Sleep Medicine Commons^™

Urine Drug Screening At The Sleep Disorder Center, Rohin Saroya, Md, Karl Doghramji, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aim

• Introduce UDS for all patients undergoing MSLT or MWT
• Eliminate false positive and negative results
• Optimize management of disorder

Goal

• To have 100% of patients undergoing an MSLT or MWT to have a UDS

A Positive Framed Message To Improve Cpap Compliance For Patients With Osa, Frances Clark

Evidence-Based Practice Project Reports

Obstructive sleep apnea (OSA) affects 24% of the US population (DiNapoli, 2014). Untreated OSA causes many diseases, affects one’s quality of life, and increases mortality (Pengo et al., 2018). Continuous positive airway pressure (CPAP) is the lifelong treatment for OSA; yet 30%-80% of OSA patients are CPAP noncompliant within one year. The purpose of this EBP project was to determine if implementing a positive frame message intervention would improve CPAP compliance for newly diagnosed OSA patients. Based on the evidence, implementation of behavioral interventions, such as a positive framed message, was effective in improving CPAP compliance (Pengo et ...

Sleep Deprivation And High-Fat Diet During Adolescence Protect Stress Effects On Object Memory During Adulthood, Karina Glushchak

Honors Theses

No abstract provided.

Motivational Interviewing For Cpap Adherence, Grayton Downing, Caitlin Green, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Untreated obstructive sleep apnea (OSA) leads to negative health outcomes. Yet, compliance rates for continuous positive airway pressure (CPAP), the gold standard of treatment, range from 30-60%. This study examines how motivational interviewing (MI), a goal-oriented form of psychotherapy, increases CPAP adherence. We hypothesize that MI increases CPAP compliance when incorporated into CPAP follow-up care.

Methods: We developed and trained our staff with a novel MI training protocol consisting of MI background readings and videos, CPAP technician shadowing, and MI role-play for certification. For the clinical trial, newly diagnosed OSA patients from Jefferson’s sleep center will be randomized ...

Sound Dampening Headband For Infants, Alexandra A. Mccullough, Mohammad Rasool, Alison Romisher, Robert S. Pugliese, Pharmd, Bcps, Bon Ku, Md, Mpp

Phase 1

Background: Noise in the Intensive Care Nursery (ICN) has been linked to sleep disruption, vital sign destabilization, abnormal development, and stress response induction in infants. Specifically, a sound level ≥60 decibels (dB) was linked to sleep disruption in infants, and the American Academy of Pediatrics (AAP) set a maximum recommended sound level of 45dB in ICNs. The present work was conducted to confirm that the Jefferson ICN exceeds the 60dB and 45dB levels, like most hospitals do, and to conduct preliminary testing on materials for a wearable intervention to reduce infants’ exposure to noise.

Methods: A group of 30 neonatologists ...

Motivational Interviewing For Cpap Adherence, Caitlin Green, Grayton Downing, Cindy Cheng, Md, Phd

Phase 1

Background: Continuous Positive Air Pressure (CPAP), is the gold standard for obstructive sleep apnea (OSA) treatment. If left untreated, patients with OSA can experience serious and potentially life-threatening consequences. However, patient CPAP adherence is an ongoing problem, as compliance rates are historically low (typically 30-60%). Engaging patients in motivational interviewing (MI) by trained providers could promote increased CPAP adherence.

Question/Purpose: Assess CPAP compliance in patients who receive motivational interviewing compared to a control attention intervention.

Methods: A team of medical students were trained in MI interviewing techniques through a novel training protocol. The training protocol includes reading articles and ...

Medical Student Knowledge Of Narcolepsy, Alyssa Sinko, Karl Doghramji, Md

Phase 1

Background: Narcolepsy is a sleep disorder, whose main symptoms include daytime sleepiness, cataplexy, sleep paralysis, disturbed sleep, and hypnagogic hallucinations. The disorder is poorly identified in medical settings. We hypothesized that lack of knowledge of narcolepsy and its hallmark symptoms are a cause for the low levels of identification of this disorder. This was a pilot study into medical student knowledge of narcolepsy at Sidney Kimmel Medical College of Thomas Jefferson University (SKMC).

Methods: Two groups of SKMC students, years 1 and 2 (before sleep medicine education) and years 3 and 4 (after sleep medicine education) were the subjects of ...

