sleep apnea – 2017 update on evaluation and management
TRANSCRIPT
![Page 1: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/1.jpg)
SLEEP APNEA 2017
UPDATE ON EVALUATION AND MANAGEMENT
February 22, 2017
![Page 2: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/2.jpg)
Disclosures
Marc L Benton, MD, FAASM, FCCP• Medical Director, The Sleep Disorders Center at
Summit Medical Group, Madison, NJ.
Kerry Kelley, RN, RRT, RPSGT• Manager – Sleep Services• The Sleep Disorders Center at Summit Medical
Group, Madison, NJ.
![Page 3: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/3.jpg)
Sleep Apnea - 2017 Update
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
![Page 4: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/4.jpg)
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
Sleep Apnea - 2017 Update
![Page 5: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/5.jpg)
Sleep affects, and in turn is affected by, almost every physiological and psychological process, i.e.,
Physical performance – work, school, life The ability to socially and emotionally relate to others Improving learning and memory Reduction in health problems and optimization of health Functioning in a safe, efficient and effective way
The Three R’s Rejuvenate, Restore, Re-energize
Sleep Apnea - Introduction
![Page 6: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/6.jpg)
All mammals and birds “sleep” as we know sleep to be.Sleep has also been observed in reptiles, fish and insects,
although it is differently defined – more as a behavioral phenomenon, and is less well-understood physiologically
Sometimes sleep needs to be ‘adaptive’, so that other basic needs can be simultaneously accommodated…
Sleep Apnea - Introduction
![Page 7: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/7.jpg)
Dolphins sleep by resting one half of their brain at a time. This is called “unihemispheric” sleep. The brain waves of dolphins that have been studied while asleep demonstrate that one side of the brain is awake while the other side is in deep sleep. Also, the eye on the side of the awake-half of the brain is open, while the
other eye is closed.
This assures that dolphins can meet their respiratory needs while also remaining vigilant enough to protect
themselves from predators even when “asleep”.
Sleep Apnea - Introduction
![Page 8: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/8.jpg)
Sleep Needs by Age
Newborns/Infants 0 - 2 months2 - 12 months
10.5 – 18 hours14 - 15 hours
Toddlers/Children 12 – 18 months18 mo. – 3 years3 – 5 years5 – 12 years
13 – 15 hours12 – 14 hours11 – 13 hours10 – 11 hours
Adolescents Average 9.25 hoursAdults Average 7 – 9 hoursOlder Adults Average Widely variable
Older adults need just as much sleep…they just don’t get itLess deep sleep = more arousals and awakenings
Medical conditions/pain = more arousals and awakenings“Sleep Debt” - just like money…
Sleep Apnea - Introduction
![Page 9: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/9.jpg)
The average person needs 7 to 9 hours sleep per 24-hour period.The “normal” sleep-onset latency is about 10 minutes.The “normal” sleep stage distribution for young-middle aged adults is:
• 5% stage I• 50% stage II• 15-25% stage III, slow wave or deep sleep• 20-25% stage REM
Sleep Apnea - Introduction
![Page 10: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/10.jpg)
Sleep Apnea - Introduction
![Page 11: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/11.jpg)
84 SLEEP DISORDERSIMPACTING
OVER 100 MILLION AMERICANS
Sleep Apnea - Introduction
![Page 12: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/12.jpg)
Classifications of sleep disorders:• Sleep-related breathing disorders• Insomnia • Central sleep apnea• Circadian rhythm sleep disorders• Parasomnias• Sleep-related movement disorders• Narcolepsy
Sleep Apnea - Introduction
![Page 13: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/13.jpg)
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
Sleep Apnea - 2017 Update
![Page 14: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/14.jpg)
• Prevalence: True frequency depends upon
definitions/cutoffs Increasing incidence from 18-45 y/o Plateau incidence over 55 y/o Males > Females AA > Caucasians - obesity, cardiovascular
disease and hypertension Asian = Caucasian despite lower BMI – narrow
anterior airway, recessed lower jaw
Demographics
![Page 15: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/15.jpg)
• Common factors that impact the frequency and severity of sleep apnea:
Body mass index (BMI) Physical characteristics – airway structure,
craniofacial abnormalities Family history – inherited structural
abnormalities, genetically prone to airway collapse
Age – loss of muscle tone Medical conditions – respiratory issues, muscular
and diaphragm issues
Demographics
![Page 16: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/16.jpg)
• OSA prevalence is estimated to be about 25% in adult males, 9-13% females
• 80-90% OSA currently undiagnosed • The worsening epidemic of obesity in the
United States guarantees a large at-risk population
• The prevalence of obesity is still increasing, although the rate of that increase is slowing
Demographics
![Page 17: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/17.jpg)
Demographics
![Page 18: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/18.jpg)
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
Sleep Apnea - 2017 Update
![Page 19: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/19.jpg)
Definition of Sleep:• A normal, reversible, recurring
behavioral state of disengagement and unresponsiveness to the environment that is characterized by typical changes in the electroencephalogram.
