Newsletter Spring '09 Volume 6 No. 2

WHAT’S INSIDE: Bi-Flex® and Positive Airway Pressure Compliance

Cardinal Chirp

Kramer DME Enhances Follow-up Protocol 2009 Sleep in America™ Poll Findings

Cardinal Sleep Disorder Centers Expands Community Presence. Increasing Sleep Awareness in Cardinal Communities The number of people reporting sleep disturbances has increased according to the National Sleep Foundation’s Sleep in America™ poll. The poll also states that while 64% of Americans report experiencing sleep problems at least a few nights a week within the past month, only 32% of all adults have ever discussed sleep with a healthcare professional. Significantly, in the group that has discussed sleep with a healthcare professional, almost one-half (42%) have/had a sleep disorder. To raise awareness about under recognized and underreported sleep disorders, Cardinal Sleep Disorder Centers of America encourages both physicians and patients to start talking about sleep. Cardinal Sleep has increased sleep education efforts in all eight locations, and is urging physicians to consider screening for sleep disorders if a patient is overweight and has high blood pressure, cardiovascular disease, and/or type 2 diabetes. Sleep disorders should also be considered in patients experiencing sexual dysfunction, nocturia, GERD, Iron deficiency, depression and mood disorders. Morris Open House Morris physicians now have the option to send patients to the new Cardinal facility on W. US Route 6. The open house and ribbon cutting was held April 1st by the Grundy County Chamber of Commerce. The Morris facility offers comfortable sleep studies performed by registered technologists and in-depth analysis, diagnosis, and recommendations provided by board-certified pulmonary and sleep physicians. Consultations and treatment options also are available through Kramer DME in an adjacent suite, therefore streamlining the diagnosis and treatment process for the patient.

Complaint Free in 2008 Cardinal Sleep Centers was awarded “Complaint Free” status for 2008, through the Better Business Bureau. Cardinal has received this award recognizing quality patient care and services for three consecutive years.

Registered Polysomnographic Technologists at Cardinal Sleep Nicole Steffes, RPSGT Manager of Clinical & Educational Services Polysomnographic (Sleep) Technologists are trained in sleep medicine through formal programs and practical work experience. At Cardinal Sleep Centers, all eligible staff members have passed the rigorous requirements to become credentialed by the Board of Registered Polysomnographic Technologists, an internationally recognized and accredited organization. This credential currently represents the highest standard in sleep technology, and is a symbol of quality, responsibility and credibility. What it takes to be a Cardinal Sleep Technologist: Training: All new sleep technicians must be enrolled in or have attended an accredited sleep training program. They must demonstrate necessary clinical experience and maintain a high level of competence and expertise in the field. Once eligible, they are required to obtain board certification by the BRPT. Professionalism: Cardinal’s staff fosters ethical practices. Our credentialed staff has made a commitment to professionalism, competence and ethics by meeting the BRPT standards for certification. High Standard of Care: Our staff members take the time to understand each individual patient and their needs….placing the well-being of our patients first. Our technologists work as part of a team with a set of specialized skills to assist the physician in the education, evaluation, treatment and follow-up. Continuing Education: Cardinal staff members are required to obtain a minimum of 10 continuing credit hours per year. Technologists attend monthly training and teaching conferences with Cardinal’s Medical Director and various sleep equipment companies to stay current on new sleep therapies, AASM standards, and techniques.

From the Cardinal’s Nest: What patients are saying… “The technician's patience and attention was outstanding. She was extremely pleasant and helpCardinal Chirp

