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Apnea Screening for Diabetes Patients

Apnea Screening for Diabetes Patients. Sensible. Simple . Effective . Reaching out to more patients. Reasons to Integrate an Apnea Screening Program. Increasing Prevalence 24%- Nearly one quarter of U.S. men suffer from some form of sleep disordered breathing (SDB).

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Apnea Screening for Diabetes Patients

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  1. Apnea Screening for Diabetes Patients Sensible. Simple. Effective. Reaching out to more patients.

  2. Reasons to Integrate an Apnea Screening Program • Increasing Prevalence • 24%- Nearly one quarter of U.S. men suffer from some form of sleep disordered breathing (SDB). • International Diabetes Federation Recommendations OSA should be considered in the assessment of all patients with Type II Diabetes. • Improving Patient Care • Early detection & treatment reduces risk of disease & death related to other serious health conditions, such as: • Type II Diabetes • Hypertension • Congestive Heart Failure • Stroke New England Journal of Medicine. 1993; 328; 1230-1235. Shaw, et. al. Diabetes Research & Clinical Practice. 2008; 81: 2-12.

  3. Diabetes & Apnea • Diabetes & Apnea Screening Should Go Hand in Hand Evidence indicates that the presence of one disease may trigger biological mechanisms that increase risk of the other. Shaw, et. al. Diabetes Research & Clinical Practice. 2008; 81: 2-12. Pagel, et. al. Supplement to The Journal of Family Practice. August 2008 ; Vol 57, No 8.

  4. Sleep Disordered Breathing (SDB) in the Diabetic Population Link Between Diabetes & SDB • 58% of Type II Diabetics have some form of sleep disordered breathing (SDB) Health Concerns • Both Diabetes & Apnea significantly increase risk of cardiovascular disease & death Treatment Concerns • Apnea negatively impacts glucose tolerance, insulin resistance & increased risk of metabolic syndrome • Leads to difficulties with diabetes management Richard; Gay & Farrell. The Economics of Sleep-Disordered Breathing. RT: June 2006. Shaw, et. al. Diabetes Research & Clinical Practice. 2008; 81: 2-12

  5. Treating Apnea Improves Factors Related to Diabetes • Improves glycemic control • Improved insulin sensitivity and leptinlevels • Reduces Sympathetic Activation • A key factor in regulation of glucose & fat metabolism, as well as systemic inflammation. – Biological mechanisms thought to contribute to insulin resistance. Reduces Cardiovascular Risk • Significantly decreases blood pressure (BP) • Improves Heart Function • Decreases # of new cardiovascular events & arrhythmias Improves Overall Patient Outcomes • Reduces morbidity & mortality associated with cardiovascular events & stroke • Patients using positive airway pressure have better Epworth Sleepiness Scale & Health-Related Quality of Life scores. Shaw, et. al. Diabetes Research & Clinical Practice. 2008; 81: 2-12 Richard; Gay & Farrell. The Economics of Sleep-Disordered Breathing. RT: June 2006.

  6. Economic Impact of Undiagnosed Apnea • SDB Places Substantial Economic Burden on the U.S. • $3.4 billion Yearly estimate of the medical costs of untreated OSA in the U.S. • $15.9 billion Collision costs directly attributable to OSA in 2000. • $5 billion Yearly loss of productivity attributable to Apnea-related fatigue. • Other Indirect Costs • E.g. higher insurance, production, & consumer costs • Higher incidence of work-related accidents • Non-Financial Burden Increased incidence of disability Diminished quality of life for affected. Richard; Gay & Farrell. The Economics of Sleep-Disordered Breathing. RT: June 2006. Shaw, et. al. Diabetes Research & Clinical Practice. 2008; 81: 2-12

  7. SCREENING IDENTIFIES PATIENTS THAT WOULD NOT SEEK TREATMENT OTHERWISE. Reasons for Apnea Screening SDB is Largely Undiagnosed Over 28 million Americans suffer from OSA, yet 20 million go undiagnosed & untreated. Increased Health Risks SDB is associated with a range of comorbid conditions. Significant Financial & Disability Burden Untreated SDB places substantial burden on both individuals & society. Logan, et. al. J Hypertens. 2001 Dec;19(12):2271-7. Jahaveri, et. al.Circulation. 1998;97:2154-2159 Basetti & Aldrich. Sleep. 1999 Mar 15;22(2):217-23. Finkel, et. al. Sleep Review July-Aug 2006. Shaw, et. al. Diabetes Research & Clinical Practice. 2008; 81: 2-12.

  8. Problems with Common Screening Methods In-lab Polysomnography (PSG) Questionnaires • Subjective • Not specific • i.e. high # of false-positives - Leads to unnecessary testing & delayed Dx for those with severe apnea • Cannot indicate type/severity of SDB • Not Validated for Diabetic Population • Costly • Impractical for Screening • Population is too large • Can Take Days or Weeks to Receive Results • Higher refusal/drop-out rates Finkel, et. al.. Sleep Review July-Aug 2006. Magalang, et. al. Chest2003; 124; 1694-1701. STOP Questionnaire; A Tool to Screen Patients for Obstructive Sleep Apnea. Chung, et. al.. Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea.Anesthesiology 2006; 104:1081–93.

  9. Meta-analysis of OSA Questionnaires Screening Test Reliability & Summary Recommendations • Many of the most commonly used screening questionnaires have poor predictive values, esp. for mild to moderate cases. *DOR combines data on sensitivity and specificity to give an indication of a test’s ability to rule in or rule out a condition. **Summary recommendations developed for preoperative use. Derived from Ramachandran, et. Al. Anesthesiology, V 110, No 4, Apr 2009

  10. The S.O.S. Approach • “S.O.S.” • Subjective Objective Screening • Research shows a combination approach can be the most feasible & effectivemethod • Subjective Screen • Use questionnaire (e.g. STOP-BANG; Berlin) to screen everyone • The population at risk is often large and will often include many patients with low risk. A much smaller subgroup with very high risk will require expedient intervention. • Objective Screen • Oximetry (e.g. SatScreen) devices are widely used because of affordability, high predictive value, & minimal patient impact. • Identifies the high risk subgroup. Hwang, et. al. Chest2008; 133; 1128-1134. 

  11. Patient Safety, IncTechnology Breakthroughs Patents High resolution oximetry with digital pattern analysis & recognition SatScreen • Oximetry screening • FDA cleared acquisition, analysis & reporting software Patient Safety Connection Center • Oximetry & HST software management platform

  12. Why SatScreen? Most oximetry software only report raw data, ODI & O2 ranges. Accurate & Cost-Effective Results in Minutes Easy to Read Green to red indices for important information Indicates Arousal Failure & Hypoventilation Syndromes Indicative of more serious SDB & may require a different treatment approach Highlights Frequency of Events & Severity of O2Desaturations Bloch. Chest 2003; 124; 1628-1630.  ASA Task Force. Anesthesiology 2006; 104:1081–93. Madani. Advance for Respiratory Care and Sleep Medicine. Posted on January 7, 2009.

  13. Get Started Define your protocol for at risk patients Determine your Screening Protocol Gather your team & assign responsibilities Practice Guidelines If patient is identified as at risk, follow ASA guidelines or preferred protocol Develop discharge instructions / plan Questions? We want to help you make your organization’s OSA screening program a success. Please contact us at: 1-888-666-0635 support@patientsafetyinc.com

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