1. Obstructive Sleep Apnea (OSA)
Ryan Pavlovich, M.D., Ph.D.
Medical Director, NSA Sleep Medicine

2. Important CME Information
DISCLOSURE INFORMATION: The planners of this activity and the speaker, Ryan Pavlovich, MD, PhD, do not have affiliations with any corporate organizations that may constitute a conflict of interest with this presentation.
CME CREDIT: Attendees must sign in to receive the online evaluation survey for this presentation. CME Credit will only be issued to attendees who complete the evaluation survey within the next 30 days.

3. OSA Process for Diagnosing OSA Limitations of Ambulatory Sleep Testing
Follow up for Sleep Apnea
New guidelines for commercial drivers
Contact Information

4. WatchPat Class Set Up:

5. A typical class held twice daily

6. Respiratory therapist after getting berated by a patient inappropriately booked in the class:

7. PROCESS FOR DIAGNOSING OSA

8. Econsult Page:
To Facility: Vacaville To Specialty: Sleep Lab Problem/Reason: Sleep Apnea
Referral Guidelines:
Adult Referrals Only
This appointment is for patients with signs/symptoms of (OSA) obstructive sleep apnea with NO prior diagnosis.
READ THE OPTIONS CAREFULLY. THE OPTION YOU CHOOSE WILL DETERMINE IF THE PATIENT RECEIVES THE CORRECT TESTING DEVICE
Please inform the patient that the testing device must be returned the next day (or Monday for an appointment on Friday)

9. QUESTION 4.
4. In order to determine an appropriate testing method, please select the following items that apply:
Pacemaker/implantable defibrillator (AICD)
CHF
<18 yrs old
Inappropriate for group setting
Spanish speaker, Patient unable to hold short acting nitrates and/or alpha blockers for five days prior to appointment.

10. 5. READ THIS QUESTION CAREFULLY
5. READ THIS QUESTION CAREFULLY. THE OPTION YOU CHOOSE WILL DETERMINE IF THE PATIENT RECEIVES THE CORRECT TESTING DEVICE
Takes short acting nitrates &/or alpha blockers that CANNOT be held five days prior to this study.
Takes short acting nitrates &/or alpha blockers that CAN be held five days prior to this study.
Patient not currently taking short acting natrates &/or alpha blockers.

11. Alpha Blockers include:
Flomax/Tamsulosin
Hytrin/Terazosin
Cardura/Doxazosin
Minipress/Prazosin
Uroxatral/Alfuzosin
Rapaflo/Silodosin
Catapres/Clonidine
Aldomet/Methyldopa
Alpha Blockers interrupt the detection of the
Stage of sleep with a standard watchpat.
These will render the WatchPat test inaccurate

12. Limitations of a Three Channel Home Ambulatory Slee Test (WatchPat)

13. Limitations of WatchPat
WatchPat Sleep Tests are of questionable validity in the following patients:
Alpha Blockers: The Watchpat extrapolates stage of sleep by an algorithm that evaluates peripheral vasodilation. Alpha blockers increase vasodilation and make the study invalid.
CHF: A watchpat does not differentiate between obstructive and central sleep apnea. These patients require evaluation for both central and obstructive sleep apnea which requires testing capable of monitoring air flow and effort.
Group Setting: Patients who are directly booked through this page are placed in a classroom and a WatchPat device is programmed for them. The respiratory therapist instructs the patient on placing the device and how to return it to us.

14. NOOOOOooooooooooooo!

15. To Facility: Vacaville To Specialty: Sleep Lab Problem/Reason: Other
“If patient has a known diagnosis of sleep apnea and requires treatment advice, please go to problem reason OTHER”
Diagnosed with MILD OSA, Wants to Try CPAP
Previous Dx of OSA at KP AND documented in HC who previously refused/intolerant/never treated, now wants to try CPAP
New to KP with documented (not pt states) OSA who needs new CPAP/BiPAP
CPAP not working
Wants to try ORAL APPLIANCE

16. Follow up for sleep apnea

17. Follow up on Positive Pressure Therapy “Too much pressure”
“CPAP not working”
“I have an Air Leak”
“I’m still tired during the day”
*These patients rarely need a repeat sleep study.

18. Resmed Airview

20. New guidelines for commercial drivers

21. Question 3. Indication For Study: Work related or DMV regulation
“Chain of Command”

22. OSA and commercial drivers
Federal Motor Carrier Safety Administration (FMCSA)
37 pages recommendations manual
“May require physicians to provide proof for CPAP compliance”

23. OSA and commercial drivers
Initial acceptable compliance is defined as at least 4 hours/ day on at least 70% of days in a two-week period
For yearly recertification, these patients are now required to show proof of CPAP usage for at least 70% of the year (minimum 4 hours per night) FOR THE ENTIRE YEAR.

24. Contact Information
Ryan Pavlovich M.D., Ph.D.
Medical Director Sleep Medicine
Kaiser Permanente Napa Solano
Office
Cell

25. REMINDER ABOUT CME CREDIT
Attendees must sign in to receive the online evaluation survey for this presentation. CME Credit will only be issued to attendees who complete the evaluation survey within the next 30 days.

26. Diagnostic studies

27. Available Sleep Studies
WatchPat
Embletta
Nox-3
Polysomnogram

28. Watch-PAT

29. Peripheral Arterial Tone (PAT) technology
Measures peripheral vascular responsiveness, finger blood flow and oxygen saturation
Detects transient elevation in peripheral resistance and heart rate which correlates with arousal and OSA
Studies have shown a high correlation with attended polysomnogram in AHI, lowest O2 saturation and sleep time

30. Contraindication for using Watch-PAT
Permanent pacemaker
Taking an alpha blocker or short-acting nitrates
Concern for central sleep apnea (CHF, opioid use)
Evaluation for anything other than obstructive sleep apnea.
!!!!Only the WatchPat tests are available for direct booking.

31. Embletta

32. Nox-3

33. Polysomnogram