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 socioeconomic classes. Approximately 5% of the adult population has undiagnosed Obstructive Sleep Apnea (OSA) which is a known risk factor for hypertension, diabetes, obesity, depression, heart attack, stroke, and cardiovascular disease. We are now offering Home Sleep Apnea Testing (HSAT) and in-center Polysomnography through a direct referral program and would like to work with you in monitoring your patients for sleep disorders including OSA. Home Sleep Apnea Testing is appropriate for any patient with a suspicion of OSA that does not exhibit a significant co-morbidity. The cost of an HSAT is about 25% of an in-center polysomnogram and is a covered service of most insurers. Following the HSAT one of Munson Medical Center s six board certified sleep specialists will interpret the home study and provide you and your patient with a comprehensive report and treatment recommendations. Munson Sleep Disorders Center is accredited by the American Academy of Sleep Medicine and is able to diagnose and treat the full spectrum of sleep disorders. Referring to the Sleep Center is Easy 1. Have your patient fill out the STOP-BANG questionnaire to identify their potential for obstructive sleep apnea. Munson s Sleep Disorders Program recommends the STOP-BANG questionnaire, a standardized, easy-to-use screening tool for clinicians and providers to use in all patient care settings. The tool has been standardized in thousands of preoperative patients and can be used in all patient care settings. It is particularly sensitive in identifying patients with moderate and severe apnea, those patients most at risk for the adverse health consequences of untreated sleep-disordered breathing. 2. Complete the screening tool and referral form and diagnostic requisition/referral (this is the physician order) for your patient. Also include any patient notes specific to sleep issues and provide a demographic sheet from the office. 3. Fax all of these items to the Sleep Disorders Center at (231) 935-9300. For patients identified by the STOP-BANG questionnaire, some will be candidates for in-home testing while others will require in-center polysomnography. We have updated criteria for home vs. in-center sleep studies, keeping the criteria aligned with that of insurance requirements and with the standards of the American Academy of Sleep Medicine. Munson Sleep Disorders Center Jon Wyckoff, Manager (231) 935-9307 phone (231) 935-9300 fax jwyckoff@mhc.net
STOP-BANG Questionnaire Name Age Height inches Weight lbs. BMI Collar size of shirt (circle one): S M L XL, or inches Neck Circumference (measured by staff) cm 1. Snoring Do you snore loudly? Yes No (Louder than talking or heard through closed doors) 2. Tired Do you often feel tired, fatigued, or sleepy during daytime? Yes No 3. Observed Has anyone observed you stop breathing during sleep? Yes No 4. Blood Pressure Do you have or are you treated for high blood pressure? Yes No 5. BMI BMI > 35 kg/m2 Yes No 6. Age Age > 50 Yes No 7. Neck Circumference Neck circumference > 40 cm Yes No 8. Gender Male gender Yes No High risk of OSA: Yes to three (3) or more items Please fax completed questionnaire to Munson Sleep Disorders Center at (231) 935-9300
Home Sleep Apnea Test and/or In-Center Polysomnography Screening Tool & Referral Form FAX TO: (231) 935-9300 Patient Name: Date of Birth: Daytime Phone ( ) Best time to contact? Referring Practitioner: Patient Exhibits / Complains of the following: (Please all that apply) Snoring Daytime sleepiness, tired or fatigue Witnessed apnea Hypertension BMI>35 Age>50 Neck Circumference > 40cm Male Restless legs or Periodic Limb Movement Disorder (PLMD) Insomnia Heart Failure (CHF, ischemic heart disease) History of myocardial infarction (heart attack) Cardiac arrhythmias (atrial fibrillation, SVT, ventricular arrhythmia) Pre-bariatric surgery Pulmonary Disease History of stroke Central Sleep Apnea Narcolepsy Sleepwalking or amnestic behavior during sleep Cognitive impairment Mood disorder Chronic pain syndrome Neuromuscular disease Nocturnal seizures Commercial driver or pilot I would like to have the following Sleep Specialist* interpret this Home Sleep Apnea Test: Charles J. Gwizdala, MD John P. Krcmarik, MD James G. Milliken, MD Margaret L. Moen, MD Cynthia D. Nichols, PhD David A. Walker, DO Or I have no Sleep Specialist preference for this Home Sleep Apnea Test *All Munson Sleep Specialists are Board-Certified by the American Academy of Sleep Medicine.
