Natalia Usatii, MD Sleep Medicine SCMG
|
|
- Logan Blankenship
- 5 years ago
- Views:
Transcription
1 Natalia Usatii, MD Sleep Medicine SCMG
2 Disclosures Reported relevant financial relationships with commercial interests: N/A Conflict of Interest STOP-Bang questionnaire: Property of University Health Network
3 Outline Obstructive sleep apnea introduction Diagnostic modalities Treatment modalities Sleep deprivation outcomes in adults and adolescents Multidisciplinary communication strategy to improve patient care in the area Questions
4 Obstructive Sleep Apnea (OSA) OSA is a disease characterized by recurrent collapse of the upper airway during sleep which results in sleep fragmentation, excessive daytime sleepiness and nocturnal hypoxemia.
5
6 Won t breathe : central apnea Can t breathe : obstructive or mixed apnea
7 Clinical Features Symptoms During Sleep Loud disruptive snoring Awakenings with gasping &/or choking Morning dry mouth &/or headaches Witnessed apnea Awakens unrefreshed Frequent urination at night Body movements and leg jerks at night Symptoms While Awake Excessive sleepiness (including involuntary dozing & asleep at wheel ) Poor performance at work Fatigue Irritability, Depression, Anxiety
8 STOP-Bang Epworth Score
9 Symptoms that predict high pre-test probability for OSA Anesthesiology 2008; 108:812 21
10 Predictive Parameters for STOP -BANG Score of 3or greater Cutoff Sensitivity Specificity PPV NPP AHI> AHI> AHI> SnNout (high Sensitivity, Negative test = rule out) STOP-Bang 0-2 * Value expressed as percentage with 95% confidence interval
11 Examination for OSA Mallampati Score
12 Estimated Prevalence of OSA (China, Japan, India) (UK, France, Germany, Spain)
13 1) Increased risk of accident 2) Decreased productivity 3) Decreased ability to learn 4) Decreased adaptability 5) Risk to public 6) Increased lost work day 1) Diminished Performance 2) Impaired Procedural memory 3) Impaired working memory 4) Fatigue 5) Impaired mood (depression and anxiety) 6) Impaired quality of life Low O2 during Sleep Obstructive Sleep Apnea (OSA) Sleep Deprivation 1) Cardiac Diseases including Heart Failure, Myocardial Ischemia 2) Brain Disease including Stroke 3) Metabolic Disease including Diabetes 4) Increased risk of cancer 1) Increased direct health care cost 2) Increased lost work day 3) Fatigue 4) Reduced Performance 5) Impaired mood (depression and anxiety) 6) Impaired quality of Life
14 OSA Remains Largely Undiagnosed 15 20% Diagnosed 80 85% Undiagnosed 1. Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997; 20: Young T, Palta M, et al. The Occurrence of Sleep-Disordered Breathing Among Middle-Aged Adults. N Eng J Med. 1993;328:
15 Nocturnal polysomnography
16 Difficulties with in lab PSG: lots of wires long waiting list inconvenience frustration
17 Cost & Access to Care Issues at SCMG Sleep Labs (Bend and Redmond) We get 480 consults per month 33% are new 58 baseline sleep studies + 88 titration studies= 146 studies/month To keep up, we would need a 12 bed lab running 360 days a year We currently have a 6 bed Bend and 6 bed Redmond running 5 days a week OUR SOLUTION: 2 MORE BEDS OPENED IN REDMOND LAST YEAR
18 Solution FROM OTHER PROVIDERS/PCPs??? Home Sleep Testing (HST)
19 ORDER HST
20 Study results showed that HST is valid Sleep Jun 1;35(6): doi: /sleep A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Rosen CL 1, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Kapur V, Rueschman M, Zee P, Redline S.