Cognitive Changes In Patients Treated For Obstructive Sleep Apnea With Upper Airway Stimulation, Maxillomandibular Advancement, Or Expansion Sphincter Pharyngoplasty, Nicolas Zingas, Colin Huntley, Matthew Stewart, Ramez Philips

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a prevalent diagnosis that has been shown to not only affect sleepiness, but daytime cognitive function — specifically attention, working memory, and executive function. CPAP treatment is troublesome for some patients and it is possible that superior treatment options, specifically novel surgical techniques, are available, though none have been evaluated for their long-term effects on neurocognition. We hypothesize that treating patients with upper airway stimulation surgery (UAS) UAS, maxillomandibular advancement surgery (MMA), and expansion sphincter pharyngoplasty surgery (ESP) for OSA produces a significant improvement in cognition from baseline.

Methods: For inclusion in the study, two ...

Primary Care Obstructive Sleep Apnea Screening (Pcosa), Alyssa Givens, Risa Goldberg, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a largely underdiagnosed disorder of upper airway collapse during sleep. Primary care providers do not routinely screen for OSA. This project aims to determine the yield of using the STOP-BANG questionnaire to identify previously undiagnosed OSA in a primary care population.

Methods: This prospective quality improvement pilot project included 181 patients of the Jefferson Department of Family Medicine identified as high-risk for OSA based on 3 EMR-based search criteria taken from STOP-BANG: hypertension, age >50 years, and BMI >35 kg/m². We attempted contact with patients by mail, followed by up to 3 ...

Identifying The Prevalence Of Underdiagnosed Obstructive Sleep Apnea (Osa) In The Primary Care Population Via Targeted Screening Measures, Risa Goldberg, Alyssa Givens, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a condition with detrimental health consequences, yet over 75% of OSA cases remain undiagnosed in the United States. This study aimed to determine the efficacy of using targeted screening measures to determine the prevalence of undiagnosed OSA in a primary care population.

Methods: This prospective pilot study utilized a primary care population from Thomas Jefferson University’s family medicine department. Participants were selected using three risk criteria for OSA from STOP-BANG identifiable from their EMR records (BMI >35, age over 50, and hypertension). After screening out patients previously diagnosed with OSA, patients were called ...

Mci: Cpap Treatment Of Osa, Kaitlin Berry, Cindy Cheng, Md, Phd, Karl Doghramji, Md

Phase 1

Introduction: An estimated 30 percent of adults (20% of men and 10% of women) in the US have sleep apnea. Approximately 60% of patients with Mild Cognitive Impairment (MCI) are also diagnosed with Obstructive Sleep Apnea (OSA). The suggested mechanism of this is damage to the brain due to hypoxia during sleep. Few studies have investigated the effect of Continuous Positive Airway Pressure (CPAP) treatment for OSA, on mild cognitive impairment.

Methods: Patients are screened for eligibility based on specific inclusion and exclusion criteria. Potentially eligible patients who screen positive for MCI using the Telephone Interview for Cognitive Status (TICS ...

Creating A Noise-Reducing, Wearable Intervention For Newborns In The Nicu, Mohammad Rasool, Alexandra A. Mccullough, Alison Romisher, Robert S. Pugliese, Pharmd, Bcps, Bon Ku, Md, Mpp

Phase 1

Background: Excessive auditory stimulation can have negative effects on the growth and development of newborn babies. The American Academy of Pediatrics states that newborns should not be exposed to sounds in excess of 45dB while they are in the hospital, however noise levels in NICUs across the country are often between 50-100dB. A design project was conducted to develop an intervention that could reduce infant exposure to excessive noise.

Methods: Neonatologists, nurses, audiologists, music therapists, sound designers, soft materials experts, and medical device designers were interviewed and consulted throughout the design process. A 24-hour sound recording using a REED-SD-4023 meter ...

Efficacy Of Cpap Compared To Standard Pharmacotherapy In Reducing Cognitive Impairment Symptoms In Patients With Alzheimer's Disease, Nicholas Moylan

Capstone Showcase

This review analyzed the following question: In adults age 65 years old or older diagnosed with Alzheimer’s Disease (P), is nightly use of CPAP (I) more effective in reducing cognitive impairment symptoms (O) than standard pharmacotherapy options (C)? A literature search conducted through Google Scholar and PubMed granted six relevant articles that provided data for this review. No current studies compared CPAP treatment with pharmacotherapy, and each study used unique measures of cognitive function, making direct comparison of the two therapies difficult. Results demonstrated that first line pharmacotherapy can improve cognitive function, but only in limited way and only ...

