Diagnosis and Management of Obstructive Sleep Apnea in Inpatients at Hoag Hospital. Main Points. Why screen?

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Diagnosis and Management of Obstructive Sleep Apnea in Inpatients at Hoag Hospital. Main Points. Why screen?"

Transcription

1 Diagnosis and Management of Obstructive Sleep Apnea in Inpatients at Hoag Hospital Angela Halpin MN, RN, CNS Hoag Memorial Hospital Presbyterian and UCLA School of Nursing Main Points (1)OSA is prevalent in medical and surgical inpatients (2) Establish rationale for screening this population (3) Review an approach to screening the Hoag Hospital process (4)Discussion: How should this be done nationwide? Why screen? Prevent post operative respiratory failure Identify patients who will benefit from long term treatment of Sleep Apnea Provides care to patients w/ existing diagnosis of OSA Patients already use CPAP/BiPap Settings are known

2 Unrecognized OSA A medical concern Current estimates suggest that moderately severe OSA is present in approximately 11.4% of men and 4.7% of women. OSA Prevalence Medical Conditions Hypertension Heart Failure Systolic Dysfunction Stroke CAD Arrhythmias End stage renal disease OSA in Surgical Patients Studies confirm risk based on criteria Risk of increase morbidity Studies vary in sample size Recovery challenge for management of airway OSA patients identified as a risk.

3 OSA Prevalent Surgical In-patients Why? Anesthesia depresses respirations in normal individuals, OSA higher risk Influences lung volume risk for collapse of lung CNS drugs diminish pharyngeal dilator muscles and promote pharyngeal collapse Reference: Paje & Kremer (2006) Pre-evaluation Algorithms Preoperative evaluation of the patient of known or suspected obstructive sleep apnea in the anesthesia clinic. Seet E, & Chung F. Management of sleep apnea in adults functional algorithms for the perioperative period: continuing professional development. Canadian Journal of Anesthesia.2010;57: Study by Chung et al Chung et al.,(2007) found 24% of 305 surgical patients were classified as being at high risk of having OSA using the Berlin questionnaire 13 patients were confirmed as having OSA by polysomnography, 4.2% of the total number of patients screened

4 Inpatient Sleep Apnea at Hoag Angela Halpin RN and Paul Selecky MD (1)Screen all inpatients with STOP- BANG questionnaire (2)Scores greater than 3 get oximetry (3)Severe OSA by oximetry results in immediate CPAP initiation. Mild to moderate are referred for outpatient evaluation Screening Tools: STOP-BANG F Chung et al Anesthesiology 108(2008): Subjects: preoperative patients Sample 2,467 patients Procedures: Methods Survey using questionnaire; Validation w/ follow up polysomnography Results: 27.5% qualified as high risk; Diagnosis of OSA actual n=122 Consistency and Sensitivity of survey effective Tool predictive by sensitivity, validation Limitations: Sample small for actual subjects tested using polysomnography Risk by Stop Bang Score Development of Stop Bang Score vs. Percentage of Risk Benefits of study Successful pilot study, 1,875 patients were screened and asked to complete the STOP questionnaire. Two hospitals preoperative clinics Tools valid and sensitive Chung,et al., 2008

5 STOP-BANG questionnaire STOP S (snore) Do you snore loudly (louder Yes/No than talking or loud enough to be heard through closed doors)? T (tired) Do you often feel tired, fatigued, Yes/No or sleepy during daytime? O (observed) Has anyone observed you stop Yes/No breathing during sleep? P HTN Do you have or are you being treated for high blood pressure? Yes/No BANG B (body mass BMI > 35 kg/m2? Yes/No index [BMI]) A (age) Age > 50 years? Yes/No N (neck) Neck circumference > 40 cm? Yes/No G (gender) Gender male? Yes/No Yes to 3 questions = high risk of obstructive sleep apnea Preadmission OSA Screening Process Flow Emergency Dept. Direct Admission 3+ Variables Indicated Nurse Reviews Patient History Nursing/RCP Assessment Continued Patient Monitoring For OSA Risk Factors Oximetry (pilot) Study Ordered By Nurse Risk Identified OSA Screening No Risk Identified Oximetry Study Reviewed By MD No Evidence of Apnea Apnea Identified CPAP Ordered Patient Referred For Sleep Study Upon Discharge How to interpret sleep oximetry Mild OSA (AHI score of 5 15) can generally be managed after surgery Moderate OSA (AHI score of 15 30) and Severe OSA (AHI score > 30) can affect perioperative management

6 Hoag Study Retrospective Quasi Experimental Procedure: retrospective chart reviews to measure compliance of nurses screening and ordering test or CPAPs Sample: Orthopedic surgical patients Methods: Pre and Post staff education Findings: 95% of same day RNs screened patients/assured screening communicated to anesthesia. Low Limitations: period between education extended. Sleep Oximetry in hospital Additional Information

7 Initiating CPAP Therapy Inpatients (1)Severe patients receive CPAP starting in the hospital (2)Settings and oxygen needs determined (3)All patients at risk placed on continuous pulse oximetry 24/7 until discharge (4)Head of Bed at 30 degrees if not contraindicated (5)Mild to moderate receive outpatient follow up (6)Education provided to patients/families Case Study 50 year old woman Recently admitted for back surgery January Hx is a smoker, BMI 38, Neck circumference 18 & ½, Snores Desaturations & AHI score Discharged w/ CPAP setting 7 cm of H 2 O Discharge Discharged w/ CPAP setting 7 cm of H 2 O Underwent sleep study post hospital Apnea Hyponea Score 15.1 Mild to loud snoring during study Decision Sleep Medicine and Pulmonoligist monitor

8 Case Study #2 A 58 year old with gastritis, liver cirrhosis, HTN, DM 2, Opiate dependency, Hypothyroidism, smokes Nursing identified patient at risk had three of more criteria base on Stop Bang Questionnaire BMI 34.3, HTN, Snores Discharge Discharged w/ CPAP setting 10 cm of H 2 O Underwent polysomnography post hospital Apnea Hyponea Score 28 Loud snoring during study CPAP ordered and follow up with Sleep Medicine with Pulmonologist to monitor Improving Post Hospital Care Issues for discussion Communication with providers Letters from hospital on any testing to PMD Peer to Peer Polysomnography testing Orders Scheduled prior to discharge CPAP management Sleep Medicine Follow Up

9 SLEEP STUDIES Conclusion OSA is widely prevalent OSA affects inpatient and outpatient outcomes Medical-surgical patients should be screened for OSA using a valid tool Positive results require oximetry and possibly CPAP Outpatient follow up is important Effective Sleep is essential. Enjoy the conference!

