AAST 2018 Annual Meeting Recordings
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Fundamentals of Advanced Titrations
Presented by Byron Jamerson, RPSGT, RST, CCSH
Technologies such as adaptive servo-ventilation (ASV) for treatment of central sleep apnea syndromes (CSAS) and adaptive volume assured pressure support (AVAPS) for chronic hypoventilation syndromes are being used to treat patients with advanced or complicated sleep disordered breathing. American Academy of Sleep Medicine (AASM) guidelines indicate that patients with severe forms of symptomatic chronic heart failure (CHF), and reduced left ventricular ejection fraction (LVEF ≤45%) using ASV may have an increased risk of cardiovascular mortality. The use of ASV in patients using opioids and those with other CSA syndromes has been shown to improve breathing function during sleep. AASM guidelines for best practices in the use of non-invasive positive pressure ventilation (NPPV) in patients with neuromuscular disease, restrictive disorders and obesity hypoventilation syndrome indicate that non-invasive positive pressure ventilatory support such as provided by advanced therapy AVAPS has been shown to improve sleep, nighttime oxygen saturation, and improved quality of life.
There is no standard approach to titration and utilization of these therapies, and there are currently no specific clinical guidelines for their use, however initial use is recommended to be in a monitored setting utilizing in-laboratory polysomnography to assess the appropriateness of both of these therapies for the individual patient. Appropriate use of ASV and AVAPS therapy is based on clinical presentation and titration of these therapies follows manufacturer specific guidelines.
- Understand the function of Auto/Adaptive ServoVentilation and how this differs from BPAP
- Understand the function of Volume Targeted Pressure Ventilation and how this differs from BPAP
- Identify the indications and key titration goals of advanced therapies
CEC Credit: 0.5
The Role of Dental Devices in Sleep Medicine
Presented by Richard A. Bonato, PhD, RPSGT
This session provides an overview of the evaluation of patients being considered for oral appliance therapy. A review of the process for determining the appropriateness of OAT for patients with SDB is covered, including the variety of oral appliances available and their indications, and the pros and cons of OAT therapy for these patients. Adherence monitoring is discussed along with the evaluation process for determination of a successful treatment with OAT.
- Categorize the major types of dental devices that sleep technologists should be familiar with and their indications
- Discuss the pros and cons of dental appliance use and recognize the patients for whom oral appliance therapy (OAT) might be considered
- Evaluate oral appliance therapy and determination of success
CEC Credit: 1.0
Sleep Win Repeat: Sleep Science in the Sports World
Presented by Brendan Duffy, RPSGT, RST, CCSH
This session looks at the world of sleep in the world of sports. During the past several years, sleep has become as important as diet and exercise in the life of athletes and coaches. This presentation provides a view into what is quickly becoming a normal part of athletic training and recovery - sleeping to win!
- Describe the reasons that sleep is necessary for optimal athletic performance
- Analyze how teams are incorporating sleep in their training and scheduling regimes at the professional and college level
- Summarize the role of the sleep professional in working within the physical fitness space
CEC Credit: 0.5
Presented by Jon Atkinson, BS, RPSGT, CCSH, FAAST
Sleep paralysis (SP), along with catalepsy, hypnagogic/hypnopompic hallucinations, excessive daytime sleepiness, and disrupted nocturnal sleep comprise the cardinal symptoms of the narcolepsy pentad. Isolated sleep paralysis, sleep paralysis without diagnosis of narcolepsy, occurs in a high percentage of people. There are identified triggers for sleep paralysis including sleep deprivation , mental disorders, changes in sleep-wake schedules, and some medications. Treatment can include reassurance, CBT, sleep hygiene, and medications depending on the frequency and severity of attacks.
- Define sleep paralysis
- Identify aggravating factors contributing to sleep paralysis
- Review therapeutic regimes for sleep paralysis
CEC Credit: 1.5
OSA and COPD (Overlap Syndrome)
Presented by Dave Glowark, RRT
Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of hospital readmissions. One complicating factor for COPD is Obstructive Sleep Apnea (OSA). The combination of these two breathing disorders is known as Overlap Syndrome (OVS). Left untreated, OSA is a predictor of hospital readmissions in COPD patients. Treating OSA is not the only opportunity to help these patients, the multiple capabilities of noninvasive ventilation (NPPV) can manage both the OSA and the hypoventilation associated with COPD. Sleep technology has a specialized role to play. There are two key roles in driving patient success. One is the sleep technologists working with the medical director determining the best positive airway pressure (PAP) option for the patient. The other is the sleep professionals with the Certification in Clinical Sleep Health (CCSH). Often performing as Sleep Navigators or Sleep Educators, these professionals can serve their organizations by leading not only the screening and educational efforts, but also the management and interpretation of the outcomes data. The right collaboration means the correct patient is screened, educated, tested, treated and managed successfully. This presentation aims to highlight the pieces many use to manage an OVS program.
Konikkara, J. et al, (2016) Early recognition of obstructive sleep apnea in patients hospitalized with COPD exacerbation is associated with reduced readmission. Hospital Practice . Volume 44, 2016. Issue 1. Pages 41-47. Retrieved from: https://doi.org/10.1080/21548331.2016.1134268
- Define COPD and OSA as Overlap Syndrome (OVS), while understanding the epidemiology and presentation of OVS
- Explore screening strategies and treatment options for patients with OVS
- Identify methods for following the patient and managing the patient data
CEC Credit: 1.0
CPAP - All Pain and No Gain?
Presented by Vikas Jain, MD
This presentation addresses the health benefits or lack thereof of CPAP for the treatment of OSA. The pros and cons of using PAP Therapy and the latest literature/research regarding the use of PAP therapy on cardiovascular outcomes are also covered.
- Discuss RCT that have shown no benefit of PAP therapy on cardiovascular outcomes. Discuss what patient populations may benefit from therapy with positive airway pressure therapy
- Discuss the impact of untreated OSA on cardiovascular disease
- Discuss the benefits of treating OSA with PAP Therapy on cardiovascular outcomes
CEC Credit: 0.5
Advanced PAP Platforms
Presented by Dave Glowark, RRT (Adapted from Dr. Teofilo Lee-Chiong, MD’s original presentation)
This session addresses the challenges of providing PAP therapies and noninvasive ventilation in the home for patients with complicated sleep-related breathing disorders are being addressed by novel technologies.
- Outline how abnormal respiratory events, responses, and controls contribute to complicated sleep-disordered breathing
- Identify the different positive airway pressure modalities that are used to manage persons with complicated sleep-disordered breathing
- Select the best therapies for persons at each stage of their chronic illness
CEC Credit: 1.0