21 Polysomnography Performed in the Unattended Home Versus the Attended Laboratory Setting Sleep Heart Health Study Methodology Conrad Iber, MD1; Susan Redline, MD2; Adele M. Kaplan Gilpin, PhD3; Stuart F. Quan, MD4; Lin Zhang, MD3; Daniel J. Gottlieb, MD5; David Rapoport, MD6; Helaine E. Resnick, PhD7; Mark Sanders, MD8; Philip Smith, MD9
22 Types of Sleep Testing
23 Apnea Link Ares Night One Alice PDX WatchPAT
24 PSG vs. HST: Conceptual Difference PSG is a tool of discovery HST is a tool of verification HST is not sensitive but specific If HST is negative CANNOT rule out OSA!!! Refer to in-lab polysomnography
25 NO HST IN CHILDREN!!
26 How to treat OSA?
27 Positive Airway Pressure Therapy GOLD STANDARD
28 Access to care Titration studies in the laboratory still have the same issues of being labor intensive and time consuming. Shortage of PSG beds and techs contribute to a back-log in titration studies as well
29 Auto-PAP Positive airway in which the pressure is set at a range rather than a fixed pressure
30 Sleep Program Schematic Sleep Clinic HST AutoPAP AutoPAP: Rule-out if patient has 1)COPD, daytime hypoxemia or hypercapnia 2)CHF or other heart disease 3)Morbid obesity (BMI 40) 4)Upper airway surgery 5)Opioid analgesics use 6)Neuromuscular, neurological or neurodegenerative disease; history of stroke; or seizure disorder Attended PSG Attended PSG Input Sources: If patient 1)Needs titrations or re-study 2)Has low clinical suspicion for SRBD or high suspicion for narcolepsy or seizure 3)Had negative HST or needs lab titration 4)Had AutoPAP failure
31 Positive airway pressure therapy CPAP BiPAP AutoPAP
32 BiPAP: Bilevel positive airway pressure BiPAP sets two pressures above the ambient, a higher inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP).
33 Indications OSA, not tolerating or ineffective CPAP COPD/CHF exacerbation OHS with worsening hypercapnia Neuromuscular disease, providing assistance with nocturnal ventilation.
34 Other Treatment modalities for OSA
35
36 Hypoglossal Nerve Stimulation for Treatment of Obstructive sleep apnea
37 STAR Trial Stimulation Therapy for Apnea Reduction (STAR) 22 leading medicalcenters across the US and Europe 126 patients Results published in the N ew England Jou rnal of Med icine, January 9, 2014 Up pe r-airway Stimulation for O bstructive Sleep Apnea Strollo PJ Jr, Soose RJ, Maure r J T et a l. N Eng J Med. 2014;370(2): Inspire "'1ed cal Syster1s, I 1c All Rights Reserved
38 STAR Trial Inclusion Criteria AHI of 20 to 50 BMI < 32 Central apneas < 25% of total events on PSG Absence of concentric collapse of airway on sleep endoscopy Absence of significant tonsillar hypertrophy Absence of severe restrictive pulmonary disease or COPD Absence of severe hypertension, pulmonary hypertension, heart failure, or severe valvular heart disease Absence of neuromuscular disease Absence of severe psychiatric disease
39
40 Tonsillectomy indications for OSA Tonsillectomy in children only with abnormal polysomnography: pulse oximetry levels less than 90-92% -AHI >1 -AHI >5 may warrant tonsillectomy Otolaryngology Head and Neck Surgery144(1S) S1 S
41 Treatment Of OSA Improved Sleep Quality No more Hypoxia (low Oxygen) Improved Quality of Life Improved Sleep Quantity No more rapid heart rate Improved Performance Improved Learning/Adaptability Decreased Accidents Decreased Disability Improved Mood Improved Comorbid Conditions Decreased Absenteeism/unproductive hours while at work Decreased Health Care Cost Potentially decreased Death Rate
42
43
44
45 Benjamin Bugsy Siegel
46 Venkatraman et al (Duke University): (fmri)found that the nucleus accumbens, an area in the brain involved with the anticipation of reward, IS ACTIVE when high risk-high payoff choices made sleep deprivation. "Sleep Deprivation Elevates Expectation of Gains and Attenuates Response to Losses Following Risky Decisions", Sleep, May 1, 2007.
