Pediatric Sleep-Disordered Breathing: More than OSA
|
|
- Dorcas Ann Malone
- 5 years ago
- Views:
Transcription
1 Pediatric Sleep-Disordered Breathing: More than OSA Carolyn M. D Ambrosio Associate Professor of Medicine Harvard Medical School Brigham and Women s Hospital Boston, MA
2 Disclosures 1. Section Editor, Dynamed, Sleep Medicine 2. Patent co-owner, circadian rhythm programmable device 3. Advisor, Advanced ICU Care
3 Obstructive sleep-disordered breathing with an AHI = 0
4 18 mo with achondroplasia including mid-facial hypoplasia, constricted foramen magnum, and decreased thoracic volume
5
6 Achrondroplasia Autosomal Dominant 1:10,000 Risk Factors Midfacial Hypoplasia Short Cranial Base Pulmonary Restriction Brainstem Compression Sleep-Disordered Breathing OSA CSA Hypoventilation ***Hypoxemia***
7 Acondroplasia: Foramen Magnum Stenosis Symptoms Weakness/Pain/Parasthesia Swallowing dysfunction Incontinence Hydrocephalus Usually Not CSA Surgical decompression Does not affect CSA White et al, AM J Med Gen 2015 PSGNOT a screening tool for symptomatic Foramen Magnum Stenosis.
8 Another case of obstruction with AHI=0 12 yr old girl with obesity, abnormal breathing pattern witnessed by parents, no snoring.
9 What is the breathing abnormality? Katz et al, Sleep Apnea, NHLBI, 2011
10 16 yo female Thin with ATH Father with OSA Slept thru a firealarm AHI 0.5/hr, Normal Oxygen EEG Arousal index >11/hr 60 secs
11 2 week-old born at 37 weeks gestation referred for irregular breathing and prolonged breath-holding
12 What is this?
13 This is another infant, what is the abnormality? 30 secs
14 Periodic Breathing: Definition Oxygen Saturation Impedance Series of 3 central apneas of > 3 second duration separated by < 20 seconds of normal breathing
15 Periodic Breathing: Epidemiology months Present in % of 1 week-old Term Infants 95% Upper Limits Term 5 10% at 1 month with Prematurity but not SIDS, HIE Pathophysiology 2% at 3 months Preterm 15 20% at 1 month 5 10% at 3 Apneic CO2 threshold is 1 torr below Eupneic CO2 Khan et al, JAP: 2005; 98:1171-
16 Periodic Breathing: Influence of Oxygen Apnea Index Periodic Breathing RA Oxygen RA Oxygen Subjects: GA 30 weeks, PCA 38 weeks Simakajornboon et al, Peds 2002; 110:884-
17 Another infant, wakes up frequently 90 secs
18 Bradycardia: GERD Marcus et al, J Peds 1999; 135:321-
19 Brainstem abnormalities Joubert CCHS RETT Tumors Chiari
20 molar tooth midbrain Joubert Kumandas et al, Eur J Neuro 2004; 11: 505- Autosomal recessive Hypotonia,developmental delay, tachypnea/apnea Breathing abnormalities occur early in life and may improve over time Cerebellar Hypoplasia
21 5 year-old Joubert 120 secs Frequent prolonged central pauses
22 5 year-old Joubert 120 secs Hyperpnea followed by a central apnea
23 5 year-old Joubert 120 secs Periodic breathing with bradypnea/hyperpnea
24 5 year-old Joubert 120 secs Bradypnea
25 5 year-old Joubert 120 secs Grouped central apneas
26 Congenital central hypoventilation syndrome (CCHS) Rare autosomal dominant (PHOX2B) Integration of CO2 by Medullary chemoreceptors Dx: Newborn >> Childhood >> Adults No primary lung, cardiac, or neuro dz 2/3 require ventilator only during sleep Autonomic Dysfunction
27 CCHS REM NREM P ET CO Wake REM Hypoventilation worse in NREM sleep in CCHS
28 Term 2 week-old Cyanotic/Apnea episodes Normal Brain/CXR CO 2 = 110 torr Treated with BiPAP 7 Hours Feed BiPAP Feed Marked, Rapid desaturation during feed and especially with transition to sleep
29 Term 2 week-old CCHS (20/25 Mutation) 60 secs Shallow breathing, obstructions without labored breathing
30 RETT syndrome Gene MECP2 on X chromosome Females 1:10,000 Developmental regression 6 18 months Features Severe retardation Dystonia Circadian disturbance Respiratory dysrhythmias after 2 yo High incidence of sudden death Dysautonomia Seizures Aspiration Interstitial Lung Disease(?)