Spring 2009 Vol. 6 No. 2

From the Medical Director’s Desk: Bi-Flex® and Positive Airway Pressure Compliance Robert Aronson MD, ABSM Medical Director, Cardinal Sleep Disorder Centers of America Obstructive sleep apnea is an independent risk factor for motor vehicle crashes and cardiovascular morbidity and mortality. Use of nasal continuous positive airway pressure (CPAP) therapy has been shown to improve crash risk and cardiovascular sequelae. Optimization of compliance is thus crucial. However, in the absence of aggressive measures to facilitate therapy, long term compliance is estimate to approximate only 50%. At Cardinal, we constantly strive to optimize those factors that limit CPAP compliance in your patients. Ballard et.al. (J. Clin. Sleep Med., 2007;3(7):706-712) assessed the effectiveness of Bi-Flex®, a positive airway pressure (PAP) mode superimposing a late inspiratory/early expiratory pressure release onto Bi-level (BiPAP®) therapy. OSA patients noncompliant with CPAP were entered first into a regimen of standard CPAP salvage strategies, including mask refitting, heated humidity, nasal rinses or steroids, and education. 24% of these previously noncompliant patients became compliant with such interventions. Of the remaining noncompliant patients, 67% agreed to proceed to a second phase in which a new polysomnography assessed Bi-Flex® settings. These patients were then randomized to continued CPAP vs. Bi-Flex®. 49% on BiFlex® became compliant, as opposed to only 28% of those continuing CPAP. The latter shows that continued attempts to achieve CPAP compliance may at times be successful, however Bi-Flex® appears to have additional effectiveness in salvaging positive airway pressure therapy. Overall, between the 2 phases of the study, 44% of previously noncompliant patients ultimately became compliant, a significant finding in light of the PAP therapy benefits noted above. Given that earlier studies have not proven benefit of C-Flex (early expiratory release applied to straight CPAP) or of standard Bi-level therapy in salvaging CPAP, the combination of early expiratory release to BiPAP® may provide benefit through yet to be clarified mechanisms. Other PAP salvage strategies deserve mention. In patients with nasal obstruction from factors such as septal deviation, polyps, or turbinate hypertrophy not responsive to medical therapy, nasal surgical intervention, while often not curing OSA, may salvage CPAP compliance. In addition, the combined use of mandibular advancement devices and CPAP is being explored in situations where the dental device alone is ineffective but the required CPAP pressures are not tolerated. In situations of CPAP noncompliance despite conventional salvage measures, assessment of Bi-Flex® may be a therapeutic option. REFERENCES:"Interventions to Improve Compliance in Sleep Apnea Patients Previously Non-Compliant with Continuous Positive Airway Pressure” from Journal of Clinical Sleep Medicine 2007; Volume 3 No. 7; 706-712.

For more information on this article please contact Community Relations at [email protected] or (815) 773-9090 ext. 300. In no way are the suggestions in this newsletter to be taken as medical advice, please seek proper medical attention from a medical professional. Cardinal Chirp

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Snooze News: Sleep in America™ Poll, Highlights & Key Findings The National Sleep Foundation’s 2009 Sleep in America™ Poll finds that: Almost one-third (27%) of Americans say their sleep has been disturbed at least a few nights a week in the past month due to personal financial concerns (16%), the U.S. economy (15%), and/or employment concerns (10%). Surprisingly, other national and global issues are affecting their sleep to a much lesser extent: healthcare costs (8%), the war in Iraq or Afghanistan (6%), global warming/environment (3%), and/or the threat of terrorism (3%). More than half of people (54%) losing sleep over economic concerns also had difficulty with their feelings at least a few days a week in the last month. Discussing Sleep with a Healthcare Professional: More than one-half of adults (54%) reported that they have driven at least once while drowsy in the past year, with almost a third (28%) reporting that they do so at least once per month.

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Visit the Web: www.cardinalsleep.com

wwww.sleepfoundation.org

Cardinal Sleep Disorder Centers is a National Sleep Foundation Sleep Care Center Member.