47 SLEEP DEPRIVATION IN TEEN
48 Impacts of chronic sleep loss: A brief literature review
49 Sleep and Suicide Over 60 studies have found correlations between chronic insufficient sleep and suicide. Unlike other suicide risk factors, sleep complaints may be particularly amenable to treatment. (pg 1) - Bernert and Joiner, Sleep disturbances and suicide risk: A review of the literature
50 Sleep and Dietary Choices 13,284 teens surveyed. Teens who slept less than 7 hours per night (compared to teens who slept more) were: More likely to consume fast food two or more times per week Less likely to consume fruits and vegetables Despite race, gender, SES, physical activity and family structure we need to start thinking about how to more actively incorporate sleep hygiene education into obesity prevention and health promotion interventions. -Lead researcher Dr. Lauren Hale, Stony Brook Medicine Press Release, June 20, 2013
51 Sleep and Insulin Resistance Matthews et al, 2012: 245 healthy white and black adolescents: Elevated insulin resistance [HOMA-IR] associated with shorter sleep duration Findings were independent of age, race, gender and adiposity [amount of body fat] interventions designed to extend sleep in short sleepers may be beneficial for metabolic health in adolescence and beyond. (pg 1357)
52 Sleep and appetite Ghrelin INCREASED Leptin DECREASED
53 Risk-Taking Obesity Stress Grades Sports Injuries Car Crashes Cancer Suicide Depression Drug Use Disparities High Blood Pressure Diabetes Pedestrian Accidents Emotional Intelligence Violence Anxiety Food Choices Immune Functioning Stroke
54 QUESTIONS Which score from STOP-Bang questionnaire predicts high pre-test probability for OSA? Answer: 3 or higher
55 Which type of home sleep testing is FDA-approved for OSA diagnosis? Answer: All types
56 In absence of cardiac, pulmonary, vascular, neurologic conditions, which test should be ordered to diagnose OSA? HST
57 What is the main indication for BiPAP? Answer: CPAP failure
58 What is the sensitivity and specificity of the home sleep testing? Answer: Low sensitivity and high specificity Negative HST CANNOT rule out OSA
59 When tonsillectomy is the first choice in treatment of obstructive sleep apnea? In pediatrics
60 Thank you
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 informationManaged Care and Sleep Medicine
Managed Care and Sleep Medicine Denice Logan, DO, FACOI Regional Medical Director Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue
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 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 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 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 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 informationSweet Dreams: The Relationship between Sleep Health and Your Weight
Sweet Dreams: The Relationship between Sleep Health and Your Weight Jason C. Ong, PhD Associate Professor Department of Neurology Center for Circadian and Sleep Medicine Northwestern University Feinberg
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 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 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 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 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 informationObstructive Sleep Apnea (OSA) and Insomnia for Primary Care FSACOFP. Michael P Coppola MD FACP Executive VP of Medical Affairs NovaSom July 26, 2018
Obstructive Sleep Apnea (OSA) and Insomnia for Primary Care FSACOFP Michael P Coppola MD FACP Executive VP of Medical Affairs NovaSom July 26, 2018 Overview Sleep differential diagnosis OSA : the disease,
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 informationOSA - Obstructive sleep apnoea What you need to know if you think you might have OSA
OSA - Obstructive sleep apnoea What you need to know if you think you might have OSA Obstructive sleep apnoea, or OSA, is a breathing problem that happens when you sleep. It can affect anyone men, women
More informationInspire Therapy for Sleep Apnea
Inspire Therapy for Sleep Apnea Patient Guide Giving You the FREEDOM TO SLEEP Like Everyone Else Take Comfort. Inspire therapy can help. Inspire therapy is a breakthrough implantable treatment option for
More 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 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 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 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 informationROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA
ROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA A Person is physically qualified to drive a motor vehicle if that person; -(5) has no established medical history or clinical diagnosis
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 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 informationEmergency Contact Information Name: Phone: Address: Employer Information Employer Name: Address/Street: City: Zip: Phone: Fax:
SUNSET SLEEP LABS PATIENT INFORMATION FORM Patient Information Name: Sex: M F Date of Birth: Address/Street: City: Zip: Phone: Alt Phone: Parent/Guardian: Phone: Social Security Number: Drivers License:
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 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 informationWHY CAN T I SLEEP? Deepti Chandran, MD
WHY CAN T I SLEEP? Deepti Chandran, MD Sleep and Aging How does sleep change as we age? Do we need less sleep as we get older? Can a person expect to experience more sleep problems or have a sleep disorder
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 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 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 informationA New, Clinically Proven Sleep Apnea Therapy for people unable to use CPAP.
