mass, Oxygen Desaturation, and Apnea-Hypopnea Indices in a Sleep Clinic Population
BODY MASS, OXYGEN DESATURATION, AND APNEA-HYPOPNEA INDICES http://dx.doi.org/10.5665/sleep.1592 Interrelationships between Body Mass, Oxygen Desaturation, and Apnea-Hypopnea Indices in a Sleep Clinic Population
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 informationEvidence-Based Outcomes to Detect Obstructive Sleep Apnea, Identify Co- Existing Factors, and Compare Characteristics of Patient Discharge Disposition
Evidence-Based Outcomes to Detect Obstructive Sleep Apnea, Identify Co- Existing Factors, and Compare Characteristics of Patient Discharge Disposition Joseph F. Burkard, DNSc, CRNA jburkard@sandiego.edu
More informationChildhood Obstructive Sleep Apnea
Childhood Obstructive Sleep Apnea 1 PROF. RAJESHWAR DAYAL MD, FAMS,FIAP,DNB, DCH (LONDON) NATIONAL CONVENOR,IAP SLEEP PROGRAM NATIONAL VICE PRESIDENT IAP 2011 HEAD DEPARTMENT OF PAEDIATRICS S. N. MEDICAL
More informationThe Epworth Sleepiness Scale (ESS) was developed by Johns
Clinical Reproducibility of the Epworth Sleepiness Scale Anh Tu Duy Nguyen, M.D. 1 ; Marc A. Baltzan, M.D., M.Sc. 1,2 ; David Small, M.D. 1 ; Norman Wolkove, M.D. 1 ; Simone Guillon, M.D. 3 ; Mark Palayew,
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 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 Bruxism and Sleep-Disordered Breathing
Sleep Bruxism and Sleep-Disordered Breathing Author STEVEN D BENDER, DDS*, Associate Editor EDWARD J. SWIFT JR., DMD, MS Sleep bruxism (SB) is a repetitive jaw muscle activity with clenching or grinding
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 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 informationPublished Papers Cardio Pulmonary Coupling
Thomas RJ, Mietus JE, Peng CK, Goldberger AL An electrocardiogram-based technique to assess cardiopulmonary coupling (CPC) during sleep SLEEP 2005; 28:1151-61 O: Evaluate a new automated measure of cardiopulmonary
More informationThe 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
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 information