Pathophysiology
![Page 20: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/20.jpg)
• Apnea: cessation of airflow for at least 10 seconds and an arousal from sleep
• Hypopnea: diminished effort in breathing lasting at least 10 seconds and associated with a 3 or 4% oxygen desaturation and an arousal from sleep
• Respiratory Event-Related Arousal (RERA): diminished effort in breathing resulting in an arousal from sleep
Pathophysiology
Respiratory Disturbances - Definitions
![Page 21: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/21.jpg)
• Apnea: cessation of airflow for at least 10 seconds and an arousal from sleep
• Hypopnea: diminished effort in breathing lasting at least 10 seconds and associated with a 3 or 4% oxygen desaturation and an arousal from sleep
• Respiratory Event-Related Arousal (RERA): diminished effort in breathing resulting in an arousal from sleep
Pathophysiology
Respiratory Disturbances - Definitions
![Page 22: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/22.jpg)
• Apnea: cessation of airflow for at least 10 seconds and an arousal from sleep
• Hypopnea: diminished effort in breathing lasting at least 10 seconds and associated with a 3 or 4% oxygen desaturation and an arousal from sleep
• Respiratory Event-Related Arousal (RERA): diminished effort in breathing resulting in an arousal from sleep
Pathophysiology
Respiratory Disturbances - Definitions
![Page 23: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/23.jpg)
• Apnea: cessation of airflow for at least 10 seconds and an arousal from sleep
• Hypopnea: diminished effort in breathing lasting at least 10 seconds and associated with a 3 or 4% oxygen desaturation and an arousal from sleep
• Respiratory Event-Related Arousal (RERA): diminished effort in breathing resulting in an arousal from sleep
Pathophysiology
Respiratory Disturbances - Definitions
![Page 24: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/24.jpg)
Apnea-Hypopnea Index (AHI): • the number of apneas and hypopneas per
hour of sleep
Respiratory Disturbance Index (RDI): • the number of apneas + hypopneas + RERA’s
per hour of sleep
Pathophysiology
Respiratory Disturbances - Definitions
![Page 25: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/25.jpg)
Pathophysiology
Anatomy of Obstructive Apnea
![Page 26: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/26.jpg)
Pathophysiology
10 Minute Compressions – Severe Sleep Apnea
![Page 27: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/27.jpg)
Pathophysiology
Severe Sleep Apnea
![Page 28: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/28.jpg)
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
Sleep Apnea - 2017 Update
![Page 29: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/29.jpg)
Common complaints:• Loud snoring, irregular breathing• Problems initiating sleep• Problems maintaining sleep• Non-restorative sleep• Early morning awakenings• Excessive daytime sleepiness• Nighttime urination• Restless legs
Risk Assessment
![Page 30: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/30.jpg)
Body-type profiling:• Elevated BMI• Compromised airway
• Large tongue• Hypertrophied tonsils• Recessed jaw
• Broad/short neck• Family history
Risk Assessment
![Page 31: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/31.jpg)
Medical co-morbidities:• Cardiac disorders• Endocrine/metabolic disorders• Neurologic disorders• Psychiatric disorders• Pre-operative evaluation• Chronic pain• Pregnancy
Risk Assessment
![Page 32: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/32.jpg)
Every day problems:• Motor vehicle accidents – trains, planes,
autos• Industrial accidents/errors • High-risk occupations• Compromised work or school
performance• Sexual dysfunction• Athletic performance
Risk Assessment
![Page 33: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/33.jpg)
OSA and children:• Poorly tolerated• School performance• Attention deficit disorders• Learning disorders• Behavioral disorders• Attendance problems• Bedwetting
Risk Assessment
![Page 34: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/34.jpg)
Exxon Valdez – Oil Spill
Chernobyl Nuclear Disaster
Three Mile Island Nuclear Meltdown
AA Flight 1420 Crash
Multiple Recent Train Accidents
Untreated Sleep Apnea?