A New, Clinically Proven Sleep Apnea Therapy for people unable to use CPAP. Take Heart. If You Have OSA, You re Not Alone. Like you, more than 18 million Americans are estimated to have Obstructive Sleep
More informationFabrice Czarnecki, M.D., M.A., M.P.H., FACOEM I have no disclosures to make.
Maryland College of Occupational and Environmental Medicine April 2014 Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM fczarnecki@gablesgroup.com I have no disclosures to make. Guidelines 2006: Joint Task
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 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 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 informationSleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address
Patient Label For office use only Appt date: Clinician: Sleep Center Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 Leading
More informationMLA HASS LUNG. SLEEP CENTER, Leominster Campus 100 Erdman Way, Leomjnster, MA Phone: Fax:
MLA HASS LUNG SLEEP CENTER, Leominster Campus 100 Erdman Way, Leomjnster, MA 01453 Phone: 978-728-4641 Fax: 978-978-1382 MEICAL IRECTOR: Payam Aghassi, M, FCCP Thank you for your sleep study order! Attached
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 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 information11/20/2015. Beyond CPAP. No relevant financial conflicts of interest. Kristie R Ross, M.D. November 12, Describe advanced ventilation options
Beyond CPAP Kristie R Ross, M.D. November 12, 2015 No relevant financial conflicts of interest Sponsored by The Warren Alpert Medical School of Brown University Describe advanced ventilation options Compare
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 informationNON-INVASIVE VENTILATION MADE RIDICULOUSLY SIMPLE
NON-INVASIVE VENTILATION MADE RIDICULOUSLY SIMPLE Jennifer Newitt, MD 3 rd year Pulmonary/Critical Care Fellow Mentor: Patrick Strollo Jr, MD Myth or Fact?!? Myth or Fact?!? Treatment for Obstructive
More informationUIHC Home Sleep Apnea Testing (HSAT)
UIHC Home Sleep Apnea Testing (HSAT) Lisa Mertens, ARNP, RRT Department of Neurology, Sleep Division Iowa River Landing East (IRL East) Respiratory Care Seminar October 19, 2018 1 Home Sleep Apnea Test
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 informationWHAT YOU NEED TO KNOW ABOUT SLEEP APNEA
WHAT YOU NEED TO KNOW ABOUT SLEEP APNEA Wayne Driscoll Clinical Education Specialist 2 SLEEP APNEA IN THE NEWS Carrie Fisher died from sleep apnea, other factors, coroner says USA Today NJ Transit engineer
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 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 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 informationHypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment
Hypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment Judith R. Fischer, MSLS, Editor, Ventilator-Assisted Living (fischer.judith@sbcglobal.net) Thanks to Josh Benditt, MD, University
More informationSleep History Questionnaire B/P / Pulse: Neck Circum Wgt: Pulse Ox
2700 Campus Drive, Ste 100 2412 E 117 th Street Plymouth, MN 55441 Burnsville, MN 55337 P 763.519.0634 F 763.519.0636 P 952.431.5011 F 952.431.5013 www.whitneysleepcenter.com Sleep History Questionnaire
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 informationSleep in the Patient with Diabetes
Sleep in the Patient with Diabetes ANDREA RINN, DO SEPTEMBER, 2017 Learning Objectives 1. Recognize the correlation between sleep apnea and diabetes 2. Review potential relationships between sleep and
More informationNew Patient Sleep Intake
New Patient Sleep Intake Name: Date of Birth: Primary Care Physician: Date of Visit: Referring Physician and/or Other Physicians: Retail Pharmacy: Mail Order Pharmacy: Address: Mail Order Phone #: Phone
