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OBSTRUCTIVE
SLEEP APNEA
P.
LYNN
NICHOLS,
M.D.
MANAGEMENT IN
DABSM,FCCP
THE USA AND
ABROAD

MEDICAL DIRECTOR

Summitsleeptn.com

Financial disclosures

I make a living as a pulmonologist

and sleep physician
No large medical company has ever
offered me any money, but I am
open to the idea

WHAT IS THE NAME OF

THIS PROCEDURE,
ANYWAY?
Home Sleep
Testing (HST)
Out of Center Sleep Testing (OCST)
Portable Monitoring (PM)
Limited Channel Testing (LCT)
*proposed- Home Obstructive Sleep
Apnea Management (HOSAM)

GOALS

Scientific rationale for HST

HST experience in socialized
medicine (New Zealand)
HST four year experience in private
US Sleep Center
Where is sleep disorder management
headed in the US?

SCIENTIFIC RATIONALE
FOR HST/HOSAM

NEW ZEALAND

HAKA

The Challenge
Design and implement an
obstructive sleep apnea diagnostic

NZ$100,000 SLEEP
PROGRAM

OTHER RESOURCES

One respiratory therapist dedicated

to pulmonary function lab and sleep
program (I had to hire)
4 small hospitals/clinics with nursing
staff
Chartered airplane (my favorite)
Support of Auckland sleep lab

MORNING COMMUTE

ITS ALL ABOUT THE

ALGORITHM

GP referral letter to Respiratory Consultant

Home sleep test with follow up at next
respiratory clinic with initiation of Auto
CPAP
Auto CPAP download next CPAP clinic and
placed on cheaper fixed CPAP unit
CPAP clinic follow ups with RT
Referral to Auckland if necessary

OUTCOME AT ONE YEAR

Around 70% of patients could be

managed without in-lab study
initially
Recruited a respiratory consultant
from South Africa to continue the
programs

Home Sleep Testing

Technical Perspective
Nicole Line, RPSGT, RST,PSGP
Clinical Director

DISCLAIMER
The following slides are opinions derived
from our experiences at Summit Sleep
Services and are in no way representative
of all Sleep Center situations.

As techs, our first reaction to

HST.

Embletta Gold by Embla

Embletta Gold by Embla

Features:
Easy application with color coded sensors
Pre-program multiple studies
Rechargeable battery
Internal position sensor
Ability to record 12 channels

Embletta Gold by Embla

Limitations:
Heavier unit
Difficult for patients to apply
themselves
Somewhat difficult to score

Nihon Kohden Nomad

Nihon Kohden Nomad

Features:
Integrates with NK system
Auto starts with pulse signal or can be set
to start at a designated time
2GB internal memory
Uses 2 AA batteries
Has ability to monitor 12 channels:
thermister, pressure transducer, snore,
body position, SPO2, pleth, pulse, chest
effort, abdominal effort, 2 limb channels
and 1 DC output

Nihon Kohden Nomad

Limitations:
Larger/heavier than most units
Higher price point
Costly to repair
Difficult for patient to apply
themselves

SleepView by CleveMed

SleepView by CleveMed
Features:
Cloud based
Easy patient application
Very light
Capable of recording 7 channels: Pulse
oximetry, heart rate, respiratory effort,
cannula based airflow, thermister based
airflow, snore, and body position
Uses 1 AAA battery
All necessary study supplies included
1 GB internal memory

SleepView by CleveMed
Limitations:
Belt seemed to slip out of place
during recording resulting in a suboptimal signal
Cumbersome log in/ log out process
for downloading, scoring and
interpreting in one location

Apnea Link Plus by ResMed

Apnea Link Plus by ResMed

Features:
4 channels: nasal flow (and snore),
pulse, oxygen saturation, and
respiratory effort
Lightweight
Easy patient application
Uses 2 AA batteries
Ability to email report and recording
Cost effective

Apnea Link Plus by ResMed

Limitations:
No body position sensor
No numerical values when scoring
desaturations

SUMMIT HST
ALGORITHM
Sleep physician consult and HST ordered if
appropriate
HST interpreted
Sleep clinic follow-up with initiation of autoCPAP 4-14 if indicated
In-lab CPAP titration if auto-CPAP fails to
resolve symptoms
If HST nondiagnostic then either repeat HST
or in-lab study ordered

HST INTERPRETATION
TEMPLATE

WHERE IS SLEEP
MEDICINE HEADED IN
THE USA?

THANK YOU