Manhattan A.W.A.K.E. 8-3-11 with Nicole Garrison RT, RPSGT

robysue wrote:

NotMuffy wrote:The reimbursement criteria for ASV are the same all over:

(1) An apnea–hypopnea index greater than five; and
(2) Central apneas/hypopneas greater than 50% of the total
apneas/hypopneas; and
(3) Central apneas or hypopneas greater than or equal to
five times per hour; and
(4) Symptoms of either excessive sleepiness or disrupted sleep.

Given these criteria, 15% of patients will qualify. If somebody is "qualifying" 70% of their patients, I would start to wonder.

Just asking out of curiosity's sake and for a bit of clarification here.

Do most sleep labs even make an effort to distinguish between central hypopneas and an obstructive hyponeas?

And how is the decision to score a hypopnea as a central one instead of an obstructive one made at a lab that does distinguish between them?

And if the lab doesn't distinguish between central and obstructive hypopneas, does that mean item #2 says 50% of the events have to be central apneas? And item #3 then says a CAI >= 5 is required?

My answers in the poll would be:

• Probably not.
• According to AASM:

  “Classification of a hypopnea as obstructive, central or mixed should not be performed without a quantitative assessment of ventilatory effort (esophageal manometry, calibrated respiratory inductance plethysmography, or diaphragmatic/intercostal EMG).

• Yes.

Some follow-up questions could be:

• When should central hypopneas be treated?
• Are central hypopneas given "snake" status?
• How can treatment of central hypopneas be properly assessed?

jnk wrote:

napstress wrote:Thanks for the summary, jnk.

Does anyone know how I might find out when future AWAKE meetings are held in the northeastern US? I'm a 2.5-hour train ride from NYC.

You are welcome.

I don't know how up-to-date the map is, but this might help:

http://www.sleepapnea.org/support/a.w.a ... k-map.html

Thanks, jnk!

NotMuffy wrote:Some follow-up questions could be:

When should central hypopneas be treated?

Will take a WAG -- when/if they cause an excessive number of arousals, wrecking the sleep architecture. And/or if they cause dangerous drops in O2 levels.

NotMuffy wrote:Are central hypopneas given "snake" status?

?
If that means do most sleep professionals consider them dangerous and something that should be dealt with? I'd say, no.
If it means something else entirely.... I'll still guess "no."

NotMuffy wrote:How can treatment of central hypopneas be properly assessed?

Full attended NPSG.

NotMuffy wrote:Some follow-up questions could be:

• When should central hypopneas be treated?

Only when that would "qualify" a patient for ASV?

NotMuffy wrote:

• Are central hypopneas given "snake" status?

Snake oil can come in handy in the desert.

NotMuffy wrote:

• How can treatment of central hypopneas be properly assessed?

That can only be done during a CBT session.

Jeff, your post was so cleverly funny, I gotta agree with carbonman... LOL!!!

JNK, you sick, twisted, guitar play'n, algorithm speculat'n, pressure analys'n freak...
I think you are right again.

viewtopic.php?p=391646#p391646

jnk wrote:
Now to the meat:



On a side note (and I have my wife's permission to say so), Ms. Garrison is not, as they say in Kentucky, hard on the eyes. She has the looks and presence of a professional actress, the education and mental sharpness of an experienced medical professional, and the kind, down-to-earth manner that puts people at ease in a way that makes information easy to swallow and sink in. She was a breath of fresh air in every way, and it was a pleasure hearing her do what she did in the way she did it.


(edited to correct typos; my copy editor has been fired)

hey got a pict? somehow South Park has left a stigmatic image for that name in many a subconscience. (i couldn't resist) thanx for the report. i think you will find no hack needed on the autoIQ there will be a hidden redundency built in(imho)

To be clear, though, it was her insightful, accurate information and her kind, caring, down-to-earth manner that were most impressive to me.

That being said, it never hurts for a rep to be someone born with charisma, presence, and naturalness.

Three reasons I could never be a rep, myself.

jnk wrote:She invited me to ask more after the meeting, but I wasn't able to stick around.

All those times that you could hang around afterwards...but this time you couldn't. Poor Jeff!

rested gal wrote:

jnk wrote:She invited me to ask more after the meeting, but I wasn't able to stick around.

All those times that you could hang around afterwards...but this time you couldn't. Poor Jeff!

Well, after the meeting, she was helping patients with individual problems on one side of the room, and I was helping patients on the other side. So, I could have stopped helping people and have interrupted her doing the same, but I hated to do that.

Anyway, I ended up staying later than I usually do, but I couldn't stay too late. I had skipped supper to make it there, and St. Mark's Two Brothers Pizza was calling my name!

The month before, MY WIFE went with me to the meeting to hear Dr. Park speak.

jnk wrote:I had skipped supper to make it there, and St. Mark's Two Brothers Pizza was calling my name!

Well of course!

This picture looks much more appealing than the picture of Ms G, doesn't it?

sorry i missed the meeting and the pizza

RG, jnk is ONLY going to agree w/you to keep his wife from slapping him alongside the head - or worse.

Slinky wrote: RG, jnk is ONLY going to agree w/you to keep his wife from slapping him alongside the head - or worse.

My wife (who happens to be the most beautiful woman on the planet) isn't the jealous type, thankfully, since, where I work, I spend all day surrounded by beautiful, intelligent, talented women.

But if she were the jealous type, she would probably be more jealous of Slinky and Rested Gal, since I am constantly quoting you two to her.

My stop at Two Brothers, on the other hand, could get me in a lot of trouble, so I hope no one tells her about that. Two classic New York thin-crust slices and a soda (fancy Yankee term for "pop") for $2.75 is just too much of a temptation to pass by, regardless of the damage to my health and sleep hygiene.

Besides, it was you two who forced me to rush up to that meeting in the first place!

jnk wrote:Besides, it was you two who forced me to rush up to that meeting in the first place!

Yeah, and you were sent on an important MISSION!! Which, as we all know now...

Slinky, ain't it just like a man? We send him out for meat and potatos, and he comes back with.... pizza and a picture.