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4 b sleep medicine reach4 moldova

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Skills training-Session on Polisomnography and CPAP therapy
Cursuri de instruire în cadrul REACH-4-Moldova
13-14 Noiembrie 2014

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4 b sleep medicine reach4 moldova

  1. 1. ACADEMY FOR RESPIRATORY MEDICINE 2014 Skills training-Session: Sleep Medicine Alexandru Corlateanu and Victoria Sircu SPONSORED BY THE GERMAN ACADEMIC EXCHANGE SERVICE 1
  2. 2. LEARNING OBJECTIVES •Describe PG, PSG and CPAP and the techniques employed in standard set-up •Describe respiratory monitoring technology in PG and PSG •Describe the varieties of limited respiratory monitoring systems ACADEMY FOR RESPIRATORY MEDICINE 2014 2
  3. 3. CONTENTS • Basics of Sleep Medicine • Sleep Diagnostic techniques • Noninvasive ventilation • Cases ACADEMY FOR RESPIRATORY MEDICINE 2014 3
  4. 4. CONTENTS • Basics of Sleep Medicine • Sleep Diagnostic techniques • Noninvasive ventilation • Cases ACADEMY FOR RESPIRATORY MEDICINE 2014 4
  5. 5. Sleep Medicine An obstructive apnoea/ hypopnoea can be defined as an event that lasts for o10 s and is characterised by a transient reduction in (hypopnoea), or complete cessation of (apnoea) breathing. ACADEMY FOR RESPIRATORY MEDICINE 2014 5
  6. 6. Definitions An obstructive apnoea/ hypopnoea can be defined as an event that lasts for o10 s and is characterised by a transient reduction in (hypopnoea), or complete cessation of (apnoea) breathing. The International Classification of Sleep Disorders. Second edition. Diagnostic and Coding Manual. Westchester, American Academy of Sleep Medicine, 2005. ACADEMY FOR RESPIRATORY MEDICINE 2014 6
  7. 7. Sleep Medicine in Moldova Nathaniel Kleitman, April 26, 1895 Chisinau – August 13, 1999 Los Angeles. He is recognized as the father of modern sleep research 1925 - established the world's first sleep lab in Abbott Hall. 1953 - reported the discovery of rapid eye movements during sleep 2013 – first Polygraphy si Polysomnography and first patient on CPAP therapy
  8. 8. Definitions An obstructive apnoea/ hypopnoea can be defined as an event that lasts for o10 s and is characterised by a transient reduction in (hypopnoea), or complete cessation of (apnoea) breathing. ACADEMY FOR RESPIRATORY MEDICINE 2014 8
  9. 9. Definitions An obstructive apnoea/ hypopnoea can be defined as an event that lasts for o10 s and is characterised by a transient reduction in (hypopnoea), or complete cessation of (apnoea) breathing. American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, American Academy of Sleep Medicine, 2007. ACADEMY FOR RESPIRATORY MEDICINE 2014 9
  10. 10. Definitions: obstructive apnea ACADEMY FOR RESPIRATORY MEDICINE 2014 10
  11. 11. Definitions: obstructive apnea ACADEMY FOR RESPIRATORY MEDICINE 2014 11
  12. 12. Definitions: central apnea ACADEMY FOR RESPIRATORY MEDICINE 2014 12
  13. 13. Definitions: OSAS OSAS is now recognised as one of the most common chronic RESPIRATORY disorders in adults. ACADEMY FOR RESPIRATORY MEDICINE 2014 13
  14. 14. Definitions: OSAS Sleep-Disordered Breathing ACADEMY FOR RESPIRATORY MEDICINE 2014 14 OASHS CSAHS CSR OHS Obstructive sleep apnea hypopnea syndrome Central sleep Apnea Hypopnea syndrome Cheyne-Stokes Respiration Obesity Hypoventilation Syndrome
  15. 15. Definitions The degree of severity is defined on the basis of the number of apnoeas and hypopnoeas occurring during 1 h of sleep (this is the apnoea–hypopnoea index (AHI)) and the severity of daytime symptoms. ACADEMY FOR RESPIRATORY MEDICINE 2014 15
  16. 16. What happens during an apnea? ACADEMY FOR RESPIRATORY MEDICINE 2014 16
  17. 17. Clinical Assessment ACADEMY FOR RESPIRATORY MEDICINE 2014 17
  18. 18. Clinical Assessment ACADEMY FOR RESPIRATORY MEDICINE 2014 18
  19. 19. Clinical Assessment: Epworth ACADEMY FOR RESPIRATORY MEDICINE 2014 19
  20. 20. Clinical Assessment: Mallampati Score ACADEMY FOR RESPIRATORY MEDICINE 2014 20
  21. 21. CONTENTS ACADEMY FOR RESPIRATORY MEDICINE 2014 21
  22. 22. CONTENTS • Basics of Sleep Medicine • Sleep Diagnostic techniques • Noninvasive ventilation • Cases ACADEMY FOR RESPIRATORY MEDICINE 2014 22
