The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

THE EFFECTS OF A SLEEP DISORDERS CLINIC FOR THE TREATMENT OF PATIENTS WITH SLEEP DISORDERED BREATHING

Brian W. Carlin1,2, Lori Dorrycott2, Lorie Smith2, Mark Kegg2, Spencer Carlin2, Becky Rohosky2; 1Pulmonary and Critical Care Medicine, Drexel University School of Medicine, Allegheny General Hospital, Pittsburgh, PA; 2Lifeline Sleep Disorders Centers, Pittsburgh, PA

Background: Compliance with continuous positive airway pressure (CPAP) therapy is a significant problem in the management of patients with obstructive sleep apnea. This study was performed to determine the effects of a sleep disorders clinic staffed respiratory therapists in the management of patients who are having difficulty with compliance with CPAP therapy. Methods: Patients who were newly diagnosed with obstructive sleep apnea (OSA) and were started on CPAP therapy are contacted by phone during the first two weeks of therapy. Patients who are having difficulty with compliance with that therapy are then offered an appointment in the sleep disorders center. In some instances (n=17), the patient was referred to the sleep disorders center for an initial evaluation for symptoms suggestive of sleep disordered breathing. Each patient is seen and evaluated by the sleep disorders physician. A respiratory therapist with expertise in positive airway pressure therapy is in attendance during each visit. Decisions for alteration(s)in therapy are made by the physician and then instituted by the RT during that visit. Results: A total of 167 new patient visits during the months from May 2008-October 2008 were conducted. 150 patients were diagnosed with OSA and were having difficulty with CPAP use. Seventeen patients were referred for other reasons. The average age was 54(12) years with 79 men and 66 women. For those patients with OSA diagnosed (n=150),changes in the existing therapy were made in 135(90%) patients. These included: mask refit (23%), decrease in CPAP pressure (17%), retitration study ordered (16%), change to other positive airway pressure device (6%), cognitive behavioral therapy (10%), referral for oral appliance (5%), initiation of CPAP therapy (5%), and other (12%). All possible interventions (e.g. mask refit, CPAP pressure change, etc) are made during that office visit. Conclusions: For patients who are having difficulty with CPAP use, a sleep disorders clinic staffed by a physician and a respiratory therapist provides an effective means to evaluate the reason for the difficulty with use. A significant number of patients evaluated required changes made to their existing therapy which was performed at the time of that visit. The availability of the respiratory therapist allows for direct intervention of those changes assuring that the patient is offered the appropriate therapy as recommended by the sleep center physician. Sponsored Research - None

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