UIHC Home Sleep Apnea Testing (HSAT)
UIHC Home Sleep Apnea Testing (HSAT)Lisa Mertens, ARNP, RRTDepartment of Neurology, Sleep DivisionIowa River Landing East (IRL East)Respiratory Care SeminarOctober 19, 2018— 1 —
Home Sleep Apnea Test (HSAT)Sometimes called OCST (Out of Center Sleep Test) A sleep test for patients with high probability of moderate-severeobstructive sleep apnea (OSA)Takes place in comfort of patient’s homeEasy to useWorn for one nightProvides equivalent results to in-lab sleep testingMandated by many 3rd party payers(Wait time for UIHC sleep lab has been approximately 3-4 months)— 2 —
Why Test?Comorbidities associated with OSA HypertensionHeart diseaseStrokeDepressionExcessive Daytime Sleepiness (EDS)/Hypersomnia (ICD-10-CM G47.19):memory loss, lack of concentration, morning headachesImpotenceEpic 2017; Spriggs, W. H. (2010) Recent literature associating Lewy Body Dementia (Alzheimer's Disease)Emamian et al., (2016)— 3 —
Process for ordering HSATWork Flow 1. Ordering practitioner has high suspicion of OSA and orders HSAT in EPIC. 2. Order reviewed by Sleep Disorder Center (SDC) Medical Director. 3. If HSAT scheduled, patient picks up device at IRL East. Demonstration andinstructions for use by the sleep technician. Two week follow-up scheduled atclinic at IRL. Device returned next morning. 4. Results interpreted by sleep physician. 5. Results and recommendations shared with patient at 2 week follow-up atIRL East.— 4 —
Qualifications for HSATEPIC order is straight-forward1. Excessive Daytime Sleepiness and two of the following: Snoring Witnessed Apnea (gasping, choking) Hypertension2. No significant co-morbidities3. 18 years— 5 —
Intent of HSAT HSAT is intended to rule OSA in (not ruleit out)— 6 —
Next steps 1. Negative HSAT If clinical suspicion for OSA remains we consider in-lab polysomnography (PSG)Consider other causes of excessive daytime sleepiness and refer appropriately2. Positive HSAT Order Auto Positive Airway Pressure (APAP) therapy3. DME (durable medical equipment) provides patient with PAP machine/equipment4. Patient returns to OSA clinic in 1-3 months— 7 —
Watch PAT Resource: Itamar Medical on-line— 8 —
Perepheral Arterial Tonography (PAT)Resource: Itamar Medical product information Proprietary PAT signal is a surrogate of changes in the sympatheticnervous system that are associated with sleep disordered breathing Embedded actigraphy differentiates between wake and sleep PAT signal attenuation and accelerated pulse rate directly reflectimmediate digital artery vasoconstriction and increased heart rate Embedded pulse oximeter— 9 —
Watch PAT Yalamanchali et al. JAMA Otolaryngol Head Neck Surg, 2013.5338 Objective: Assess correlation between sleep indexes measured by aportable sleep-testing device (Peripheral Arterial Tonometry [PAT ]) andthose measured by PSG. Methods: 14 studies qualified for inclusion criteria, 909 patients 18,studies reviewed by 2 independent reviewers: AHI (apnea hypopneaindex), 0.893 (0.857-0.920; p .0001) Takeaway: PAT demonstrated high degree of correlation of sleep variablescompared to PSG with convenience and low cost— 10 —
AHIBerry et al. (2012) A apnea (no breathing) H hypopnea (shallow breathing) I index (As and Hs added together divided by # hours asleep) 0-5 normal5-15 mild15-30 moderate 30 severe— 11 —
After one year on the job Be careful of preconceived phenotype— 12 —
Not just old, not just fat, not just menNeither gender or BMI is part of Epic order Thin women have OSA too And so do kids--Alexandra Iannone, DO (peds sleep)(*not diagnosed by HSAT)— 13 —
So Clean machinesJust my perspective Convenient?Effective?More effective than standard cleaning?Evidence of becoming ill with “dirty” machine?— 14 —
SummaryHome Sleep Apnea Testing Cost effectiveMore accessibleConvenientReduced time to diagnosis Process following new diagnosis of OSA at UIHC is evolving— 15 —