10 References 1. Basner, R.C. (2007). Continuous Positive Airway Pressure for obstructive sleep apnea. New England Journal of Medicine;. 356; 17: Berend, et al. (2010). Prevalence & Management of Obstructive Sleep Apnea in patients undergoing Total Joint Arthroplasty. 25(6) Carpenito, L.J. (2000). Nursing diagnosis application to clinical practice. Eighth Edition Philadelphia, New York, Baltimore. Lippincott. 4. Chung, F., Yegneswaran, B. Liao, P., Chung,P., Vairavanathan et. al. Stop Bang Questionnaire, A Tool to Screen Patients for Obstructive Sleep Apnea. Anesthesiology, (2007).108: Chung F, Ward B, Ho J, Yuan H, Kayumov L, Shapiro C: Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. Journal of Clinical Anethesia 2007; 19: Harrison, Childs, & Carson (2003). Incidence of undiagnosied Sleep Apnea in patients scheduled for elective total joint arthroplasty. The Journal of Arthroplasty 18(8), Kushida, C.A, Litner. M.R., Morgenthaler, T., Alessi., C.A., Bailey, D., Coleman, J., Freidman, L., Hirshkowitz, M.., Kapen, S., Kramer, M.., Lee-Chiong, T., Loube, D.L., Owens, J., Pancer, J.P., Wise, M. (2005). Practice Parameters for indications for Polysomnography and Related Procedures: An Update for Sleep; 28 (4) References 8. Meoli AL, Rosen CL, Kristo D, et al. (2003). Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period avoiding complications. Clinical Practice Review Committee, American Academy of Sleep Medicine. Sleep; 26: Shafazand, S. (2009). Perioperative management of obstructive sleep apnea: Ready for prime time? Cleveland Clinic Journal of Medicine, 76(Suppl 4):S98; /ccjm.76.s Young, T. Shahar, E., Nieto, J. Redline, S., Newman, A., Gottlieb, D. J., Walsleben, J.A.., Finn, L. Enright, P.Samet, J.M. (2002). Predictors of Sleep-Disordered Breathing in Community-Dwelling Adults. Arch Intern Med;162, Nursing Practice Act. Business and Professions Code of California. Article 2. Scope of Regulation Legislative intent; Practice of nursing defined. & Standardized Procedure Guidelines. Title 16, CCR Section Stop Bang Questionnaire OSA risk: Gay, P.C.(2010). Sleep and sleep disorder breathing in the hospitalized patient. Respiratory Care; 55(9) Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea. (2006) Anesthesiology, 104: Quality Improvement (Force #7); Retrieved online 10/29/08:

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Perioperative Management of Patients with Obstructive Sleep Apnea Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Disclosures. This activity is supported by an education grant from Trivalley

More information

Screening for Obstructive Sleep Apnea in Hospitalized Patients Using the STOP-Bang Questionnaire

Screening for Obstructive Sleep Apnea in Hospitalized Patients Using the STOP-Bang Questionnaire Screening for Obstructive Sleep Apnea in Hospitalized Patients Using the STOP-Bang Questionnaire Tonya L. Appleby, MSN, CCRN, CEN, CRNP Clinical & Administrative Coordinator, Hospitalist Service University

More information

Is Obstructive Sleep Apnea Affecting Your Daily Life?

Is Obstructive Sleep Apnea Affecting Your Daily Life? Is Obstructive Sleep Apnea Affecting Your Daily Life? Is Obstructive Sleep Apnea Affecting Your Daily Life? Do you feel sleepy during the day no matter how much sleep you get? Can you fall asleep easily

More information

Diagnosis and Treatment

Diagnosis and Treatment Sleep Apnea: Diagnosis and Treatment Sleep Apnea Sleep Apnea is Common Dangerous Easily recognized Treatable Types of Sleep Disordered Breathing Apnea Cessation of airflow > 10 seconds Hypopnea Decreased

More information

Changes in the Evaluation and Treatment of Sleep Apnea

Changes in the Evaluation and Treatment of Sleep Apnea Changes in the Evaluation and Treatment of Sleep Apnea Joseph DellaValla, MD FACP Medical Director Center for Sleep Medicine At Androscoggin Valley Hospital Sleep Related Breathing Problems Obstructive

More information

Underwriting Sleep Apnea

Underwriting Sleep Apnea Underwriting Sleep Apnea Joel Weiner, MD, FLMI April 29, 2014 WAHLU The Northwestern Mutual Life Insurance Company Milwaukee, WI A Brief Survey Before We Get Started The Weiner Sleepiness Scale How likely

More information

Obstructive Sleep Apnea:

Obstructive Sleep Apnea: Obstructive Sleep Apnea: Review of Screening and Management JOHN REID MD, FRCP(C), D.ABSM CSIM CONFERENCE CALGARY OCTOBER 2014 Disclosure Slide No financial or intellectual conflicts of interest to declare

More information

Obstructive Sleep Apnea Case Study

Obstructive Sleep Apnea Case Study Obstructive Sleep Apnea Case Study Shirin Shafazand, MD, MS Neomi Shah, MD for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee August 2014 Part 1: Case Presentation Mr. Simon

More information

COPD and Sleep Apnea (an overview)

COPD and Sleep Apnea (an overview) COPD and Sleep Apnea (an overview) Michael Zgoda, MD, MBA, FCCP Chief, Department of Medicine CMC-University Assoc. Prof. of Medicine, UNC Chapel-Hill Case Presentation 65 yo female with 44 pack year tobacco

More information

HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE

HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE The following diagnostic tests for Obstructive Sleep Apnea (OSA) should

More information

The Interface Between Sleep Apnea and Seizures. Hrayr Attarian M.D. Northwestern University Feinberg School of Medicine.