31 RETT: Central Apnea Inspiratory Breath Hold Tachypnea 41 Seconds Marcus et al, J Peds 1994; 125: 218-
32 RETT: Grouped Central Apneas
33 Chiari Malformations Herniations of Cerebellum or brainstem through Foramen magnum My present at any age 1:1000 Symptoms Headache Neck pain Ataxia Oculomotor CSA OSA Early surgical Tx may be helpful Recurrences are common BiPAP/Oxygen for Residual CSA Van den Broek, Eu J Paed Neur 2009
34 Chiari Malformations Herniations of Cerebellum or brainstem through Foramen magnum May present at any age 1:1000 Symptoms Ataxia Headache, Neck pain, CSA 24 68% OSA Poor correlation between herniation severity and PSG Early surgical Tx may be helpful Recurrences are common BiPAP/Oxygen for Residual CSA Van den Broek, Eu J Paed Neur 2009 Alsaadi et al, Peds Int 2012: 54: 623-
35 Periodic Breathing (Chiari) Abel et al, BMJ 2012; 344: e3022-
36 7 yo female Chiari 120 secs
37 2 yo, many >20 sec CA, marked desats Brainstem Compression: Irregularly irregular 120 Seconds
38 17 yo. Hypoxemia, bradypniec. Given narcotics before sleep and periodically overnight
39 Sleep Onset Hypoventilation 100% - S p O 2 60 Torr - CO 2 P ET CO 2
40 Narcotic-induced CSA Seen in >30% on chronic opioids Often c/o EDS Both OSA and CSA CSA often in REM sleep Ainslie et al, Resp Phys Neurobiol 2013; 188: 233-
41 Unusual Patterns Respiratory flutter Rebreathing VNS Muscle weakness Behavioral hyperventilation
42 Respiratory Flutter Katz et al, AJRCCM 2001; 164:1161-
43
44 Why is this patient hypercapnic? Carol Rosen, MD
45 Vagal Nerve Stimulator (VPN) Causing hypopnea VNS
46 Myelomeningocele: Age 11 yrs SpO PETCO 2 Stage Wake REM Scoliosis, obesity, respiratory muscle weakness
47 Myelomeningocele: Age 13 yrs SpO 2 PETCO 2 Stage Wake REM Scoliosis, obesity, respiratory muscle weakness
48 Behavioral Hyperventilation 5 minute Johnston et al, JCSM 2015; 11:487-9 yo, No PMHx, 2 CA s at sleep onset 32 & 51 seconds. A PetCO2 few prolonged 20 torr after respiratory hyperventilation. pauses are ph commonly 7.48/PCO2 observed 25/ HCO3- in 13. infants Brain MRI and normal. children. Dx: Oxygen Anxiety desaturations & Rx Clonazepam are rare after infancy.
49 Behavioral Hyperventilation 5 minute Johnston et al, JCSM 2015; 11: yo, many CA s at sleep onset up to 79 seconds. PetCO2 22 torr after hyperventilation associated with anxiety. Brain MRI normal. Dx: Anxiety
50 Summary 1.Many causes of sleep-disordered breathing in children 2.Children with syndromes, particularly Down s, Joubert, Achondroplasia, Prader- Willi, etc are at very high risk 3.Remember opiates as a main cause of central apneas.
