home sleep testing in the usa and abroad-nichols-2

8/17/2019 Home Sleep Testing in the Usa and Abroad-nichols-2

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HOMEHOME

OBSTRUCTIVEOBSTRUCTIVESLEEP APNEASLEEP APNEA

MANAGEMENT INMANAGEMENT IN

THE USA ANDTHE USA AND

ABROAD ABROAD

P. LYNN NICHOLS, M.D.P. LYNN NICHOLS, M.D.

DABSM,FCCPDABSM,FCCP


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MEDICAL DIRECTOR MEDICAL DIRECTOR


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Summitsleeptn.com


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Financial disclosuresFinancial disclosures

I make a livin as a pulmonoloistI make a livin as a pulmonoloist

an! sleep p"#sicianan! sleep p"#sician

No la$e me!ical compan# "as eve$No la$e me!ical compan# "as eve$

o%%e$e! me an# mone#, &ut I amo%%e$e! me an# mone#, &ut I am

open to t"e i!eaopen to t"e i!ea


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HAT IS THE NAME OF

THIS PROCEDURE! AN"A"# Home Sleep 'estin (HS')Home Sleep 'estin (HS') Out o% Cente$ Sleep 'estin (OCS')Out o% Cente$ Sleep 'estin (OCS')

Po$ta&le Monito$in (PM)Po$ta&le Monito$in (PM)

Limite! C"annel 'estin (LC')Limite! C"annel 'estin (LC')

*p$opose!+ Home O&st$uctive Sleep*p$opose!+ Home O&st$uctive Sleep

Apnea Manaement (HOSAM)Apnea Manaement (HOSAM)


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GOALS

Scienti%ic $ationale %o$ HS'Scienti%ic $ationale %o$ HS'

HS' epe$ience in sociali-e!HS' epe$ience in sociali-e!

me!icine (Ne /ealan!)me!icine (Ne /ealan!) HS' %ou$ #ea$ epe$ience in p$ivateHS' %ou$ #ea$ epe$ience in p$ivate

0S Sleep Cente$0S Sleep Cente$

1"e$e is sleep !iso$!e$ manaement1"e$e is sleep !iso$!e$ manaement"ea!e! in t"e 0S2"ea!e! in t"e 0S2


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SCIENTIFIC RATIONALESCIENTIFIC RATIONALE

FOR HST$HOSAMFOR HST$HOSAM


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NEW ZEALANDNEW ZEALAND


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HAKAHAKA


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T%e C%allen&e

Desin an! implement anDesin an! implement an

o&st$uctive sleep apnea !ianostico&st$uctive sleep apnea !ianostic


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N'()**!*** SLEEPN'()**!*** SLEEP

PROGRAMPROGRAM


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OTHER RESOURCESOTHER RESOURCES

One $espi$ato$# t"e$apist !e!icate!One $espi$ato$# t"e$apist !e!icate!

to pulmona$# %unction la& an! sleepto pulmona$# %unction la& an! sleep

p$o$am (I "a! to "i$e)p$o$am (I "a! to "i$e)

6 small "ospitals7clinics it" nu$sin6 small "ospitals7clinics it" nu$sin

sta%% sta%%

C"a$te$e! ai$plane (m# %avo$ite)C"a$te$e! ai$plane (m# %avo$ite)

Suppo$t o% Aucklan! sleep la&Suppo$t o% Aucklan! sleep la&


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MORNING COMMUTEMORNING COMMUTE


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IT+S ALL ABOUT THEIT+S ALL ABOUT THE

ALGORITHM ALGORITHM 8P $e%e$$al lette$ to 9espi$ato$# Consultant8P $e%e$$al lette$ to 9espi$ato$# Consultant

Home sleep test it" %ollo up at netHome sleep test it" %ollo up at net

$espi$ato$# clinic it" initiation o% Auto$espi$ato$# clinic it" initiation o% Auto

CPAPCPAP Auto CPAP !onloa! net CPAP clinic an!Auto CPAP !onloa! net CPAP clinic an!

place! on c"eape$ %ie! CPAP unitplace! on c"eape$ %ie! CPAP unit

CPAP clinic %ollo ups it" 9'CPAP clinic %ollo ups it" 9' 9e%e$$al to Aucklan! i% necessa$#9e%e$$al to Aucklan! i% necessa$#


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OUTCOME AT ONE "EAR OUTCOME AT ONE "EAR

A$oun! :5; o% patients coul! &eA$oun! :5; o% patients coul! &e

manae! it"out in+la& stu!#manae! it"out in+la& stu!#

initiall#initiall#

9ec$uite! a $espi$ato$# consultant9ec$uite! a $espi$ato$# consultant

%$om Sout" A%$ica to continue t"e%$om Sout" A%$ica to continue t"e

p$o$amsp$o$ams


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Home Sleep TestingHome Sleep Testing

'ec"nical Pe$spective'ec"nical Pe$spective

Nicole Line, 9PS8', 9S',PS8PNicole Line, 9PS8', 9S',PS8P

Clinical Di$ecto$Clinical Di$ecto$


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DISCLAIMERDISCLAIMER

'"e %olloin sli!es a$e opinions !e$ive!'"e %olloin sli!es a$e opinions !e$ive!

%$om ou$ epe$iences at Summit Sleep%$om ou$ epe$iences at Summit Sleep

Se$vices an! a$e in no a# $ep$esentativeSe$vices an! a$e in no a# $ep$esentative

o% all Sleep Cente$ situations.o% all Sleep Cente$ situations.


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As techs, our first reaction to As techs, our first reaction to

HST…….HST…….


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Emletta !ol" # EmlaEmletta !ol" # Emla


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Featu$es c"annelsA&ilit# to $eco$! 3> c"annels


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Limitations


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$ihon %oh"en $oma"$ihon %oh"en $oma"


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Featu$es8B inte$nal memo$#>8B inte$nal memo$# 0ses > AA &atte$ies0ses > AA &atte$ies Has a&ilit# to monito$ 3> c"annels c"annels<

t"e$miste$, p$essu$e t$ans!uce$, sno$e,t"e$miste$, p$essu$e t$ans!uce$, sno$e,&o!# position, SPO>, plet", pulse, c"est&o!# position, SPO>, plet", pulse, c"este%%o$t, a&!ominal e%%o$t, > lim& c"annelse%%o$t, a&!ominal e%%o$t, > lim& c"annelsan! 3 DC outputan! 3 DC output


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Limitations


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Sleep&ie' # Cle(eMe"Sleep&ie' # Cle(eMe"


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Featu$es


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Limitations


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Apnea Lin) *lus # ResMe" Apnea Lin) *lus # ResMe"


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Featu$es AA &atte$ies0ses > AA &atte$ies A&ilit# to email $epo$t an! $eco$!inA&ilit# to email $epo$t an! $eco$!in Cost e%%ectiveCost e%%ective


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Limitations


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SUMMIT HST

ALGORITHMSleep 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 symptomsIf HST nondianostic then either repeat HST

or in-lab study ordered


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HST INTERPRETATIONHST INTERPRETATION

TEMPLATETEMPLATE


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WHERE IS SLEEPWHERE IS SLEEP

MEDICINE HEADED IN MEDICINE HEADED INTHE USA? THE USA?


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THA!" #$% THA!" #$%

home sleep testing in the usa and abroad-nichols-2

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