The Interface Between Sleep Apnea and Seizures. Hrayr Attarian M.D. Northwestern University Feinberg School of Medicine. The Interface Between Sleep Apnea and Seizures Hrayr Attarian M.D. Northwestern University Feinberg School of Medicine. What is Sleep Apnea? Obstructive sleep apnea syndrome (OSA) is characterized by repeated

More information

Raising Sleep Apnea Awareness:

Raising Sleep Apnea Awareness: Raising Sleep Apnea Awareness: Among People with Diabetes in North Carolina, 2012 People with diabetes have more sleep problems than people without diabetes in the same age, sex, and race/ethnicity group.

More information

The heart of the matter. Sleep apnea and cardiovascular disease

The heart of the matter. Sleep apnea and cardiovascular disease The heart of the matter Sleep apnea and cardiovascular disease The cardiologist s role Obstructive Sleep Apnea (OSA) is a common breathing disorder that has been associated with an increased risk of hypertension,

More information

elf-awareness Toolkit

elf-awareness Toolkit S Snoring & Sleep Apnea elf-awareness Toolkit Snoring: Your Dentist Can Test So You Can Rest 2009 Snoring Isn t Sexy, LLC S Snoring & Sleep Apnea elf-awareness Toolkit Snoring: Your Dentist Can Test So

More information

ROLE OF ORAL APPLIANCES TO TREAT OBSTRUCTIVE SLEEP APNEA

ROLE OF ORAL APPLIANCES TO TREAT OBSTRUCTIVE SLEEP APNEA 1 ROLE OF ORAL APPLIANCES TO TREAT OBSTRUCTIVE SLEEP APNEA There are three documented ways to treat obstructive sleep apnea: 1. CPAP device 2. Oral Appliances 3. Surgical correction of nasal and oral obstructions

More information

Sleep Apnea. ACP Oct 26, 2014. Bashir Chaudhary, MD Sleep Institute of Augusta, Augusta GA

Sleep Apnea. ACP Oct 26, 2014. Bashir Chaudhary, MD Sleep Institute of Augusta, Augusta GA Sleep Apnea ACP Oct 26, 2014 Bashir Chaudhary, MD Sleep Institute of Augusta, Augusta GA Emeritus Professor of Medicine and Assistant Dean of Clinical Affairs, CAHS Medical College of Georgia, Georgia

More information

Does sleep apnea cause heart disease?

Does sleep apnea cause heart disease? Does sleep apnea cause heart disease? Updates in Cardiology 2015 7 Mar 2015 Robert J Farney MD Intermountain Sleep Disorders Center LDSH Medical Director robertjfarney@gmail.com Does sleep apnea cause

More information

Creating a Safer Perioperative Environment With an Obstructive Sleep Apnea Screening Tool

Creating a Safer Perioperative Environment With an Obstructive Sleep Apnea Screening Tool Creating a Safer Perioperative Environment With an Obstructive Sleep Apnea Screening Tool Linda Lakdawala, DNP, RN, CPAN Obstructive sleep apnea (OSA) is a common condition that increases the risk of complications

More information

Oximetry Alone Versus Portable Polygraphy for Sleep Apnea Screening Before Bariatric Surgery

Oximetry Alone Versus Portable Polygraphy for Sleep Apnea Screening Before Bariatric Surgery OBES SURG (2010) 20:326 331 DOI 10.1007/s11695-009-0055-9 CLINICAL RESEARCH Oximetry Alone Versus Portable Polygraphy for Sleep Apnea Screening Before Bariatric Surgery Maude Malbois & Vittorio Giusti

More information

Fiberoptic bronchoscopy (FOB) is a procedure that pulmonologists

Fiberoptic bronchoscopy (FOB) is a procedure that pulmonologists Original Article Diagnosing Obstructive Sleep Apnea by Performing Fiberoptic Bronchoscopy and PEEP Titration of Mask Continuous Positive Airway Pressure Saenghirunvattana S, MD Sawang Saenghirunvattana,

More information

Does Depression affect compliance with CPAP therapy in patients with Obstructive Sleep Apnea? Ramesh Metta, MBBS M Jeffery Mador, MD

Does Depression affect compliance with CPAP therapy in patients with Obstructive Sleep Apnea? Ramesh Metta, MBBS M Jeffery Mador, MD Does Depression affect compliance with CPAP therapy in patients with Obstructive Sleep Apnea? Ramesh Metta, MBBS M Jeffery Mador, MD Background Obstructive Sleep Apnea(OSA) Obstructive sleep apnea (OSA)

More information

Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients.

Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients. Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients. Prevalence of OSA and diabetes Prevalence of OSA Five

More information

What you Need to Know about Sleep Apnea and Surgery

What you Need to Know about Sleep Apnea and Surgery What you Need to Know about Sleep Apnea and Surgery UHN For patients with sleep apnea who are going to have surgery Read this brochure to learn: What sleep apnea is Risks of having sleep apnea when going

More information

SLEEP APNEA SCREENING AND SURVEILLANCE Low Cost Monitoring Device

SLEEP APNEA SCREENING AND SURVEILLANCE Low Cost Monitoring Device SLEEP APNEA SCREENING AND SURVEILLANCE Low Cost Monitoring Device Sammy Homsi and Mustafa Muhyi Team Number: 42 Teacher: Rebecca Galves Mentor: Noor Muhyi CONTENTS Figure and tables...2 Abstract 3 Introduction..