References Berry, R. B., Budhiraja, R., Gottlieb, D. J., Gozal, D., Iber, C., Kapur, V. K., Tangredi, M. M. (2012).Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleepand Associated Events: Deliberations of the Sleep Apnea Definitions Task Force of the American Academyof Sleep Medicine. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the AmericanAcademy of Sleep Medicine, 8(5), 597–619. http://doi.org/10.5664/jcsm.2172 Emamian, F., Khazaie, H., Tahmasian, M., Leschziner, G. D., Morrell, M. J., Hsiung, G.-Y. R., Sepehry,A. A. (2016). The Association Between Obstructive Sleep Apnea and Alzheimer’s Disease: A MetaAnalysis Perspective. Frontiers in Aging Neuroscience, 8, 78. http://doi.org/10.3389/fnagi.2016.00078 Spriggs, W. H. (2010). Essentials of Polysomnography. Jones and Bartlett, Sudbury: MA Yalamanchali S, Farajian V, Hamilton C, Pott TR, Samuelson CG, Friedman M. Diagnosis of ObstructiveSleep Apnea by Peripheral Arterial TonometryMeta-analysis. JAMA Otolaryngol Head Neck Surgery2013;139(12):1343–1350. doi:10.1001/jamaoto.2013.5338— 16 —
Home Sleep Apnea Test (HSAT) Sometimes called OCST (Out of Center Sleep Test) A sleep test for patients with high probability of moderate-severe obstructive sleep apnea (OSA) Takes place in comfort of patient’s home Easy to use Worn for one night Provides equivalent r
Sleep apnea occurs when you stop breathing during the night. There are three types of sleep apnea: 1) Obstructive Sleep Apnea (OSA) – upper airway collapse causing obstruction. This is the most common form of sleep apnea. 2) Central Sleep Apnea
criteria for apnea or hypopnea Measures of Sleep Apnea Frequency Apnea / Hypopnea Index (AHI) # apneas hypopneas per hour of sleep Respiratory Disturbance Index (RDI) # apneas hypopneas RERAs per hour of sleep Respiratory Event Index (REI) # respiratory events per hour of monitoring time on Home Sleep Apnea Testing (HSAT)
The source of the sleep disordered breathing determines the type or classification of sleep apnea. Obstructive sleep apnea (OSA): OSA is caused by a physical obstruction in the upper airway. Sleep study recording characterized by: Loud snoring Obstructive apnea events – scored as apneas with apnea index or AI
sleep apnea The first thing to know about sleep apnea is that you are not alone. 7% of men are living with sleep apnea 5 % of women are living According to the American Academy of Sleep Medicine Frost and Sullivan report from 2016, approximately 12% suffer from
SL-3: Pediatric Sleep Guidelines 26 SL-4: Treatment of Obstructive Sleep Apnea (OSA) and Other Sleep-related Breathing Disorders 30 SL-5: Sleep Apnea Treatment Program Exclusions 43 SL-6: Actigraphy (CPT 95803) 45 SL-7: Practice Notes 47 SL-8: Questionnaires 50 SL-9: Oral Appliances for the Treatment of Obstructive Sleep Apnea 56 References 59
SL-3: Pediatric Sleep Guidelines 26 SL-4: Treatment of Obstructive Sleep Apnea (OSA) and Other Sleep-related Breathing Disorders 30 SL-5: Sleep Apnea Treatment Program Exclusions 42 SL-6: Actigraphy (CPT 95803) 44 SL-7: Practice Notes 46 SL-8: Questionnaires 48 SL-9: Oral Appliances for the Treatment of Obstructive Sleep Apnea 54 References 57
significant sleep apnea over a period as short as four years.7 Raising the head of the bed and avoiding the supine position during sleep are methods of decreasing the incidence of apnea. Eleva-tion of the head tends to bring the tongue forward, while sleeping on the side moves the tongue laterally. Patients with mild sleep apnea tend to
ARALING PANLIPUNAN I (Effective and Alternative Secondary Education) MODYUL 8 PAGSIBOL NG KAMALAYANG PILIPINO BUREAU OF SECONDARY EDUCATION Department of Education DepEd Complex, Meralco Avenue Pasig City . 1 MODYUL 8 PAGSIBOL NG KAMALAYANG PILIPINO Ang Pilipino ay likas na mapagtiis at mapagbigay kung kaya’t ang mga pagmamalabis at pang-aabuso ng mga Espanyol sa kanilang karapatan ay tiniis .
