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Tools of the Trade in Sleep Medicine

Tools of the Trade in Sleep Medicine. Klaas van Kralingen, somnologist SEIN April 2019. What is the core business?. Classical Medicine. Sleep medicine is age old, and very young!. Sleep in Hebrew, 800BCE. Sleep and electrodes, 1930 CE. Tools of the Trade: the List. “ Neurology”.

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Tools of the Trade in Sleep Medicine

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  1. Tools of the Trade in Sleep Medicine Klaas van Kralingen, somnologist SEIN April 2019

  2. What is the core business?

  3. Classical Medicine

  4. Sleep medicine is age old, and very young! Sleep in Hebrew, 800BCE Sleep and electrodes, 1930 CE

  5. Tools of the Trade: the List “Neurology” “Respiratory”

  6. The Gold Standard: Polysomnography

  7. Observation of the waves

  8. Counting the waves…………

  9. Op het EEG op die momenten steeds een arousal

  10. Klinisch steeds een snurk  OSAS

  11. Tijdens slaap in de trends regelmatig korte verandering in de power en de ritmiciteit. NB: Tijdsas is een uur.

  12. Definition diseases

  13. Evaluation of the Gold Standard

  14. The polygraphy: a practical solution?

  15. Prevalentie probleemHypnoLaus Study 2015

  16. Polygraphy: a meta-analysis (Ghegan Laryngoscope 2006)

  17. Polygraphy: example

  18. Manual scoring?

  19. PG vs. PSG ziekte II PGPSG REI/AHI20.928.5 Mild/no% 41.225 Mod.%23.925.9 Severe %34.949.1 ODI16.718.2 Rx CPAP of Life style CPAP: REI/AHI > 5 met klachten/CVM CPAP : REI/AHI > 30 Outcome: PG=PSG, ondanks 15% niet met CPAP Behandeld OSA in PG groep

  20. Pulmonary (patho) physiology in a few slides

  21. Cause of elevated pCO2

  22. Causes hypercapnia

  23. Ventilatoire respons pCO2

  24. Ventilatie in normale slaap Douglas Thorax 1982

  25. Obesitas Hypoventilation Does isolated nocturnal hypoventilation exist? Relevant entity? Treatment?

  26. AASM and Hypoventilation

  27. Staging Hypoventilation in Obesity

  28. Patient 80956: Tired with PAP

  29. cBGA: I-STAT

  30. Analysis blood gas Normal values: pCO2 35-45 mm HG pH 7.35-7.45 HCO3: > 27 mmol/l SAO2 in capillary gas not reliable

  31. SENTEC

  32. Poli!

  33. Patient 82553: Talking only

  34. Patient 82669: Into the rhythm

  35. Patient 82748: No rhythm in the rhythm!

  36. Patient77956 Smiling and Falling

  37. Patient55049 Things going bump

  38. Patient 81560: Classical OSAS

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