Diagnostic Requisition/Referral DATE: NAME OF PATIENT: DOB Please Print Referring physician approves Home Sleep Apnea Test (HSAT) or an in-center Polysomnogram (PSG) based on Munson Sleep Disorders Center approved protocols Other Insurance required pre-authorization form, if needed REFERRING PHYSICIAN: Please Print Physician Phone: Fax: NPI: PHYSICIAN SIGNATURE: Please fax completed form to Munson Sleep Disorders Center at (231) 935-9300 If you have questions please call (231) 935-9307 Munson Sleep Disorders Center Munson Community Health Center
Facts About Sleep Obstructive sleep apnea is common, with moderate to severe disease present in approximately 9% of middle aged men and 4% of women. The prevalence of OSA in certain patient populations (such as elderly patients, hypertensive patients, patients with coronary disease, and prebariatric surgery patients) is even greater. 1 Sedation, anesthesia, opioids, and REM sleep rebound have been shown to cause worsening of sleep apnea in the perioperative period that may lead to increase in the rate of perioperative complications. It is important to identify these patients preoperatively so that appropriate actions can be taken during their perioperative care. 2 Prospective findings from 4- to 15-year follow-up data indicate that untreated sleep apnea predicts increased blood pressure, hypertension, stroke, depression, and mortality. 3 Obstructive sleep apnea has emerged as an important risk factor for the development of cardiovascular disease. Epidemiologic and clinical evidence has prompted the American Heart Association to issue a scientific statement describing the need to recognize sleep apnea as an important target for therapy in reducing cardiovascular disease risks. 4 Patients with untreated obstructive sleep apnea have a higher recurrence of atrial fibrillation after cardioversion than patients without sleep apnea. Appropriate treatment with CPAP is associated with lower recurrence of atrial fibrillation. 5 A meta-analysis of 15 articles (615 patients) demonstrated significant improvements in all indices of arterial stiffness after CPAP treatment in patients with OSA. 6 Obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension. 7 Obese women with gestational hypertension have a much higher frequency of sleep-disordered breathing than healthy women with uncomplicated pregnancies (53% vs. 12%). 8 Chronic sleep restriction among adolescents is associated with an increase in suicidal risk. 9 Short sleep duration in the natural environment may negatively affect in vivo antibody responses to novel antigens, providing a possible explanation for observed associations of poor sleep with increased susceptibility to infectious disease. 10 Symptoms of sleep deprivation overlap with symptoms of ADHD in children. 11 References 1 (Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Progress in Cardiovascular Diseases 2009;51(4):285-93.). 2 (Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 2012;8(2):199-207.). 3 (Young T, Palta M, Dempsey J, Peppard PE, Nieto FJ, Hla KM. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ 2009; 108(5):246-9.). 4 (Jean-Louis G, Brown CD, Zizi F, Ogedegbe G, Boutin-Foster C, Gorga J, McFarlane SI. Cardiovascular disease risk reduction with sleep apnea treatment. Expert Review of Cardiovascular Therapy 2010; 8(7): 995-1005.). 5 (Kanagala R, Murali N, Friedman P, eammash N, Gersh V, Ballman K, Shamsuzzaman A, Somers V. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003;107:2589-2594). 6 (Vlachantoni I, Kikaiakou E, Antonopoulos C, Stefanadis C, Daskalopoulou S, Petridou E. Effects of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea in arterial stiffness: A meta analysis. Sleep Medicine Reviews 2013;17:19-28.). 7 (Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. New England Journal of Medicine 2005; 353(19):2034-41, 2005.). 8 (53% vs. 12%) (Reid J, Skomro R, Cotton D, Ward H, Olatunbosun F, Gjevre J, Guilleminault C. Pregnant women with gestational hypertension may have a high frequency of sleep disordered breathing Sleep 2011;34(8):1033-1038.). 9 (Lee YJ, Cho SJ, Cho IH, Kim SJ. Insufficient sleep and suicidality in adolescents. Sleep 2012;35(4):455-460.). 10 (Prather AA, Hall M, Fury JM, Ross DC, Muldoon MF, Cohen S, Marsland AL. Sleep and antibody response to hepatitis B vaccination. Sleep 2012;35(8):1063-1069). 11 (Chervin R, Dillon J, Gassetti C, Ganoczy D, Pituch K. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997;20(12):1185-1192).