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HOME OBSTRUCTIVE SLEEP APNEA MANAGEMENT IN THE USA AND ABROAD

HOME OBSTRUCTIVE SLEEP APNEA MANAGEMENT IN THE USA AND ABROAD. P. LYNN NICHOLS, M.D. DABSM,FCCP. MEDICAL DIRECTOR. Summitsleeptn.com. Financial disclosures. I make a living as a pulmonologist and sleep physician

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HOME OBSTRUCTIVE SLEEP APNEA MANAGEMENT IN THE USA AND ABROAD

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  1. HOME OBSTRUCTIVE SLEEP APNEA MANAGEMENT IN THE USA AND ABROAD P. LYNN NICHOLS, M.D. DABSM,FCCP

  2. MEDICAL DIRECTOR

  3. Summitsleeptn.com

  4. Financial disclosures • I make a living as a pulmonologist and sleep physician • No large medical company has ever offered me any money, but I am open to the idea

  5. WHAT IS THE NAME OF THIS PROCEDURE, ANYWAY? • Home Sleep Testing (HST) • Out of Center Sleep Testing (OCST) • Portable Monitoring (PM) • Limited Channel Testing (LCT) • *proposed- Home Obstructive Sleep Apnea Management (HOSAM)

  6. GOALS • Scientific rationale for HST • HST experience in socialized medicine (New Zealand) • HST four year experience in private US Sleep Center • Where is sleep disorder management headed in the US?

  7. SCIENTIFIC RATIONALE FOR HST/HOSAM

  8. NEW ZEALAND

  9. HAKA

  10. The ChallengeDesign and implement an obstructive sleep apnea diagnostic and treatment program for 150,000 rural New Zealanders

  11. NZ$100,000 SLEEP PROGRAM

  12. OTHER RESOURCES • One respiratory therapist dedicated to pulmonary function lab and sleep program (I had to hire) • 4 small hospitals/clinics with nursing staff • Chartered airplane (my favorite) • Support of Auckland sleep lab

  13. MORNING COMMUTE

  14. IT’S ALL ABOUT THE ALGORITHM • GP referral letter to Respiratory Consultant • Home sleep test with follow up at next respiratory clinic with initiation of Auto CPAP • Auto CPAP download next CPAP clinic and placed on cheaper fixed CPAP unit • CPAP clinic follow ups with RT • Referral to Auckland if necessary

  15. OUTCOME AT ONE YEAR • Around 70% of patients could be managed without in-lab study initially • Recruited a respiratory consultant from South Africa to continue the programs

  16. Home Sleep Testing Technical Perspective Nicole Line, RPSGT, RST,PSGP Clinical Director

  17. DISCLAIMER The following slides are opinions derived from our experiences at Summit Sleep Services and are in no way representative of all Sleep Center situations.

  18. As techs, our first reaction to HST…….

  19. Embletta Gold by Embla

  20. Embletta Gold by Embla Features: • Easy application with color coded sensors • Pre-program multiple studies • Rechargeable battery • Internal position sensor • Ability to record 12 channels

  21. Embletta Gold by Embla Limitations: • Heavier unit • Difficult for patients to apply themselves • Somewhat difficult to score

  22. Nihon Kohden Nomad

  23. Nihon Kohden Nomad Features: • Integrates with NK system • Auto starts with pulse signal or can be set to start at a designated time • 2GB internal memory • Uses 2 AA batteries • Has ability to monitor 12 channels: thermister, pressure transducer, snore, body position, SPO2, pleth, pulse, chest effort, abdominal effort, 2 limb channels and 1 DC output

  24. Nihon Kohden Nomad Limitations: • Larger/heavier than most units • Higher price point • Costly to repair • Difficult for patient to apply themselves

  25. SleepView by CleveMed

  26. SleepView by CleveMed Features: • Cloud based • Easy patient application • Very light • Capable of recording 7 channels: Pulse oximetry, heart rate, respiratory effort, cannula based airflow, thermister based airflow, snore, and body position • Uses 1 AAA battery • All necessary study supplies included • 1 GB internal memory

  27. SleepView by CleveMed Limitations: • Belt seemed to slip out of place during recording resulting in a sub-optimal signal • Cumbersome log in/ log out process for downloading, scoring and interpreting in one location

  28. Apnea Link Plus by ResMed

  29. Apnea Link Plus by ResMed Features: • 4 channels: nasal flow (and snore), pulse, oxygen saturation, and respiratory effort • Lightweight • Easy patient application • Uses 2 AA batteries • Ability to email report and recording • Cost effective

  30. Apnea Link Plus by ResMed Limitations: • No body position sensor • No numerical values when scoring desaturations

  31. Summit Sleep ServicesHST Volume

  32. SUMMIT HST ALGORITHM Sleep physician consult and HST ordered if appropriate HST interpreted Sleep clinic follow-up with initiation of auto-CPAP 4-14 if indicated In-lab CPAP titration if auto-CPAP fails to resolve symptoms If HST nondiagnostic then either repeat HST or in-lab study ordered

  33. HST INTERPRETATION TEMPLATE

  34. WHERE IS SLEEP MEDICINE HEADED IN THE USA?

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