More information

Diseases and Health Conditions that can Lead to Daytime Sleepiness

Diseases and Health Conditions that can Lead to Daytime Sleepiness October 21, 2014 Diseases and Health Conditions that can Lead to Daytime Sleepiness Indira Gurubhagavatula, MD, MPH Associate Professor Director, Occupational Sleep Medicine University of Pennsylvania,

More information

About Sleep Apnea ABOUT SLEEP APNEA

About Sleep Apnea ABOUT SLEEP APNEA ABOUT SLEEP APNEA About Sleep Apnea What is Sleep Apnea? Sleep Apnea (from Greek, meaning "without breath") is one of the most common sleep disorders in which breathing stops and then restarts again recurrently

More information

Sign up to receive ATOTW weekly - email worldanaesthesia@mac.com

Sign up to receive ATOTW weekly - email worldanaesthesia@mac.com OBSTRUCTIVE SLEEP APNOEA AND ANAESTHESIA ANAESTHESIA TUTORIAL OF THE WEEK 152 21 ST SEPTEMBER 2009 Dr Shona Bright Royal Hobart Hospital Correspondence to shona.bright@dhhs.tas.gov.au QUESTIONS Before

More information

American Academy of Sleep Medicine Response to the ACP Clinical Practice Guideline for the Diagnosis of Obstructive Sleep Apnea in Adults

American Academy of Sleep Medicine Response to the ACP Clinical Practice Guideline for the Diagnosis of Obstructive Sleep Apnea in Adults American Academy of Sleep Medicine Response to the ACP Clinical Practice Guideline for the Diagnosis of Obstructive Sleep Apnea in Adults September 2014 Timothy I. Morgenthaler, MD President Note: The

More information

MODULE. POSITIVE AIRWAY PRESSURE (PAP) Titrations

MODULE. POSITIVE AIRWAY PRESSURE (PAP) Titrations MODULE POSITIVE AIRWAY PRESSURE (PAP) Titrations POSITIVE AIRWAY PRESSURE (PAP) TITRATIONS OBJECTIVES At the end of this module the student must be able to: Identify the standards of practice for administering

More information

Out of Center Sleep Testing and Auto-titrating CPAP: Gizmos and Gadgets. Kathleen Sarmiento, MD NAMDRC 2014

Out of Center Sleep Testing and Auto-titrating CPAP: Gizmos and Gadgets. Kathleen Sarmiento, MD NAMDRC 2014 Out of Center Sleep Testing and Auto-titrating CPAP: Gizmos and Gadgets Kathleen Sarmiento, MD NAMDRC 2014 DISCLOSURE Dr. Sarmiento has received research grants from Philips Respironics and ResMed, these

More information

Polysomnography in Patients with Obstructive Sleep Apnea. OHTAC Recommendation. Polysomnography in Patients with Obstructive Sleep Apnea

Polysomnography in Patients with Obstructive Sleep Apnea. OHTAC Recommendation. Polysomnography in Patients with Obstructive Sleep Apnea OHTAC Recommendation Polysomnography in Patients with Obstructive Sleep Apnea June 16, 2006 1 The Ontario Health Technology Advisory Committee (OHTAC) met on June 16, 2006 and reviewed a health technology

More information

Munson Sleep Disorders Center

Munson Sleep Disorders Center Home Sleep Apnea Testing and/or Polysomnography Direct Referral Program The CDC and National Institutes of Health estimate that sleep-related problems affect 50 to 70 million Americans of all ages and

More information

Maharashtra University of Health Sciences, Nashik. Syllabus. Fellowship Course in Sleep Medicine

Maharashtra University of Health Sciences, Nashik. Syllabus. Fellowship Course in Sleep Medicine Maharashtra University of Health Sciences, Nashik Syllabus Fellowship Course in Sleep Medicine Appendix A a) Title of the Fellowship Course: Fellowship Course in Sleep Medicine b) Duration of Course: 1

More information

Sleep Apnea: Treatment

Sleep Apnea: Treatment Sleep Apnea: Treatment I. Policy University Health Alliance (UHA) will reimburse for positive airway pressure devices for the treatment of obstructive sleep apnea (OSA) when it is determined to be medically

More information

Developing a Perioperative Sleep Apnea Safety Program

Developing a Perioperative Sleep Apnea Safety Program Developing a Perioperative Sleep Apnea Safety Program Wm. Charles Sherrill, Jr M.D. Sleep Program Medical Director Presbyterian Sleep Health Novant Carolina Sleep Society May 5, 2012 Conflict of Interest:

More information

Understanding Sleep Apnea

Understanding Sleep Apnea Understanding Sleep Apnea www.sleepmangementsolutions.com What is Obstructive Sleep Apnea (OSA)? OSA afflicts 20 million adult men and women in the U.S. People who have OSA stop breathing repeatedly during

More information

CHILDHOOD OBSTRUCTIVE SLEEP APNEA SYNDROME

CHILDHOOD OBSTRUCTIVE SLEEP APNEA SYNDROME CHILDHOOD OBSTRUCTIVE SLEEP APNEA SYNDROME Chng Seo Yi Obstructive Sleep Apnea Syndrome (OSAS) in children is a disorder of breathing during sleep characterized by upper airway obstruction that disrupts

More information

Sleep Apnea Dr. Douglas Tapper

Sleep Apnea Dr. Douglas Tapper Sleep Apnea Dr. Douglas Tapper Dr. Hendler: Hello and welcome to KP Healthcast. I m your host today, Dr. Peter Hendler, and our guest is Dr. Douglas Tapper who is the chief of Pulmonary Medicine at Kaiser

More information

Arlington Dental Associates Ira Stier DDS PC 876 Dutchess Tpk 2 Lafayette Ct. Poughkeepsie, NY 12603 Fishkill, NY 12524 845-454-7023 845-896-4977

Arlington Dental Associates Ira Stier DDS PC 876 Dutchess Tpk 2 Lafayette Ct. Poughkeepsie, NY 12603 Fishkill, NY 12524 845-454-7023 845-896-4977 Home Sleep Test Liability Form Study Equipment Due: @ I, accept responsibility for the sleep monitoring device while it is in rny possession. I understand that if I fail to return the device or I return

More information

The patient did not complete sleep diaries which confirmed the impressions above.

