Posted by sak on April 06, 2003 at 14:43:56:Hi Everyone,
This message we sent out last week to all on the email list.
We hope the study process is going well. Do not
panic if it is not. There are many in the same boat.
Most are carrying a heavy clinical load and have
family or personal issues that constantly steal those
precious hours (minutes even -- give me 10 minutes!!
some are saying.
We know the exam is soon.
Review the Primer of PSG Interpretation we gave you
if you have not. Especially review the cases at the end.
Review the homework cases we sent before the course.
The answers to these cases are in the final section of the
binder. Any differences before/after the course in terms
of your thinking?
Try to keep a global perspective (soft eyes so have a
broader field of vision). Do not get lost in minutia.
Your job as a sleep specialist is to find those things in
the patient's history (lifestyle, medical history, psych history,
family history) that may contribute to the patient's current state.
How/why did they present? Usually there a few things going on.
Sleep history - by self report? We know the patients are not
good at this. The data are mounting regarding neurocognitive
consequences of untreated sleep and breathing problems,
sleep loss alone can have profound effects. It is good to pay
attention to what others in patients circle are saying
(family, employers, other medical / social information).
Look at objective data. It is OK to question
the data if they do not match what you expect.
It is your job to be able to state concerns about
data. Remember "technically sub-optimal" tracings
are part of life in the lab. You need to assess to what extent
does it compromise your ability to make a good clinical decision.
(or answer the question)
It is OK to change your mind if the data do not support or original
hypothesis. You may need more data. You can ask for it. Just good
clinical decision making process.
E cases: (If you are having difficulty installing Sandman on a Disk
on to your computer you should call their Tech support. The
number is 1 800 663-3336 and press 5 for tech support. They
do not answer clinical questions but will help with the disk
installation and software problems.)
AA was an older woman with severe sleep apnea,
claustrophobia and a renal stone requiring immediate
surgery.
This case requires you to recognize the apnea in
the study but more importantly recognize the
need to inform the surgeons and anesthesiologists
about apnea and the perioperative risks.
She has claustrophobia.
She needs education so she can make an informed decision.
She should be informed about tracheostomy. Ideally, she
would choose to try CPAP but she will need
desensitization, relaxation, other supportive measures
and be cpap compliant. If not, she needs to know
risks / consequences of her decisions. After surgery ideally
she continues with cpap whenever she is asleep.
Recovery, ICU on the ward. --- Whenever she is asleep,
not just at night. Continuous pulse ox please.
Nursing should be instructed
CC was a male with OSA -- report says "lots of spikes"
by report -- do you agree? If so what epochs?
Are you sure ?
HH was an 80 year old with heart disease and
Cheyne Stokes respiration. You know there has been
a great deal published about increased cardiovascular
risks secondary to untreated OSA.
Does this patient's cardiologist know?
How/ why did he present ?
EE was the sleepy air traffic controller. Again -- more a
management question than diagnosis.
He needs to recognize that his sleepiness is a risk
to the health and safety of others. His employers
may need education regarding his sleep disorder and treatment
plans.
E MSLTs , MWT :
mean sleep latency and rem onset data to follow in next email.
Tip to increase focus for study :
Take a long slow deep breath, hold it for 2 seconds, exhale
slowly through your mouth --until forced expiration--
hold end expiration for 2 seconds, surrender to the inhalation.
-- repeat 3-6 times.
Best wishes,
The SSM Team
- MSLT / MWT data sak 00:28 4/07/03 (0)