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 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: A Forgotten Component of Overall Health Demarcus Sneed Health and Human Sciences Educator Madison County October 5, 2016
Sleep: A Forgotten Component of Overall Health Demarcus Sneed Health and Human Sciences Educator Madison County October 5, 2016 Lesson Objectives Understand the importance of having consistent, quality
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 informationPULMONARY & CRITICAL CARE CONSULTANTS OF AUSTIN 1305 West 34 th Street, Suite 400, Austin, TX Phone: Fax:
Name: Sex: Age: Date: Date of Birth Height Weight Neck size Referring Physician: Primary Care MD: Main Sleep Complaint(s) trouble falling asleep trouble remaining asleep excessive sleepiness during the
More informationSleep Labs are Obsolete for Perioperative Assessment of Sleep-Disordered Breathing: Pro
Sleep Labs are Obsolete for Perioperative Assessment of Sleep-Disordered Breathing: Pro Lawrence J. Epstein, MD Brigham and Women s Hospital Harvard Medical School Welltrinsic Sleep Network Conflicts of
More information2/13/2018 OBESITY HYPOVENTILATION SYNDROME
OBESITY HYPOVENTILATION SYNDROME David Claman, MD UCSF Professor of Medicine Director, UCSF Sleep Disorders Center Disclosures: None. 1 COMPLICATIONS OF OSA Cardiovascular HTN, CHF, CVA, arrhythmia, Pulm
More informationWELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS
WELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS Prior to your office visit, we request that you complete this questionnaire. It asks questions not only about your sleeping habits and behavior
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 informationSleep Disorders Diagnostic Center 9733 Healthway Drive, Berlin, MD , ext. 5118
Sleep Questionnaire *Please complete the following as accurate as possible. Please bring your completed questionnaire, insurance card, photo ID, Pre-Authorization and/or Insurance referral form, and all
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 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 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 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 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 informationPATIENT DEMOGRAPHICS
PATIENT DEMOGRAPHICS NPSG CPAP CPAP Retitration Split Night PATIENT INFORMATION: Name: Last First Middle Initial Address: City: State: Zip: Social Security #: DOB: Gender: Age: Phone Number: Cell: Work:
More informationsleepview by midmark Home Sleep Test
sleepview by midmark HST Home Sleep Test Introducing SleepView. Better for your patients, designed for your practice. Home sleep testing (HST) brings the diagnosis and management of OSA to the front lines
More informationAsleep at the Wheel Understanding and Preventing Drowsy Driving
LIFESAVERS April 23, 2018 San Antonio, TX 2:15 3:45 PM Room 214 D Sleepiness and Accidents: A Crash Course EVOLVING SAFETY PRIORITIES AND SOLUTIONS Asleep at the Wheel Understanding and Preventing Drowsy
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 informationRediscover the power of sleep
Rediscover the power of sleep Patient Copy Apnea solutions for all ages Mobile Sleep Services Who We Are An experienced and well trained team of sleep care professionals consisting of Registered Sleep
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 informationSleep and Executive Performance
Sleep and Executive Performance 2017 United Fresh Produce Executive Development Program Ana C. Krieger, MD, MPH, FAASM, FCCP Medical Director, Center for Sleep Medicine Associate Professor, Weill Cornell
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 informationAshok K. Modh, M.D., F.C.C.P. Naishadh K. Mandaliya, M.D., F.C.C.P. Jerges J. Cardona, M.D. Nirav B. Patel, M.D.