Effect Of Sleep Deprivation And Sleep Recovery On Heart Rate And Heart Rate Variability In Males Versus Females, Abrianna Lochner Spt, Elena Crooks Pt, Dpt, Phd, Myles Gordon Finlay Ba, Julie A. Erwin Ms, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Elevated heart rate (HR) and low HR variability (HRV) are indicators of increased sympathetic tone and cardiovascular risk. Here, we assess the effect of one night of sleep deprivation and a subsequent night of recovery sleep on HR and HRV in healthy males versus females.

Methods

Fifty-nine subjects (29.5±8.5y, n=35 female) completed a 4-day/3-night laboratory study. Subjects had a baseline sleep opportunity (22:00–08:00), followed by 38h of sleep deprivation, and a recovery sleep opportunity (22:00–08:00). EKG was monitored via Holter monitors to measure HR and the pNN50 and ...

Is Napping A Good Thing?, Sammar Atassi

Marshall Journal of Medicine

This article aims to explore new findings in research in the relationship between sleep disorders and dementia. The new research questions the glymphatic system's role in clearing the toxic proteins from the brain during sleep.

Therapeutic Alternatives With Cpap In Obstructive Sleep Apnea, Corina E. Budin, Lorena Ciumarnean, Anca Maierean, Ruxandra Rajnovean, Bianca D. Gergely, Milena Man, Maria Aluas, Angela Cozma, Roxana I. Bordea

Journal of Mind and Medical Sciences

Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority ...

Wavelet-Based Analysis Of Physical Activity And Sleep Movement Data From Wearable Sensors Among Obese Adults, Rahul Soangra, Vennila Krishnan

Physical Therapy Faculty Articles and Research

Decreased physical activity in obese individuals is associated with a prevalence of cardiovascular and metabolic disorders. Physicians usually recommend that obese individuals change their lifestyle, specifically changes in diet, exercise, and other physical activities for obesity management. Therefore, understanding physical activity and sleep behavior is an essential aspect of obesity management. With innovations in mobile and electronic health care technologies, wearable inertial sensors have been used extensively over the past decade for monitoring human activities. Despite significant progress with the wearable inertial sensing technology, there is a knowledge gap among researchers regarding how to analyze longitudinal multi-day inertial sensor data ...

A Strategy For Noise Reduction To Improve Patient Experiences With Sleep (Snores), Vikas Sunder, Eitan Frankel, Neelam Upadhyaya, Merlin Mathew, Ritu Nahar, Michael Brister, Nicholas Young, Yair Lev, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aim

Our aim was to improve patient-reported sleep satisfaction on the 5 W telemetry unit at Thomas Jefferson University Hospital over a 4 month time period (11/2018 to 2/2019) using a Marpac white noise machine.

Comprehensive Sleep Apnea Screening In Veterans With Posttraumatic Stress Disorder, Richard W. Schulz

Doctor of Nursing Practice Final Manuscripts

Objectives: Recent studies have shown a higher prevalence of sleep apnea in veterans with Posttraumatic Stress Disorder (PTSD). It is estimated that 69 to 83% of veterans have Obstructive Sleep Apnea (OSA) while 80 to 90% are undiagnosed or untreated. Untreated OSA can lead to severe chronic medical conditions as well as impairment of neurocognitive and fear extinction processing potentially decreasing responsiveness to trauma focused therapy. Despite the widespread dissemination of knowledge regarding the negative effects of OSA, many veterans are not screened. The goal of this project is to increase the rate of identifying veterans who are high-risk for ...

Effects Of An Obstructive Sleep Apnea Screening Program On Providers' Adherence, Kelsie A. Tokarczyk

Evidence-Based Practice Project Reports

Obstructive sleep apnea (OSA) is a widely prevalent chronic disease estimated to affect 22 million Americans, with 80 percent of moderate to severe cases undiagnosed (American Sleep Apnea Association [ASAA], 2017). Unmanaged OSA has been associated with numerous detrimental health outcomes including hypertension, chronic heart failure, atrial fibrillation, stroke, and other cardiovascular conditions (ASAA, 2017). The purpose of this evidence-based practice project was to determine if the implementation of a screening protocol would affect providers’ adherence to screening for OSA. The Theory of Planned Change was used as a guide to optimize providers’ adherence to the protocol at a family ...