11/20/2015. Eighth Bi-Annual Pediatric Sleep Medicine Conference. November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida
Eighth Bi-Annual Pediatric Sleep Medicine Conference November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida Carol L. Rosen, MD Case Western Reserve University School of Medicine
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 informationSLEEP STUDIES IN THE VERY, VERY YOUNG
SLEEP STUDIES IN THE VERY, VERY YOUNG Julie DeWitte, RCP, RPSGT, RST Assistant Department Administrator Kaiser Permanente Fontana Sleep Center AAST Director-at-Large Board Member NEONATES THROUGH INFANCY
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 informationChallenging Cases in Pediatric Polysomnography. Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep
Challenging Cases in Pediatric Polysomnography Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep Conflict of Interest None pertaining to this topic Will be using some slides from
More informationRespiratory/Sleep Disordered Breathing. William Walker, MD, Chair Iris Perez, MD
Respiratory/Sleep Disordered Breathing William Walker, MD, Chair Iris Perez, MD Definitions SDB is highly prevalent, under recognized, under reported and under treated Central Central sleep apnea (CSA)
More informationShort Cases M I CHA E L DE RYNCK, M D U N I V ERSITY OF CA LG A RY F E BR UA RY
Short Cases MICHAEL DERYNCK, MD UNIVERSITY OF CALGARY FEBRUARY 15 2018 Case 1: Beyond Bronchiolitis Presentation 2 month old, term girl Cough and rhinitis, increased work of breathing, wheeze and apnea
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 informationRecognition and Management of High Loop Gain Sleep Apnea
Recognition and Management of High Loop Gain Sleep Apnea Robert Joseph Thomas, M.D. Beth Israel Deaconess Medical Center, Boston, MA 02215 Associate Professor of Medicine, Harvard Medical School NEPS 2016
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 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 informationChiari Malformations. Google. Objectives Seventh Annual NKY TBI Conference 3/22/13. Kerry R. Crone, M.D.
Chiari Malformations Kerry R. Crone, M.D. Professor of Neurosurgery and Pediatrics University of Cincinnati College of Medicine University of Cincinnati Medical Center Cincinnati Children s Hospital Medical
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 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 informationSleep Medicine. Maintenance of Certification Examination Blueprint. Purpose of the exam
Sleep Medicine Maintenance of Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the
More informationCAPNOGRAPHY in the SLEEP CENTER Julie DeWitte, RCP, RPSGT, RST Assistant Department Administrator Kaiser Permanente Fontana Sleep Center
FOCUS Fall 2018 CAPNOGRAPHY in the SLEEP CENTER Julie DeWitte, RCP, RPSGT, RST Assistant Department Administrator Kaiser Permanente Fontana Sleep Center 1 Learning Objectives The future of in laboratory
More informationA 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation
1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation The following 3 minute polysomnogram (PSG) tracing was recorded in a 74-year-old man with severe ischemic cardiomyopathy
More informationComplex Sleep Apnea. Can we do better? David Weed D.O.,FCCP,FAASM. September 8, 2016
Complex Sleep Apnea Can we do better? David Weed D.O.,FCCP,FAASM September 8, 2016 If you don t know where you are going, you ll end up somewhere else. Yogi Berra Objectives Discuss what syndromes comprise
More informationPediatric OSA. Pediatric OSA: Treatment Options Beyond AT. Copyright (c) 2012 Boston Children's Hospital 1
Pediatric OSA Treatments Options Beyond AT Report of Financial Relationships (past 12 months) with commercial entities producing, marketing, re selling, or distributing health care goods or services consumed
More informationSleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK
Sleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK Sleep Disordered Breathing in CHF Erratic breathing during sleep known for years e.g.
More 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 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 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 informationThe Use and Outcomes of Long-term Non-invasive Ventilation in Infants
The Use and Outcomes of Long-term Non-invasive Ventilation in Infants by Prabhjot Kaur Bedi A thesis submitted in partial fulfillment of the requirements for the degree of Master in Science Medical Sciences
More informationAn Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy
An Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy Housekeeping: I have no financial disclosures Learning objectives: Develop an understanding of bronchopulmonary dysplasia (BPD)
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 informationIdentification and Treatment of the Patient with Sleep Related Hypoventilation
Identification and Treatment of the Patient with Sleep Related Hypoventilation Hillary Loomis-King, MD Pulmonary and Critical Care of NW MI Munson Sleep Disorders Center X Conflict of Interest Disclosures
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 informationRare Sleep Disorders. Carolyn D Ambrosio, MD, MSc.
Rare Sleep Disorders Carolyn D Ambrosio, MD, MSc. Director, Harvard-Brigham and Women s Hospital Pulmonary and Critical Care Fellowship Faculty, Harvard Medical School Boston, MA Case #1 2 week old baby,
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 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 informationNovel pathophysiological concepts for the development and impact of sleep apnea in CHF.
