HOME OBSTRUCTIVE SLEEP APNEA MANAGEMENT IN THE USA AND ABROAD P. LYNN NICHOLS, M. D. DABSM, FCCP
MEDICAL DIRECTOR
Summitsleeptn. com
Financial disclosures n n 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
WHAT IS THE NAME OF THIS PROCEDURE, ANYWAY? n n n Home Sleep Testing (HST) Out of Center Sleep Testing (OCST) Portable Monitoring (PM) Limited Channel Testing (LCT) *proposed- Home Obstructive Sleep Apnea Management (HOSAM)
GOALS n n Scientific rationale for 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?
SCIENTIFIC RATIONALE FOR HST/HOSAM
NEW ZEALAND
HAKA
The Challenge Design and implement an obstructive sleep apnea diagnostic and treatment program for 150, 000 rural New Zealanders
NZ$100, 000 SLEEP PROGRAM
OTHER RESOURCES n n 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
MORNING COMMUTE
IT’S ALL ABOUT THE ALGORITHM n n n GP referral letter to Respiratory Consultant Home sleep test with follow up at next respiratory clinic with initiation of Auto CPAP download next CPAP clinic and placed on cheaper fixed CPAP unit CPAP clinic follow ups with RT Referral to Auckland if necessary
OUTCOME AT ONE YEAR n n Around 70% of patients could be managed without in-lab study initially Recruited a respiratory consultant from South Africa to continue the programs
Home Sleep Testing Technical Perspective Nicole Line, RPSGT, RST, PSGP Clinical Director
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.
As techs, our first reaction to HST…….
Embletta Gold by Embla
Embletta Gold by Embla Features: n Easy application with color coded sensors n Pre-program multiple studies n Rechargeable battery n Internal position sensor n Ability to record 12 channels
Embletta Gold by Embla Limitations: n Heavier unit n Difficult for patients to apply themselves n Somewhat difficult to score
Nihon Kohden Nomad
Nihon Kohden Nomad Features: n Integrates with NK system n Auto starts with pulse signal or can be set to start at a designated time n 2 GB internal memory n Uses 2 AA batteries n Has ability to monitor 12 channels: thermister, pressure transducer, snore, body position, SPO 2, pleth, pulse, chest effort, abdominal effort, 2 limb channels and 1 DC output
Nihon Kohden Nomad Limitations: n Larger/heavier than most units n Higher price point n Costly to repair n Difficult for patient to apply themselves
Sleep. View by Cleve. Med
Sleep. View by Cleve. Med Features: n Cloud based n Easy patient application n Very light n Capable of recording 7 channels: Pulse oximetry, heart rate, respiratory effort, cannula based airflow, thermister based airflow, snore, and body position n Uses 1 AAA battery n All necessary study supplies included n 1 GB internal memory
Sleep. View by Cleve. Med Limitations: n Belt seemed to slip out of place during recording resulting in a suboptimal signal n Cumbersome log in/ log out process for downloading, scoring and interpreting in one location
Apnea Link Plus by Res. Med
Apnea Link Plus by Res. Med Features: n 4 channels: nasal flow (and snore), pulse, oxygen saturation, and respiratory effort n Lightweight n Easy patient application n Uses 2 AA batteries n Ability to email report and recording n Cost effective
Apnea Link Plus by Res. Med Limitations: n No body position sensor n No numerical values when scoring desaturations
Summit Sleep Services HST Volume
SUMMIT HST ALGORITHM Sleep physician consult and HST ordered if appropriate HST interpreted Sleep clinic follow-up with initiation of auto-CPAP 414 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
HST INTERPRETATION TEMPLATE
WHERE IS SLEEP MEDICINE HEADED IN THE USA?
THANK YOU
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