Sleep Medicine Commons^™

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 …

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.

Diagnostic Accuracy Of Home Sleep Apnea Testing (Hsat) Based On Recording Duration, Angela Alnemri, Theodora Fynn, Prakash Vasudevan, Ritu Grewa, Karl Doghramji

Phase 1

Introduction: Obstructive Sleep Apnea (OSA) is a chronic sleeping disorder with serious health consequences. Currently, standard diagnosis is through in-lab polysomnography; however, there has been a shift to greater use of Home Sleep Apnea Testing (HSAT) for patients with a high pre-test probability of having OSA.

Objective: To investigate the minimum recording time needed during HSAT to accurately diagnose the presence and severity of OSA.

Methods: A retrospective review was conducted of HSATs done from January-October 2017. Each study was divided into 1-, 2-,3-,4-,5-, 6-, and 7 hour intervals beginning at the recording start time. The respiratory event index (REI) …

Comparing Treatment Efficacy Of Upper Airway Stimulation To Cpap For Obstructive Sleep Apnea, Alec Furstenberg, Colin Huntley, Md, Adam Vasconcellos, Md, Ayan Kumar, Karl Doghramji, Md, Maurits Boon, Md

Phase 1

Introduction

Upper airway stimulation (UAS) is newer treatment option for the management of Obstructive Sleep Apnea (OSA) and presents an alternative to the traditional Continuous Positive Airway Pressure (CPAP). Previously published data has shown good control of disease severity utilizing UAS with high patient tolerance and compliance. We aim to compare a cohort of patients treated with UAS and CPAP and evaluate therapy usage and disease control through use of the mean disease alleviation concept.

Methods

We evaluated demographic, pre and post-treatment sleep study, and therapy utilization data of cohorts of patients with OSA treated with CPAP and UAS. We …

A Multicomponent Quality Improvement Project To Improve Sleep In Hospitalized Patients: A Single Center Pilot Experience, Michelle Konkoly, Alan Kubey, Md

Phase 1

No abstract provided.

The Use Of Online Cbt-I At Jefferson Sleep Disorder Clinic: A Quality Improvement Study, Kathy Tran, Do, Ritu Grewal, Md

Department of Sleep Medicine Posters

Objectives

We propose to introduce online CBT-I into our patient practice by distributing flyers to patients who complain of insomnia. We have made flyers available in all the exam rooms and educated physicians, nurse practitioners and staff. We will then review charts after the intervention period to evaluate for an increase in recommendation for CBT-I as a treatment option and education for patients.

Effect Of Manual Over Scoring On Automated Analysis Of Level 3 Home Sleep Testing (Hst) Results, Theodora Fynn, Ritu Grewal, Karl Doghramji, Prakash Vasudevan, Tingting Zhan

Department of Sleep Medicine Posters

No abstract provided.

Treatment Of Obstructive Sleep Apnea With Maxillo-Mandibular Advancement Surgery: Evaluation And Predictors Of Success, Daniel Taub, Dmd, Md, Michael Courtney, Dmd, Md, Karl Doghramji, Md

Department of Oral and Maxillofacial Surgery Posters

Obstructive sleep apnea (OSA) is a well-recognized disease entity affecting approximately 2% to 4% of the population. Maxillomandibular advancement (MMA) surgery is a highly successful surgical alternative to poorly tolerated CPAP therapy and achieves a success rate of 89% in the current literature. Our present study evaluates the effectiveness of MMA surgery in the treatment of patients with moderate to severe OSA based on Shers criteria of 50% reduction in AHI and AHI < 20. Radiographic and clinical treatment variables were evaluated in determining predictors of success for MMA in individuals with OSA.

Does Transition From Cpap To Bipap Improve Symptoms Of Aerophagia?, Kathy Tran, Do, Karl Doghramji, Md

Department of Sleep Medicine Posters

Introduction

Adherence to continuous positive airway pressure (CPAP) therapy has been an ongoing dilemma in obstructive sleep apnea patients and up to 83% of patients are noncompliant. It is believed that mask discomfort or pressure intolerance are the major causes. Aerophagia, or “air swallowing” may be an under-recognized and insidious cause for CPAP nonadherence. Patients generally complain of belching, bloating, abdominal pain and distention. Some studies have reported worsening gastrointestinal reflux symptoms from PAP-induced aerophagia. Although bi-level positive airway pressure (BIPAP) is often utilized in such circumstances, this practice had not been examined. We hypothesized that transitioning patients from CPAP …

Mindfulness Meditation Targets Transdiagnostic Symptoms Implicated In Stress-Related Disorders: Understanding Relationships Between Changes In Mindfulness, Sleep Quality, And Physical Symptoms., Jeffrey M. Greeson, Haley Zarrin, Moria J. Smoski, Jeffrey G. Brantley, Thomas R. Lynch, Daniel M. Webber, Martica H. Hall, Edward C. Suarez, Ruth Q. Wolever

Student Papers, Posters & Projects

Mindfulness-Based Stress Reduction (MBSR) is an 8-week meditation program known to improve anxiety, depression, and psychological well-being. Other health-related effects, such as sleep quality, are less well established, as are the psychological processes associated with therapeutic change. This prospective, observational study (

A Quality Improvement Project To Reduce The Wait Time For Initial Appointment In An Urban Outpatient Sleep Center, Anasua Chakraborty, Md, Ritu G. Grewal, Md

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

Project aim:

In this study we aimed to see if replacing one face to face follow up visit after sleep study with a phone call by a trained office staff will

• decrease the total number of follow up office visits, thus decreasing health care cost
• increase the number of new patients seen during the 6 month follow up period
• Did not decrease patient compliance

Poster presented at annual Thomas Jefferson University Hospital House Staff Quality Improvement and Patient Safety conference.