![Page 35: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/35.jpg)
Routine medical/dental provider evaluation
Validated questionnaires Family/friend concerns Occupational/licensing screening
Risk Assessment
Screening Tools
![Page 36: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/36.jpg)
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
Sleep Apnea - 2017 Update
![Page 37: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/37.jpg)
What testing is appropriate?• Home/portable vs. in-labWho/what decides what testing is done?• Medical provider• Insurance company• Medical conditions• Prior sleep history
Evaluation ProcessSleep Apnea Testing
![Page 38: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/38.jpg)
Evaluation ProcessHome Sleep Apnea Testing
![Page 39: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/39.jpg)
Evaluation ProcessHome Sleep Apnea Testing
![Page 40: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/40.jpg)
Evaluation ProcessHome Sleep Apnea Testing
![Page 41: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/41.jpg)
Evaluation ProcessHome Sleep Apnea Testing
![Page 42: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/42.jpg)
Evaluation ProcessAttended Sleep Testing
![Page 43: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/43.jpg)
Types of attended sleep studies• Diagnostic• Therapeutic • Split-night • NPSG + MSLT• MWT• MATRx
Evaluation ProcessAttended Sleep Testing
![Page 44: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/44.jpg)
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
Sleep Apnea - 2017 Update
![Page 45: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/45.jpg)
• Positive Airway Pressure therapy• Dental appliances• Surgery• Weight loss• Nasal valves• Positional therapy• Implantable neurostimulator• Exercises/Didgeridoo• Combination therapy
Treatment Options
![Page 46: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/46.jpg)
Treatment OptionsPAP Therapy
![Page 47: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/47.jpg)
Treatment OptionsPAP Therapy
![Page 48: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/48.jpg)
Treatment OptionsAttended testing
![Page 49: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/49.jpg)
Treatment OptionsAttended testing – pre-treatment
![Page 50: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/50.jpg)
Treatment OptionsAttended testing – initial treatment titration
![Page 51: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/51.jpg)
Treatment OptionsAttended testing – successful treatment titration
![Page 52: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/52.jpg)
Sleep Apnea – Pathophysiology10 Minute Compression – Severe Sleep Apnea
![Page 53: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/53.jpg)
Sleep Apnea – Pathophysiology10 Minute Compression – No Sleep Apnea
![Page 54: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/54.jpg)
Treatment OptionsPAP Therapy - Then and Now
![Page 55: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/55.jpg)
Treatment OptionsNew PAP Devices
![Page 56: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/56.jpg)
Treatment OptionsPAP Therapy
• Auto-PAP• CPAP• CPAP with C-Flex• BiPAP• BiPAP with BiFlex• AVAPS• BiPAP-SV
![Page 57: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/57.jpg)
Treatment OptionsInterfaces
![Page 58: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/58.jpg)
Treatment OptionsPAP Therapy
Upsides:• Best outcomes, especially in more severe OSA• Detailed feedback on efficacy and compliance• Widely varied and customizable treatment options
Downsides:• Requires maintenance (cleaning and parts replacement)• Side effects (sinus issues, air-swallowing, dry mouth)• Problems with equipment suppliers• Less portable
![Page 59: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/59.jpg)
Treatment OptionsOral Appliance Therapy
![Page 60: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/60.jpg)
Treatment OptionsOral Appliance Therapy
![Page 61: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/61.jpg)
Treatment OptionsOral Appliance Therapy
![Page 62: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/62.jpg)
Treatment OptionsOral Appliance Therapy
Upsides:• Easier to manage• More portable• Less likely to exacerbate sinus problems
Downsides:• Less likely to be effective, especially in more severe cases• No feedback regarding efficacy• Provider variability in proficiency• Cost• Side effects
![Page 63: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/63.jpg)
Sleep 2013 Oct 1;36(10):1517-25, 1525A
Treatment OptionsOral Appliance Therapy - MATRx
![Page 64: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/64.jpg)
• Procedures• Nasal surgery• Tonsillectomy• UP3• LAUP• Somnoplasty• Pillar procedure• Tongue ablation• Tongue or hyoid advancement• Mandibular advancement• Tracheostomy
Treatment OptionsUpper Airway Surgery
![Page 65: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/65.jpg)
Weight loss strategies Bariatric medical evaluation Bariatric surgery
• Gastric sleeve• Lap band surgery• Roux-en-y gastric bypass surgery
Treatment OptionsWeight Loss
![Page 67: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/67.jpg)
Treatment OptionsInspire Implantation
![Page 68: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/68.jpg)
"In a study published in the British Medical Journal, 25 patients with sleep apnea whopracticed playing it for about 30 minutes a day, six days a week for four months, significantly reduced the number of apneas they had during sleep; daytime sleepiness also decreased. Scientists believe the breathing technique required to play the didgeridoo strengthens the upper airway and makes it less likely to collapse."