The patient did not complete sleep diaries which confirmed the impressions above. History of the present illness: 70 year old patient went to the sleep lab at his wife s request in 2007 with the results shown below. He denied sleepiness at the time and denies that CPAP led him to feel

More information

Obstructive Sleep Apnoea

Obstructive Sleep Apnoea for health professionals Obstructive Sleep Apnoea Obstructive Sleep Apnoea Definition Sleep apnoea is a disorder in which breathing is repeatedly interrupted during sleep. The word apnoea literally means

More information

Treatment of Obstructive Sleep Apnea (OSA)

Treatment of Obstructive Sleep Apnea (OSA) MP9239 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes as shown below None Prevea360 Health Plan Medical Policy: 1.0 A continuous positive airway

More information

Obstructive Sleep Apnea and Obstructive Airway Diseases. Interactions

Obstructive Sleep Apnea and Obstructive Airway Diseases. Interactions Obstructive Sleep Apnea and Obstructive Airway Diseases Interactions Conflicts of Interest Work: Funded by University of Alberta Research: GSK, AZ, BI; Public Health Agency of Canada; CADTH Honoraria:

More information

GEORGIA UROLOGY AMBULATORY SURGERY CENTER 2685 MILSCOTT DRIVE, DECATUR, GA 30033 TELEPHONE 404-292-7333

GEORGIA UROLOGY AMBULATORY SURGERY CENTER 2685 MILSCOTT DRIVE, DECATUR, GA 30033 TELEPHONE 404-292-7333 GEORGIA UROLOGY AMBULATORY SURGERY CENTER 2685 MILSCOTT DRIVE, DECATUR, GA 30033 TELEPHONE 404-292-7333 PLEASE PRINT, COMPLETE AND RETURN THE FOUR PAGE PRE-OPERATIVE HEALTH QUESTIONNAIRE WITHIN 5 DAYS

More information

BCN e-referral Questionnaire Preview: Sleep study, outpatient facility or clinic-based setting

BCN e-referral Questionnaire Preview: Sleep study, outpatient facility or clinic-based setting Sleep studies, outpatient facility or clinic-based setting Blue Care Network provides coverage for attended sleep studies in the outpatient treatment setting for pediatric members and for adult members

More information

Obstructive Sleep Apnea: Test and you will diagnose But what does that mean? A PCP s attempt to understand

Obstructive Sleep Apnea: Test and you will diagnose But what does that mean? A PCP s attempt to understand Obstructive Sleep Apnea: Test and you will diagnose But what does that mean? A PCP s attempt to understand John Koeppe, MD General Internal Medicine Grand Rounds March 18 th, 2014 Disclosures No financial

More information

Snoring and Obstructive Sleep Apnea (updated 09/06)

Snoring and Obstructive Sleep Apnea (updated 09/06) Snoring and Obstructive Sleep Apnea (updated 09/06) 1. Define: apnea, hypopnea, RDI, obstructive sleep apnea, central sleep apnea and upper airway resistance syndrome. BG 2. What are the criteria for mild,

More information

PAGE 1 OF 1 0 REFERENCE CURRENT EFFECT DATE 10/13 ORIGINAL ISSUE DATE 09/12 TITLE: SUBJECT: Patient Care

PAGE 1 OF 1 0 REFERENCE CURRENT EFFECT DATE 10/13 ORIGINAL ISSUE DATE 09/12 TITLE: SUBJECT: Patient Care PAGE 1 OF 1 0 REFERENCE [ ] All Sharp HealthCare AFFECTED DEPARTMENTS: ACCREDITATION: [ ] System Services Surgery Centers: [ ] SRS [ ] CV-OPS [ ] SCMG [ ] GPSC [ ] SHP [ ] SMH-OPP Hospitals (check all

More information

Medical Affairs Policy & Procedure

Medical Affairs Policy & Procedure Medical Affairs Policy & Procedure Service: Sleep Disorder Testing (Polysomnogram, Split Night Polysomnogram, Sleep Study, Multiple Sleep Latency Test (MSLT), Maintenance of Wakefulness Testing (MWT),

More information

Comparing the Performance and Efficacy of the 3B/BMC RESmart. Auto-CPAP with the ResMed S9 AutoSet

Comparing the Performance and Efficacy of the 3B/BMC RESmart. Auto-CPAP with the ResMed S9 AutoSet 3B MEDICAL, INC., 21301 US HIGHWAY 27, LAKE WALES, FL. 33859 Comparing the Performance and Efficacy of the 3B/BMC RESmart Auto-CPAP with the ResMed S9 AutoSet Zhi Zhuang, PhD, Research and Development,

More information

BIPAP Coverage Guidelines

BIPAP Coverage Guidelines BIPAP Coverage Guidelines BIPAP/E0470 DX: Thoracic Disorder There is documentation in the patient's medical record of a neuromuscular disease (for example, amyotrophic lateral sclerosis) or a severe thoracic

More information

BREATHE EASY WHY AM I USING CPAP?

