home obstructive sleep apnea management in the usa and abroad
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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

HOME OBSTRUCTIVE SLEEP APNEA MANAGEMENT IN THE USA AND ABROAD

P. LYNN NICHOLS, M.D.

DABSM,FCCP

financial disclosures
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
what is the name of this procedure anyway
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)
goals
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?
slide24
The ChallengeDesign and implement an obstructive sleep apnea diagnostic and treatment program for 150,000 rural New Zealanders
other resources
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
it s all about the algorithm
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
outcome at one year
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
home sleep testing

Home Sleep Testing

Technical Perspective

Nicole Line, RPSGT, RST,PSGP

Clinical Director

disclaimer
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.

embletta gold by embla1
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
embletta gold by embla2
Embletta Gold by Embla

Limitations:

  • Heavier unit
  • Difficult for patients to apply themselves
  • Somewhat difficult to score
nihon kohden nomad1
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
nihon kohden nomad2
Nihon Kohden Nomad

Limitations:

  • Larger/heavier than most units
  • Higher price point
  • Costly to repair
  • Difficult for patient to apply themselves
sleepview by clevemed1
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
sleepview by clevemed2
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
apnea link plus by resmed1
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
apnea link plus by resmed2
Apnea Link Plus by ResMed

Limitations:

  • No body position sensor
  • No numerical values when scoring desaturations
summit hst algorithm
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

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