Ashok K. Modh, M.D., F.C.C.P. Naishadh K. Mandaliya, M.D., F.C.C.P. Jerges J. Cardona, M.D. Nirav B. Patel, M.D. Dear, Your physician has requested that you be scheduled for a sleep study. Your appointment
More informationI would like for my patient to be seen in Sleep Medicine consultation and managed by the sleep physician. Yes No
701 E. COUNTY LINE ROAD, SUITE 207. GREENWOOD, IN. 46143 OFFICE317-887-6400 FAX 317-887-6500 indianasleepcenter.com REFERRAL FOR SLEEP EVALUATION Patient Name:_ Phone: I would like for my patient to be
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 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 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 informationCase. Case. Case. Sleep Disorders: A Case-based Approach. LeRoy Essig, MD Rami Khayat, MD ROS:
Sleep Disorders: A Case-based Approach LeRoy Essig, MD Rami Khayat, MD Case ROS: 30 Lbs wt gain/1year Fatigue Heart burn Nasal congestion, dry mouth Reduced concentration/memory Case 47 y/o male presents
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 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 informationIntake Questionnaire
Intake Questionnaire In order to make the best use of your appointment time, please complete this form prior to your initial appointment. What is your name? (Who filled in this form?) (Y= yes N=no DK=
More informationmore than 50% of adults weigh more than 20% above optimum
In the US: more than 50% of adults weigh more than 20% above optimum >30 kg m -2 obesity >40 kg m -2 morbid obesity BMI = weight(kg) / height(m 2 ) Pounds X 2.2 Inches divided by 39, squared From 2000
More informationSleep Apnoea : its impact outside the chest. Dr Tom Mackay Consultant Respiratory Physician Royal Infirmary Edinburgh
Sleep Apnoea : its impact outside the chest Dr Tom Mackay Consultant Respiratory Physician Royal Infirmary Edinburgh Body Mass Index < 20 kg/m 2 20-25 kg/m 2 25-30 kg/m 2 > 30 kg/m 2 underweight normal
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 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 informationSleep and Epilepsy. Nancy Foldvary-Schaefer, DO, MS
Sleep and Epilepsy Nancy Foldvary-Schaefer, DO, MS Burden of epilepsy Affects over 50 million people worldwide; 2 million new cases/yr Estimated 30-40% continue to have seizures despite anti-seizure medications
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 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 Center New Patient Questionnaire
For office use only Appt date: Sleep Center Clinician: Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 #1 respiratory hospital
More informationLittleton, CO Welcome Packet 8151 Southpark Lane, Suite 200 Littleton, CO 80120
Littleton, CO Welcome Packet For any after-hours questions, please call (303) 956-5145 Dear Mountain Sleep Patient, You have been scheduled for a sleep study at 8151 Southpark Lane, Suite 200, Littleton,
More informationObstructive Sleep Apnea
Obstructive Sleep Apnea Introduction Obstructive sleep apnea is an interruption in breathing during sleep. It is caused by throat and tongue muscles collapsing and relaxing. This blocks, or obstructs,
More informationHelping You to Breathe Better, Sleep Easy & Live Well
Helping You to Breathe Better, Sleep Easy & Live Well Your Guide to CPAP Therapy info@cansleep.ca Vancouver Island Lower Mainland Fraser Valley Sleep Apnea & Symptoms Obstructive Sleep Apnea (OSA) occurs
More informationDear, Respectfully, United Sleep Centers SLEEP STUDY DATE: FEBUARY 26, 2015 AT OUR DOWNEY CENTER TIME: 10PM, PLEASE ARRIVE ON TIME
Sleep Study Instructions SLEEP STUDY DATE: FEBUARY 26, 2015 AT OUR DOWNEY CENTER TIME: 10PM, PLEASE ARRIVE ON TIME ADDRESS: 11411 BROOKSHIRE AVE SUITE 505 DOWNEY, CA Dear, Thank you for choosing us as
More information