BREATHE EASY WHY AM I USING CPAP? BREATHE EASY WHY AM I USING CPAP? Your doctor has prescribed Continuous Positive Airway Pressure or CPAP (pronounced See -pap) therapy for you. When used appropriately, CPAP therapy is nearly 100% effective

More information

Truck driving is a hazardous occupation,

Truck driving is a hazardous occupation, 324 Validation of Sleep Apnea Screening Criteria Talmage et al Consensus Criteria for Screening Commercial Drivers for Obstructive Sleep Apnea: Evidence of Efficacy James B. Talmage, MD Toney B. Hudson,

More information

CPAP Treats Muscle Cramps in Patients with Obstructive Sleep Apnea

CPAP Treats Muscle Cramps in Patients with Obstructive Sleep Apnea CPAP Treats Muscle Cramps in Patients with Obstructive Sleep Apnea Andrew J Westwood, M.D., MRCP(UK) 1, Andrew R Spector, M.D., 2 Sanford H Auerbach, M.D. 3 1 Columbia University College of Physicians

More information

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012 Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced

More information

Sleep Medicine 10 (2009) 753 758. Contents lists available at ScienceDirect. Sleep Medicine. journal homepage: www.elsevier.

Sleep Medicine 10 (2009) 753 758. Contents lists available at ScienceDirect. Sleep Medicine. journal homepage: www.elsevier. Sleep Medicine 10 (2009) 753 758 Contents lists available at ScienceDirect Sleep Medicine journal homepage: www.elsevier.com/locate/sleep Original Article Prevalence of undiagnosed obstructive sleep apnea

More information

Vtial sign #1: PULSE. Vital Signs: Assessment and Interpretation. Factors that influence pulse rate: Importance of Vital Signs

Vtial sign #1: PULSE. Vital Signs: Assessment and Interpretation. Factors that influence pulse rate: Importance of Vital Signs Vital Signs: Assessment and Interpretation Elma I. LeDoux, MD, FACP, FACC Associate Professor of Medicine Vtial sign #1: PULSE Reflects heart rate (resting 60-90/min) Should be strong and regular Use 2

More information

POSA(S) a forgotten dimension in OSA(S) Philip Tønnesen, M.D., Dr.Med:Science Danish Center for Sleep Medicine Glostrup Hospital Denmark March 2015

POSA(S) a forgotten dimension in OSA(S) Philip Tønnesen, M.D., Dr.Med:Science Danish Center for Sleep Medicine Glostrup Hospital Denmark March 2015 POSA(S) a forgotten dimension in OSA(S) Philip Tønnesen, M.D., Dr.Med:Science Danish Center for Sleep Medicine Glostrup Hospital Denmark March 2015 Disposition: POSAS Different definitions of POSAS Prevalence

More information

Diagnosis of Sleep Apnea

Diagnosis of Sleep Apnea Diagnosis of Sleep Apnea John E. Stevenson, MD, FACP ABSTRACT Rapidly accumulating evidence shows that sleep apnea is a major factor influencing personal health and public safety. Diagnosis and treatment

More information

SERVICE: Obstructive Sleep Apnea: Diagnosis and Treatment.

SERVICE: Obstructive Sleep Apnea: Diagnosis and Treatment. Obstructive Sleep Apnea: Page 1 of 6 MEDICAL COVERAGE POLICY Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based

More information

Understanding sleep apnea

Understanding sleep apnea Understanding sleep apnea What is Obstructive Sleep Apnea (OSA)? OSA is a common, yet often undiagnosed sleep disorder. It afflicts 20 million adult men and women in the U.S. People who have OSA stop breathing

More information

Compliance Issues in Home CPAP Therapy. Joseph Lewarski, BS, RRT, FAARC

Compliance Issues in Home CPAP Therapy. Joseph Lewarski, BS, RRT, FAARC Compliance Issues in Home CPAP Therapy Joseph Lewarski, BS, RRT, FAARC Obstructive Sleep Apnea Syndrome OSA 1 st recognized over 30 years ago 1981 Sullivan publishes small study in Lancet¹ Late 80s, early

More information

Jennifer Wink, MD February 6, 2016 SLEEP APNEA: DEVICE AND DIAGNOSTIC UPDATE

Jennifer Wink, MD February 6, 2016 SLEEP APNEA: DEVICE AND DIAGNOSTIC UPDATE Jennifer Wink, MD February 6, 2016 SLEEP APNEA: DEVICE AND DIAGNOSTIC UPDATE I have no Conflict of Interest Objectives Participants will gain an understanding of the different types of diagnostic sleep

More information

Rapid Resolution of Intense Suicidal Ideation after Treatment of Severe. From the Department of Psychiatry and Psychology (L.E.K.

Rapid Resolution of Intense Suicidal Ideation after Treatment of Severe. From the Department of Psychiatry and Psychology (L.E.K. Category [Case Report] Rapid Resolution of Intense Suicidal Ideation after Treatment of Severe Obstructive Sleep Apnea Lois E. Krahn, MD Bernard W. Miller, RPSGT Larry R. Bergstrom, MD From the Department

More information

Summary and Conclusions

Summary and Conclusions Summary and Conclusions Summary and Conclusions Conclusions Cardiovascular complications, diabetes mellitus and death q Obstructive sleep apnoea syndrome covaries with cardiovascular disease, including

More information

Patient Optimization Improves Outcomes, Lowers Cost of Care >

Patient Optimization Improves Outcomes, Lowers Cost of Care > Patient Optimization Improves Outcomes, Lowers Cost of Care > Consistent preoperative processes ensure better care for orthopedic patients The demand for primary total joint arthroplasty is projected to

More information

Children Who Snore Do they have Sleep Apnea? Iman Sami, M.D. Division of Pulmonary and Sleep Medicine, Children s National