Olaf Oldenburg Novel pathophysiological concepts for the development and impact of sleep apnea in CHF. Sleep apnea the need to synchronize the heart, the lung and the brain. Heart Failure 2011 Gothenburg,
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 informationObstructive Sleep Disordered Breathing in children and Growth
Obstructive Sleep Disordered Breathing in children and Growth Diana Marangu Kenya Paediatric Association Respiratory Symposium Wednesday, 26 th April 2017 Outline Obstructive sleep disordered breathing
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 informationRETT SYNDROME AND SLEEP
2015 A good night s sleep promotes learning, improved mood, general good health, and a better quality of life for both your child and the whole family. This article written for Rettsyndrome.org by Dr Daniel
More informationCOMPLEX SLEEP APNEA IS IT A DISEASE? David Claman, MD UCSF Sleep Disorders Center
COMPLEX SLEEP APNEA IS IT A DISEASE? David Claman, MD UCSF Sleep Disorders Center CENTRAL APNEA Central Apnea Index > 5 ( >50% of apnea are central) Mayo Clinic Proc 1990; 65:1255 APNEA AT SLEEP ONSET
More informationBRUE and Apnea at Term, how do they relate?
BRUE and Apnea at Term, how do they relate? Mary Elaine Patrinos, M.D. Attending Neonatologist Rainbow Babies and Children s Hospital Director, Infant Apnea Program Apnea at Term Can it happen? How does
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 informationA TECH S TOOLKIT FOR THE PEDIATRIC SLEEP LAB
A TECH S TOOLKIT FOR THE PEDIATRIC SLEEP LAB Craig Canapari, MD craig.canapari@gmail.com drcraigcanapari.com: Updated syllabus will be here along with link to visual presentation. Twitter: DrCanapari INTRODUCTION
More informationDiagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome Director, Sleep Laboratory Center for Pediatric Sleep Disorders Boston Children s Hospital Copyright 2014 Boston Children s Hospital
More informationPain patient with sleep-disordered breathing
Pain patient with sleep-disordered breathing Clinical scenario: A 50-year old female with a history of acid reflux, fibromyalgia, spinal stenosis and degenerative disk disease s/p C3/C4 disk fusion, depression
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 informationObjectives. Apnea Definition and Pitfalls. Pathophysiology of Apnea. Apnea of Prematurity and hypoxemia episodes 5/18/2015
Apnea of Prematurity and hypoxemia episodes Deepak Jain MD Care of Sick Newborn Conference May 2015 Objectives Differentiating between apnea and hypoxemia episodes. Pathophysiology Diagnosis of apnea and
More informationIntroducing the WatchPAT 200 # 1 Home Sleep Study Device
Introducing the WatchPAT 200 # 1 Home Sleep Study Device Top 10 Medical Innovation for 2010 Cleveland Clinic Fidelis Diagnostics & Itamar Medical Fidelis Diagnostics founded in 2004, is a privately-held
More informationChoosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting Lisa F. Wolfe MD Northwestern University Chicago, Illinois Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
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 informationPediatric Considerations in the Sleep Lab
AAST Technologist Fundamentals Date: May 7, 2017 Focus Conference Location: Orlando, Florida Workshop Pediatric Considerations in the Sleep Lab By Joel Porquez, BS, RST/RPSGT, CCSH X X X X X X Conflict
More informationObstructive Sleep Apnea:
Obstructive Sleep Apnea: A Physiological Approach Robert L. Owens, MD February 2018 Outline Cause(s) of OSA Can we measure the causes in an individual? Is that useful? 1 Thoracic pressure swings ( LV a
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 informationJulie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist
Julie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist Objectives Define capnography vs. end tidal CO2 (EtCO 2 ) Identify what normal vs. abnormal EtCO2 values mean and what to do Understand when to
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 informationOSA in children. About this information. What is obstructive sleep apnoea (OSA)?
About this information This information explains all about sleep-related breathing problems in children, focusing on the condition obstructive sleep apnoea (OSA). It tells you what the risk factors are
More informationCentral Sleep Apnea Problem Based Learning Module
Central Sleep Apnea Problem Based Learning Module Vidya Krishnan, and Sutapa Mukherjee for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee 2015 Case Section I A 75 year old
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 informationPulmonary Care for Patients with Mitochondrial Disorders
Pulmonary Care for Patients with Mitochondrial Disorders Rajeev Bhatia, MD, MBBS, DCH, FAAP Pediatric Pulmonologist Assistant Professor of Pediatrics, NEOMED Medical Director, Clinical Exercise Physiology
More informationBreathing Irregularities Why is breathing so funny when our girls/ boys wake up, almost as if startled?
