Transcutaneous Monitoring in the Sleep Center - Is This Really Necessary?
Traditionally, sleep centers performed overnight polysomnography primarily for the management of obstructive sleep apnea (OSA) which would typically comprise 90% of studies. As home sleep apnea testing use has been increasing and becoming the primary modality for diagnosing OSA, the nature of polysomnography is evolving as it emphasizes the evaluation of patients with complex diseases. In these settings, OSA may comprise only 25% of polysomnography studies while the majority are performed to evaluate patients with respiratory failure, neuromuscular disease, and complex pediatric pulmonary sleep disorders. In fact, there are approximately 90 identified sleep disorders which require therapists to have strong clinical acumen with greater ability to assess a comprehensive set of clinical information and translate them into proper clinical decision making.
Complex sleep patients require monitoring of clinical information beyond that traditionally required by the sleep technologist. Not only are additional cardiopulmonary physiologic parameters necessary such as continuous measurement of CO2, these values must be understood within the context of a greater knowledge of the patient’s underlying pathophysiology, diagnoses, and previous relevant medical testing. For example, performing a polysomnogram in a patient with chronic hypercapnic respiratory failure requires an understanding of the cause of hypoventilation (for example, COPD or neuromuscular weakness), an assessment of whether laboratory values and pulmonary function testing support the suspected etiology, the utilization of this information to develop therapy goals, and the interpretation of CO2 values as a diagnostic tool to determine whether target therapeutic response has been achieved. The ability to provide real-time and continuous capnography monitoring is critical to performing polysomnography properly in the complex sleep patient.
This webinar will review the evolution of sleep medicine and analyze the future of polysomnography. Case studies will be presented to demonstrate the importance of transcutaneous monitoring during polysomnography and illustrate the advantages of transcutaneous monitoring over end-tidal CO2 monitoring. This session will also review the interpretation of transcutaneous monitoring values and describe the method used to recognize improper values.
CE credit for US attendees and Certificates of Attendance for international attendees will be available.
Julie DeWitte, RPSGT, RST, RCP - Asst. Administrator, Sleep Disorders Center Kaiser Permanente Fontana Medical Center, Fontana, CA
Julie DeWitte has over 25 years’ experience in the field of sleep diagnostics and respiratory therapy. Ms. DeWitte has organized and developed multiple sleep centers and has extensive experience with the management of patients with complex sleep and respiratory disorders including chronic hypercapnic respiratory failure and neonatal respiratory disorders. She is currently an administrator under the direction of Dr. Dennis Hwang at Kaiser Permanente Fontana Sleep Disorders Center. This center is a leader in the field of sleep medicine that manages a large volume of patients with complex sleep and respiratory disorders.