Children Who Snore Do they have Sleep Apnea? Iman Sami, M.D. Division of Pulmonary and Sleep Medicine, Children s National Children Who Snore Do they have Sleep Apnea? Iman Sami, M.D. Division of Pulmonary and Sleep Medicine, Children s National June 3, 2015 No disclosures relevant to this talk No disclosures relevant to this

More information

Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing

Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing 2011 Canadian Thoracic Society and its licensors All rights reserved. No parts of this publication

More information

Sleep Position Trainer. The best treatment for Positional OSAS

Sleep Position Trainer. The best treatment for Positional OSAS Sleep Position Trainer The best treatment for Positional OSAS Innovation distinguishes between a leader and a follower. - Steve Jobs Positional Therapy for (P)OSAS Positional Obstructive Sleep Apnea Syndrome

More information

Updates: DOT Physicals and Compliance. What s New? Pam Matheny Transportation Department Public Utilities Commission State of Ohio

Updates: DOT Physicals and Compliance. What s New? Pam Matheny Transportation Department Public Utilities Commission State of Ohio Updates: DOT Physicals and Compliance What s New? Pam Matheny Transportation Department Public Utilities Commission State of Ohio Agenda n Overview of the Commercial Motor Carrier Industry and FMCSA Medical

More information

Sleep Difficulties. Insomnia. By Thomas Freedom, MD and Johan Samanta, MD

Sleep Difficulties. Insomnia. By Thomas Freedom, MD and Johan Samanta, MD Sleep Difficulties By Thomas Freedom, MD and Johan Samanta, MD For most people, night is a time of rest and renewal; however, for many people with Parkinson s disease nighttime is a struggle to get the

More information

Executive Summary. An American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Clinical Practice Guideline

Executive Summary. An American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Clinical Practice Guideline Executive Summary Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015 An American Academy of Sleep Medicine and American

More information

Scientific investigations

Scientific investigations Scientific investigations Persistence of Obstructive Sleep Apnea After Surgical Weight Loss Christopher J. Lettieri, M.D. 1,2 ; Arn H. Eliasson, M.D. 1,2 ; David L. Greenburg, M.D. 2,3 1 Pulmonary, Critical

More information

Treatment for Snoring and Obstructive Sleep Apnea. Ri 林 鴻 錡 /AsP 譚 慶 鼎

Treatment for Snoring and Obstructive Sleep Apnea. Ri 林 鴻 錡 /AsP 譚 慶 鼎 Treatment for Snoring and Obstructive Sleep Apnea Ri 林 鴻 錡 /AsP 譚 慶 鼎 Nonsurgical treatment Weight loss Avoidance of alcohol,sedatives,tobacco Positional devices Oral or nasal appliances Nasal continuous

More information

What is Obstructive Sleep Apnoea?

What is Obstructive Sleep Apnoea? Patient Information Leaflet: Obstructive Sleep Apnoea Greenlane Respiratory Services, Auckland City Hospital & Greenlane Clinical Centre Auckland District Health Board What is Obstructive Sleep Apnoea?

More information

Sleep Apnea from an Anatomical, Anthropologic and Developmental Perspective.

Sleep Apnea from an Anatomical, Anthropologic and Developmental Perspective. Sleep Apnea from an Anatomical, Anthropologic and Developmental Perspective. Brian Palmer, DDS Kansas City, Missouri ADSM June 4 2004 www.brianpalmerdds.com A1 Warning Some pictures in this presentation

More information

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a SCIENTIFIC INVESTIGATIONS Use of Complementary and Alternative Medicine Treatments by Patients with Obstructive Sleep Apnea Hypopnea Syndrome Amit Sood, M.D., M.Sc. 1 ; Sujata Narayanan, M.B.B.S. 1 ; Dietlind

More information

EFFECTS OF NASAL OBSTRUCTION AND CORRECTION IN SLEEP APNEA. Michael Friedman, MD

EFFECTS OF NASAL OBSTRUCTION AND CORRECTION IN SLEEP APNEA. Michael Friedman, MD EFFECTS OF NASAL OBSTRUCTION AND CORRECTION IN SLEEP APNEA Michael Friedman, MD The Nasal Exam Nasal Obstruction in OSA Nasal obstruction is often found in patients with OSA Nasal valve collapse, DNS,

More information

Restoring a good night s sleep

Restoring a good night s sleep Restoring a good night s sleep Products for diagnosing, treating, and monitoring sleep apnea Sleep apnea solutions A good night s sleep is an essential part of healthy living, but for patients diagnosed

More information

Sleep Apnea in Stroke. Diagnosis, Consequences & Treatment J.A. Aaronson

Sleep Apnea in Stroke. Diagnosis, Consequences & Treatment J.A. Aaronson Sleep Apnea in Stroke. Diagnosis, Consequences & Treatment J.A. Aaronson SLEEP APNEA IN STROKE: SUMMARY The overall objective of this thesis was to improve our understanding of the effects of obstructive

More information

Screening for obstructive sleep apnea before surgery: why is it important? Frances Chung and Hisham Elsaid

Screening for obstructive sleep apnea before surgery: why is it important? Frances Chung and Hisham Elsaid Screening for obstructive sleep apnea before surgery: why is it important? Frances Chung and Hisham Elsaid Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto,

More information

OSA Reference Material. Table of Contents

OSA Reference Material. Table of Contents OSA Reference Material Table of Contents 1. Guidance a. OSA Protocol and Decisions Consideration table b. Quick-Start for AMEs c. OSA Flow Chart d. AASM Tables 2 and 3 e. AME Actions f. Specification Sheet

More information

SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY

SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY PS1006 SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY TITLE: NON-INVASIVE POSITIVE PRESSURE (NPPV) VENTILATION (CPAP/BIPAP) Job Title of Reviewer: EFFECTIVE DATE: REVISED DATE: POLICY TYPE: Director, Respiratory

More information

X-Plain Preparing For Surgery Reference Summary

X-Plain Preparing For Surgery Reference Summary X-Plain Preparing For Surgery Reference Summary Introduction More than 25 million surgical procedures are performed each year in the US. This reference summary will help you prepare for surgery. By understanding

More information

Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care

Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care Charley P. Starnes, RRT, RCP Clinical Respiratory Specialist- COPD Education Important Milestones July 2011-

More information

Update on Home Sleep Studies Is there a Home for Portable Monitoring?