RettEd Q&A: Respiratory Issues in Rett Syndrome Dr. Marianna Sockrider, Pediatric Pulmonologist, Texas Children's Hospital Webcast 02/13/2018 Facilitator: Paige Nues, Rettsyndrome.org Recording link: https://register.gotowebinar.com/recording/1810253924903738120
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 information6/5/2017. Mellar P Davis MD FCCP FAAHPM Geisinger Medical Center Danville, PA
Mellar P Davis MD FCCP FAAHPM Geisinger Medical Center Danville, PA Opioids adversely influence respiration in five distinct ways Opioids cause complex sleep disordered breathing consisting of central
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 and Heart Health: Consequences of OSA
Sleep and Heart Health: Consequences of OSA Michelle Zetoony, DO, FCCP, FACOI Sleep Medicine Specialist Board Certified Pulmonary, Critical Care, Sleep and Internal Medicine 2014 Objectives Explain the
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 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 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(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 informationNeonatal/Pediatric Cardiopulmonary Care. Persistent Pulmonary Hypertension of the Neonate (PPHN) PPHN. Other. Other Diseases
Neonatal/Pediatric Cardiopulmonary Care Other Diseases Persistent Pulmonary Hypertension of the Neonate (PPHN) PPHN 3 Also known as Persistent Fetal Circulation (PFC) Seen most frequently in term, post-term
More informationCardiac Arrhythmias in Sleep
Cardiac Arrhythmias in Sleep Only 53 Slides! Gauresh H Kashyap, MD, FACP, FCCP, FAASM 1 2 Cardiac Arrhythmias in Sleep Out of 400 Patients with OSA, 48% had some Arrhythmias 20% - 2 PVCs/min 7% - Bradycardia
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 informationAuto Servo Ventilation Indications, Basics of Algorithm, and Titration
Auto Servo Ventilation Indications, Basics of Algorithm, and Titration 1 ASV Learning Objectives Understand the indications for Auto Servo Ventilation Differentiate obstructive versus central hypopneas
More informationCONTROL OF BREATHING DURING WAKEFULNESS AND SLEEP. Renata Pecotić, M.D., PhD.
CONTROL OF BREATHING DURING WAKEFULNESS AND SLEEP Renata Pecotić, M.D., PhD. Shev Gul, BSc, NLP & Hypnosis Master Pract, Life and Sports Coach, WSCA, ASCA, ASA GB FIOS(cc) Why do we have to breathe?? Breathing
More informationRespiratory Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross
Respiratory Physiology Part II Bio 219 Napa Valley College Dr. Adam Ross Gas exchange Gas exchange in the lungs (to capillaries) occurs by diffusion across respiratory membrane due to differences in partial
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 informationAll About Positive Airway Pressure (PAP) Therapy
All About Positive Airway Pressure (PAP) Therapy Nitipatana Chierakul Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Medical School Siriraj Sleep Center: Fiscal-year
More informationPediatric Patients. Neuromuscular Disease. Teera Kijmassuwan, MD Phetcharat Netmuy, B.N.S., MA Oranee Sanmaneechai, MD : Preceptor
Patient Management Pediatric Patients with Neuromuscular Disease Teera Kijmassuwan, MD Phetcharat Netmuy, B.N.S., MA Oranee Sanmaneechai, MD : Preceptor Case Thai boy 1 year old Present with Respiratory
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 informationClinical and Regulatory Challenges in Developing New Treatments for Rare Diseases
Clinical and Regulatory Challenges in Developing New Treatments for Rare Diseases R. Anand, M.D. APC AG, Switzerland ISCTM, Washington DC February 20 th, 2018 Conflict of Interests A - Z Too many to mention
More informationResearch in Medical Physics: Physiological Signals and Dynamics
Research in Medical Physics: Physiological Signals and Dynamics Incidents of apnea or of sepsis create critical situations in a neonatal intensive care unit (NICU). Of the 4.2 million babies born annually
More informationWRHA Surgery Program. Obstructive Sleep Apnea (OSA)
WRHA Surgery Program Obstructive Sleep Apnea (OSA) March 2010 Prepared by WRHA Surgery & Anesthesiology Programs Objectives 1. Define obstructive sleep apnea (OSA). 2. Purpose of the guidelines. 3. Identify