Commentary: How To Make The Ghosts In My Bedroom Disappear? Focused-Attention Meditation Combined With Muscle Relaxation (Mr Therapy)-A Direct Treatment Intervention For Sleep Paralysis., Brian A. Sharpless, Karl Doghramji

Department of Sleep Medicine Faculty Papers

No abstract provided.

Healthy Living An In-Depth Look, Nina Radcliff, Md, Kristin Detterline

Jefferson Sleep Disorders Center in the News

Features Dr. Ritu Grewal, pulmonologist and attending physician at Jefferson Sleep Disorder Center Women's Program.

Do Pressure Requirements Change Over Time With Auto Titrating Positive Airway Pressure Therapy For Obstructive Sleep Apnea?, Anupama Tiwari, Md, Karl Doghramji, Md, Ritu Grewal, Md

Department of Sleep Medicine Faculty Papers

Study Objective:

Prior studies have demonstrated reduced inflammation after chronic use of CPAP therapy. This may lead to reduced pressures over time as the upper airway becomes more compliant. We sought to determine if there was a reduction in 90th percentile pressure requirements in patients on Auto PAP for OSA.

Methods:

A retrospective chart review of 988 patients who underwent a sleep study at our sleep center was performed. Those with moderate to severe sleep apnea who were prescribed and compliant with Respironics Auto PAP were included, yielding a total of 46 patients for analysis. All statistical analysis analyses were …

Does A Short, Thick Neck Predict Obstructive Sleep Apnea?: The Role Of Physical Examination In Osa Screening, Ramya Punati, Md, Shivan Saxena, Md, Constantine Daskalakis, Sc.D., Salvatore Mangione, Md, Ritu G. Grewal, Md

Department of Sleep Medicine Faculty Papers

Purpose:

The purpose of this study was to determine whether a short neck, alone or together with a thick neck, can predict obstructive sleep apnea (OSA).

Methods:

The laryngeal heights of 169 new adult patients presenting to a sleep medicine physician were measured over a period of 5 months. Neck circumference, Mallampati score, and body-mass index (BMI) were also determined, together with medical history, smoking status, and serum bicarbonate. Lastly, patients’ polysomnograms were obtained in order to ascertain the presence or absence of OSA as indicated by the apnea-hypopnea index, as well as other sleep study parameters.

Results:

No association …

Severe Obesity Hypoventilation Syndrome Treated With Auto-Cpap, Zhanna Fast, Md, Ritu G. Grewal, Md

Department of Sleep Medicine Faculty Papers

Summary

Obesity hypoventilation syndrome (OHS) is a serious medical condition that remains undiagnosed in seriously ill hospitalized patients. Significant improvement of daytime hypercapnia can be achieved with positive airway pressure (PAP) therapy. Bi-level PAP is generally employed with the goal of improving ventilation. A 50-year-old woman with OHS and severe hypercapnia was successfully treated with an auto titrating continuous PAP (Auto-CPAP) device. The major role in the pathogenesis of daytime hypercapnia in patients with OHS, is the progressive accumulation of carbon dioxide (CO2) caused by repetitive obstructive events at night, which can be eliminated with the low cost approach of …

Treatment Of Cardiomyopathy With Pap Therapy In A Patient With Severe Obstructive Sleep Apnea., Ritu G. Grewal, Md

Department of Sleep Medicine Faculty Papers

Obstructive sleep apnea is common in patients with heart failure. This case illustrates that treatment with PAP therapy can improve cardiac function in patients with both conditions. CPAP-emergent central apnea, as seen in this patient, has multiple etiologies. It is commonly seen in patients with severe sleep apnea, usually resolves over time, and does not need treatment with adaptive servoventilation.

Obstructive Sleep Apnea Syndrome And Perioperative Complications: A Systematic Review Of The Literature., Tajender S. Vasu, Md, Ms, Ritu G. Grewal, Md, Karl Doghramji, Md

Department of Sleep Medicine Faculty Papers

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely …

Sleep Strategies: Sleep In Women A Changing Perspective, Misha Peter, Md, Ritu G. Grewal, Md

Jefferson Sleep Disorders Center in the News

As with many other specialties, sleep medicine has been shifting toward helping clinicians obtain a better understanding of gender-specific issues in disorders and disturbances. It is easier today to appreciate the complex dynamics of biological, psychosocial, and cultural factors that define sleep patterns and problems in women. Sleep in women changes across their life spans, with three major shifts likely due to hormonal differences: at the onset of the menstrual cycle, during pregnancy, and during the perimenopausal period.