Update on Home Sleep Studies Is there a Home for Portable Monitoring? Update on Home Sleep Studies Is there a Home for Portable Monitoring? Samuel T. Kuna, MD Center for Sleep and Respiratory Neurobiology University of Pennsylvania and Pulmonary, Critical Care & Sleep Section

More information

What to Expect During Your Stay at a Sleep Disorders Lab

What to Expect During Your Stay at a Sleep Disorders Lab What to Expect During Your Stay at a Sleep Disorders Lab Information for patients and families Read this information to learn: what a sleep study is what a CPAP titration study is how to prepare what to

More information

Developing a Sleep Domain Ontology

Developing a Sleep Domain Ontology Developing a Sleep Domain Ontology Sivaram Arabandi, MD Case Western Reserve University Signs, Symptoms and Findings: Towards an Ontology of Clinical Phenotypes September 4-5, 2009 - Milan, Italy 1 Overview

More information

Obesity Compared to other Diseases in US

Obesity Compared to other Diseases in US Fatima Cody Stanford, MD, MPH Obesity Medicine & Nutrition Massachusetts General Hospital Harvard Medical School Harvard Kennedy School of Government Obesity Compared to other Diseases in US 1 CDC.gov

More information

DIAGNOSING SLEEP APNEA. Christie Goldsby Florida State University PHY 3109 04/09/14

DIAGNOSING SLEEP APNEA. Christie Goldsby Florida State University PHY 3109 04/09/14 DIAGNOSING SLEEP APNEA Christie Goldsby Florida State University PHY 3109 04/09/14 Outline of Talk Background information -what is sleep apnea? Diagnosing sleep apnea -polysomnography -respiratory airflow

More information

Scoring (manual, automated, automated with manual review)

Scoring (manual, automated, automated with manual review) A. Source and Extractor Author, Year Reference test PMID RefID Index test 1 Key Question(s) Index test 2 Extractor B. Study description Sampling population A Recruitment Multicenter? Enrollment method

More information

Paul Wylie, MD 1, Sukhdev Grover, MD 2 1 Arkansas Center for Sleep Medicine, Little Rock AR; 2 Sleep Center of Greater Pittsburgh, Pittsburgh, PA

Paul Wylie, MD 1, Sukhdev Grover, MD 2 1 Arkansas Center for Sleep Medicine, Little Rock AR; 2 Sleep Center of Greater Pittsburgh, Pittsburgh, PA Automatic Bi-level Positive Airway Pressure Delivery with Flow-Directed Pressure Modulation and Expiratory Pressure Relief an In-laboratory Comparison with Conventional Bi-level Positive Airway Pressure

More information

pii: jc-00031-15 http://dx.doi.org/10.5664/jcsm.4556

pii: jc-00031-15 http://dx.doi.org/10.5664/jcsm.4556 SPECIAL SECTION pii: jc-00031-15 http://dx.doi.org/10.5664/jcsm.4556 Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea R. Nisha Aurora, MD 1 ; Nancy A. Collop, MD 2 ; Ofer Jacobowitz,

More information

Saint Francis Kidney Transplant Program Issue Date: 6/9/15

Saint Francis Kidney Transplant Program Issue Date: 6/9/15 Kidney Transplant Candidate Informed Consent Education Here are educational materials about Kidney Transplant. Please review and read these before your evaluation visit. The RN Transplant Coordinator will

More information

Summary of AASM Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea - Updated July 2012

Summary of AASM Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea - Updated July 2012 Summary of AASM Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea - Updated July 2012 SUMMARY: Sleep technologists are team members who work

More information

Preoperative tests. National Clinical Guideline Centre. Routine preoperative tests for elective surgery. Clinical guideline <...

Preoperative tests. National Clinical Guideline Centre. Routine preoperative tests for elective surgery. Clinical guideline <... National Clinical Guideline Centre Draft for consultation Preoperative tests Routine preoperative tests for elective surgery Clinical guideline Appendix N: Research recommendations October 2015 Draft

More information

Cardio Respiratory. Obstructive Sleep Apnoea (OSA) Department. We Care

Cardio Respiratory. Obstructive Sleep Apnoea (OSA) Department. We Care Cardio Respiratory Department Obstructive Sleep Apnoea (OSA) Obstructive sleep apnoea (OSA) is a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. If

More information

Resistant Hypertension, Sleep Apnea and Hyperaldosteronism. Faculty Disclosure

Resistant Hypertension, Sleep Apnea and Hyperaldosteronism. Faculty Disclosure Resistant Hypertension, Sleep Apnea and Hyperaldosteronism David A. Calhoun, M.D. Professor of Medicine Vascular Biology and Hypertension Program Center for Sleep/Wake Disorders University of Alabama at

More information

THE LUNGS IN MARFAN SYNDROME

THE LUNGS IN MARFAN SYNDROME THE LUNGS IN MARFAN SYNDROME Many people with Marfan syndrome and some related disorders experience pulmonary complications, or problems with their lungs. If you have Marfan syndrome, it is important for

More information

Policy Name: Patient Monitoring via the Patient SafetyNet (PSN) Monitoring System

Policy Name: Patient Monitoring via the Patient SafetyNet (PSN) Monitoring System Healthcare Facility: Catholic Health Mercy Hospital of Buffalo Policy Name: Patient Monitoring via the Patient SafetyNet (PSN) Monitoring System Catholic Health Mercy Hospital of Buffalo has granted permission

More information