  23. 23. Sleep monitoring devices ACADEMY FOR RESPIRATORY MEDICINE 2014 23 Type 1: Attended polysomnography Type 2: Portable polysomnography Attended or unattended: not recommended Type 3: PG: Limited channel (> 4) Some evidence to support in-lab use to rule in or out OSA. Unattended: not recommended Type 4: one or two cardiopulmonary Attended or unattended: not recommended
  24. 24. PSG •The term polysomnography was first introduced by Holland et al in 1974 •Recording, analysis and interpretation of multiple, simultaneous, physiologic parameters •Essential in the diagnosis of many sleep disorders •Essential to the understanding of normal and abnormal sleep ACADEMY FOR RESPIRATORY MEDICINE 2014 24
  25. 25. PSG Sleep signals EEG with at least 2 channels EOG with two channels EMG submentalis Respiration Oronasal airflow Respiratory effort / movement / snoring Effect of respiration / oximetry / CO2 ACADEMY FOR RESPIRATORY MEDICINE 2014 25
  26. 26. PSG Cardiovascular system ACADEMY FOR RESPIRATORY MEDICINE 2014 ECG Movement EMG tibialis Body position - Indications and Standards for Cardiopulmonary Sleep Studies. ARRD 139: 559-568 (1989) 26
  27. 27. PSG Cardiovascular system ACADEMY FOR RESPIRATORY MEDICINE 2014 ECG Movement EMG tibialis Body position - Indications and Standards for Cardiopulmonary Sleep Studies. ARRD 139: 559-568 (1989) 27
  28. 28. ACADEMY FOR RESPIRATORY MEDICINE 2014 28
  29. 29. Sleep monitoring devices ACADEMY FOR RESPIRATORY MEDICINE 2014 29
  30. 30. CONTENTS • Basics of Sleep Medicine • Sleep Diagnostic techniques • Noninvasive ventilation • Cases ACADEMY FOR RESPIRATORY MEDICINE 2014 30
  31. 31. Treatment of SAOS • Basics of Sleep Medicine • Sleep Diagnostic techniques • Noninvasive ventilation • Cases ACADEMY FOR RESPIRATORY MEDICINE 2014 31
  32. 32. NIV • Basics of Sleep Medicine • Sleep Diagnostic techniques • Noninvasive ventilation • Cases ACADEMY FOR RESPIRATORY MEDICINE 2014 32
  33. 33. NIV ACADEMY FOR RESPIRATORY MEDICINE 2014 33
  34. 34. CONTENTS • Basics of Sleep Medicine • Sleep Diagnostic techniques • Noninvasive ventilation • Cases ACADEMY FOR RESPIRATORY MEDICINE 2014 34
  35. 35. Case 1 Patient C.R.- man, 37 years old, nonsmoker, driver Complains : - Loud snoring - witnessed and reported by the bed partner apnoeas - Excessive daytime sleepiness - Fatigue - Morning dry mouth - Morning headache ACADEMY FOR RESPIRATORY MEDICINE 2014 35
  36. 36. Case 1 Physical examination: Weight - 130 kg Height - 1m75cm BMI - 42,4 kg/m2 Neck circumference- 46 cm Mallampati score- III (the degree of pharyngeal narrowing) ACADEMY FOR RESPIRATORY MEDICINE 2014 36
  37. 37. Case 1 The Epworth Sleepiness Scale (ESS) – 19 points The Berlin Questionnaire – High risk of OSAS ACADEMY FOR RESPIRATORY MEDICINE 2014 37
  38. 38. Case 1 SOMNOcheck micro ACADEMY FOR RESPIRATORY MEDICINE 2014 38
  39. 39. Case 1 ACADEMY FOR RESPIRATORY MEDICINE 2014 39
  40. 40. Case 1 ACADEMY FOR RESPIRATORY MEDICINE 2014 40
  41. 41. Case 1 ACADEMY FOR RESPIRATORY MEDICINE 2014 41 Diagnosis: - Severe Obstructive sleep apnoea syndrome, AHI= 43,1/h (N < 5/h). SPO2 average 90% (N 94-98%) Obesity III Recommendation: 1. Titration with auto CPAP and Poligraphy 2. Use autoCPAP min. 5h/night 3. Don’t use any alcohol, sedative medication 3-4 hours before sleep without using autoCPAP
  42. 42. Case 1 Automatic Positive Airway Pressure (APAP) devices SOMNObalance e ACADEMY FOR RESPIRATORY MEDICINE 2014 42
  43. 43. Case 1 Result- Titration with autoCPAP and SOMNOcheck micro ACADEMY FOR RESPIRATORY MEDICINE 2014 43
  44. 44. Somnocheck micro - 5 min S ACADEMY FOR RESPIRATORY MEDICINE 2014 44
  45. 45. Somnocheck micro – 5 min SS ACADEMY FOR RESPIRATORY MEDICINE 2014 45
  46. 46. Somnocheck micro – 5 min ACADEMY FOR RESPIRATORY MEDICINE 2014 46
  47. 47. PG- central apnea ACADEMY FOR RESPIRATORY MEDICINE 2014 47
  48. 48. Poligraphy- ( 5 min) – central and mixed apnea ACADEMY FOR RESPIRATORY MEDICINE 2014 48
  49. 49. Polisomnography – 5 min ACADEMY FOR RESPIRATORY MEDICINE 2014 49
  50. 50. Control therapy autoCPAP (before CPAP AHI was 77,1/h) ACADEMY FOR RESPIRATORY MEDICINE 2014 50

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