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 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 informationSleep Medicine Maintenance of Certification Examination Blueprint
Sleep Medicine Maintenance of Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the
More informationNASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR OBSTRUCTIVE SLEEP APNEA IN CHILDREN. Dr. Nguyễn Quỳnh Anh Department of Respiration 1
1 NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR OBSTRUCTIVE SLEEP APNEA IN CHILDREN Dr. Nguyễn Quỳnh Anh Department of Respiration 1 CONTENTS 2 1. Preface 2. Definition 3. Etiology 4. Symptoms 5. Complications
More information3/10/2014. Pearls to Remember. 1) Consequences of OSA related to both arousals and hypoxia. 2) Arousals provoke increased
Cardiovascular disease and Sleep Disorders Timothy L. Grant, M.D.,F.A.A.S.M. Medical Director Baptist Sleep Center at Sunset Medical Director Baptist Sleep Education Series Medical Director Sleep Division
More informationCapnography. Capnography. Oxygenation. Pulmonary Physiology 4/15/2018. non invasive monitor for ventilation. Edward C. Adlesic, DMD.
Capnography Edward C. Adlesic, DMD University of Pittsburgh School of Dental Medicine 2018 North Carolina Program Capnography non invasive monitor for ventilation measures end tidal CO2 early detection
More informationDisclosures. Objectives. OSA Death and Near Miss Registry The path to creation.
OSA Death and Near Miss Registry The path to creation. October 23, 2015 Norman Bolden, M.D. Vice-Chairman, Department of Anesthesiology Associate Professor, Case Western Reserve University n None Disclosures
More informationThe AASM Manual for the Scoring of Sleep and Associated Events
The AASM Manual for the Scoring of Sleep and Associated Events The 2007 AASM Scoring Manual vs. the AASM Scoring Manual v2.0 October 2012 The American Academy of Sleep Medicine (AASM) is committed to ensuring
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 informationIndex SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type. Cerebrospinal fluid analysis, for Kleine-Levin syndrome,
165 SLEEP MEDICINE CLINICS Index Sleep Med Clin 1 (2006) 165 170 Note: Page numbers of article titles are in boldface type. A Academic performance, effects of sleepiness in children on, 112 Accidents,
More informationApnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing. Alan S Maisel MD
Apnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing Alan S Maisel MD Triumvirate of Health-public awareness 1.8% Sleep Physical Fitness Nutrition 91.3% 99.9% Sleep is important to
More 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 informationObstructive Sleep Apnea
Obstructive Sleep Apnea Definition: Repetitive episodes of upper airway obstruction (complete or partial) that occur during sleep and are associated with arousals or desaturations +/or daytime sleepiness.
More 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 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 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 informationFall 2014 Meeting October 3-4, 2014 Overview of Pediatric Sleep Medicine
Fall 2014 Meeting October 3-4, 2014 Overview of Pediatric Sleep Medicine Jason Coles MD Spectrum Medical Group Helen DeVos Children s Hospital Conflict of Interest Disclosures for Speakers X 1. I do not
More informationDisclosures. Learning Objectives. Mechanical Ventilation of Infants with Severe BPD: An Interdisciplinary Approach 3/10/2017
Mechanical Ventilation of Infants with Severe BPD: An Interdisciplinary Approach Steven H. Abman, MD Professor, Department of Pediatrics Director, Pediatric Heart Lung Center University of Colorado School
More informationPediatric Sleep Disorders
Pediatric Sleep Disorders S. SHAHZEIDI, MD, FAAP, FCCP, FAASM GRAND HEALTH INSTITUTE Objectives Discuss the importance of screening for snoring Explain the signs and symptoms of parasomnias and sleep apnea
More informationBiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides
More informationManaging Sleep Disorders in Primary Care. Objectives. Disclosures. Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center
Managing Sleep Disorders in Primary Care Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center www.sleeplessinidaho.com 1 Objectives 1) Identify stages and behaviors for normal
More information