Treatment OptionsExercises, Didgeridoo
![Page 69: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/69.jpg)
Treatment OptionsAlternative Facts
![Page 70: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/70.jpg)
• Introduction• Demographics• Pathophysiology• Risk Assessment• Evaluation Process• Treatment Options• Optimizing Outcomes
Sleep Apnea - 2017 Update
![Page 71: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/71.jpg)
• Good data, good decisions• Education, education, education• Close follow-up through initial phases of
therapy• Compliance tracking• Manage the home care (DME) issues• Train and utilize Compliance Specialists• Long term follow-up
Optimizing Outcomes
![Page 72: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/72.jpg)
• Get good data, make good decisions The correct treatment of the wrong problem is
the incorrect treatment Perform high-quality diagnostic and
therapeutic sleep studies, and make sure the results are consistent with clinical expectations
Getting prior test results and treatment information can be very useful
Know when an attended sleep study is necessary, and fight to get it done
Optimizing Outcomes
![Page 73: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/73.jpg)
• Education, education, education For the patient, for the providers, and the staff The better-informed the patient is, the better
patient they will be (usually) Education can help the patient assume some
ownership of the problem, which should facilitate better outcomes
Providing regular and constructive feedback to the patient can be invaluable
Optimizing Outcomes
![Page 74: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/74.jpg)
• Close follow-up through initial phases of therapy
Performance in the first week and first month most commonly predict long-term outcomes
You cannot find solutions until you are aware that there is a problem
Fixing problems earlier rather than later improves patient satisfaction, outcomes, and retention
Early feedback and additional education help prevent the development of behavior patterns that undermine successful treatment
Optimizing Outcomes
![Page 75: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/75.jpg)
• Compliance tracking The ability to obtain accurate
usage/compliance and treatment efficacy data has revolutionized the treatment of OSA
Patient’s subjective assessments of their status is often useful but frequently incorrect
Acquiring compliance and efficacy data, and acting on it as needed is the current standard-of-care in sleep medicine
Acquiring and integrating real-time compliance data into the patient record is becoming easier and more beneficial to patients and providers
Optimizing Outcomes
![Page 76: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/76.jpg)
• Manage the equipment issues This is often the weak link in managing OSA
treatment This is by far the most common thing that
patients complain about It contributes to poor outcomes, abandoned
therapy, and patient migration to other doctors Investing the time and effort in knowing which
companies to use, which to avoid, and how to get the patients the services that they need is key
Optimizing Outcomes
![Page 77: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/77.jpg)
• Train and utilize Compliance Specialists In order to optimize outcomes and patient
satisfaction, it is necessary to have personnel who are able to turn failures into successes, and problems into solutions
This requires expertise, experience, insight, observational and communication skills, along with the time and tools to perform the work that is required
Developing and customizing algorithms, cultivating relationships with patients and being accessible and helpful will always result in a better product
Optimizing Outcomes
![Page 78: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/78.jpg)
Treatment OptionsNasal Masks
![Page 79: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/79.jpg)
Treatment OptionsNasal Pillows
![Page 80: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/80.jpg)
Treatment OptionsFull Face Masks
![Page 81: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/81.jpg)
Optimizing Outcomes
![Page 82: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/82.jpg)
Optimizing Outcomes
![Page 83: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/83.jpg)
Optimizing Outcomes
![Page 84: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/84.jpg)
Optimizing Outcomes
![Page 85: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/85.jpg)
% Nights CPAP Used: 90%, % Nights Used > 4 hrs: 10%, Ave. Daily Usage: 2h:17m
Optimizing Outcomes
![Page 86: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/86.jpg)
% Nights CPAP Used: 90%, % Nights Used > 4 hrs: 10%, Ave. Daily Usage: 2h:17m
Optimizing Outcomes
% Nights CPAP Used: 100%, % Nights Used > 4 hrs: 60%, Ave. Daily Usage: 4h:35m
![Page 87: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/87.jpg)
% Nights CPAP Used: 90%, % Nights Used > 4 hrs: 10%, Ave. Daily Usage: 2h:17m
Optimizing Outcomes
% Nights CPAP Used: 100%, % Nights Used > 4 hrs: 60%, Ave. Daily Usage: 4h:35m
% Nights CPAP Used: 100%, % Nights Used > 4 hrs: 87%, Ave. Daily Usage: 5h:24m
% Nights CPAP Used: 100%, % Nights Used > 4 hrs: 90%, Ave. Daily Usage: 5h:44m
![Page 88: Sleep Apnea – 2017 Update on Evaluation and Management](https://reader038.vdocument.in/reader038/viewer/2022110218/58d1a4191a28ab6f6b8b5aff/html5/thumbnails/88.jpg)
• Long term follow-up People change – medications, new medical
problems, lifestyles, priorities – and treatments often need to be modified
Successfully treated patients can slowly drift away from those successes if they are not periodically monitored
The condition that is being treating will evolve over time, and it may require different therapy
New treatments, better ideas, and different approaches need to be integrated into management plans over time
Optimizing Outcomes