What’s New in OSA? Marsha Cronkrite, R. PSG. T. Clinical Administrator Committed to quality sleep-related care, Kramer DME has expanded areas of service to include Cook, DuPage, Grundy, Kankakee, Kendall, LaSalle and Will counties. Both home and office setups are available, with emergency coverage provided 24 hours a day, 7 days a week. To accommodate this growth and continue to provide better sleep solutions, Kramer DME has updated their protocol for patient follow-up and compliance. Kramer DME provides: Thorough set-up – Specially designed for each individual patient with a treatment plan explained to them by a Registered Polysmnographic Technologist or Sleep Equipment Specialist. Education on sleep disordered breathing. Review of sleep study results. Instruction on equipment use and care. Custom fitting of the mask. All questions answered. Continuous follow-up - Calls are made to patients on an ongoing basis to answer questions, assess equipment and provide reminders regarding equipment care. Reporting to Physician – Setup confirmation is sent to the physician’s office with information on the patient’s equipment, pressure, mask, and initial follow-up on patient compliance to therapy during the first 3 days of use. In addition, Kramer DME provides an extensive report on the patient’s follow-up and use of their equipment throughout the course of treatment. Reports include but are not limited to: date of initial setup, machine type, mask type, pressure, average number of nights they are using therapy, how often they are waking up throughout the night, if they are still snoring, how they are caring for their machine, and an Epworth Sleepiness Scale to assess their current daytime sleepiness. Educational support group meetings – Kramer DME hosts a monthly support group meeting for CPAP/Bi-level users that fosters improved patient compliance with prescribed therapy. Patients reach a better understanding of their diagnosis through monthly presentations on topics including: “the Heart and Sleep Apnea,” “Diabetes and Sleep,” and “What the Sleep Technician Sees.” An annual Equipment Fair and Machine Check also is held to showcase the latest advances in sleep technology. Desensitization - Offered for potential Kramer DME patients. In the instance of a failed titration study, this acclimation process prepares the patient for a successful study and increases patient compliance and understanding of therapy when received. Kramer DME’s treatment protocol has proven to increase patient compliance to over 85 percent. Cardinal Chirp

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215 N. Convent Street #2 Bourbonnais, IL 60914

2340 Dean Street St. Charles, IL 60175

18401 Maple Creek Dr., Suite 700 Tinley Park, IL 60477

925 West Street Peru, IL 61354

948 W. Route 6, Suite A Morris, IL 60450

1100 East Norris Drive Ottawa, IL 61350

1300 Copperfield Ave., Suite 4090 Joliet, IL 60432

3077 W. Jefferson St., Suite 210 Joliet, IL 60435

EIGHT CONVENIENT LOCATIONS—Toll Free 888-740-5700—www.cardinalsleep.com

Cardinal Chirp 3077 W. Jefferson St. Ste 210 Joliet, IL 60435

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Cardinal Chirp Cardinal Sleep Disorder Centers of America 888-740-5700 www.cardinalsleep.com Newsletter Spring 2009 Vol. 6 No. 2

CPAP/Bi-level Support Group At Silver Cross Hospital in Joliet Specialty Care Pavilion, Room 1005 every fourth Tuesday, 6:30 - 8:00 p.m. At Ottawa Regional Hospital Meeting Rms. 2&3 Every last Monday, 6:30—8:00 p.m.

Community Calendar

April 22—Active Senior Expo, Georgio’s Banquets, 8:30am-2:30pm 25—Family Health Fair, Orland Park Sports Plex, 8:30am-12pm 27—CPAP/Bi-level Support Group, Ottawa 28—CPAP/Bi-level Support Group, Joliet

May

21—Women’s Health Fair, Ottawa Knights of Columbus 9:30am-6:00pm 25– Memorial Day 26—CPAP/Bi-level Support Group, Joliet

June 3—Health Fair, Carillon Adult Master’s Association, Plainfield, 7:30am - 12:30pm 23—CPAP/Bi-level Support Group, Joliet, Surgical 29—CPAP/Bi-level Support Group, Ottawa

2 —Chiro One Health Fair, Plainfield N. High School, 9:30am-5:00pm 13—Senior Triad Fair, Romeoville Rec. Center, 8:30am-12:00pm 15—IVCH Senior Health Fair, Peru Mall, 10am—2pm For updated Calendar Events visit: 18—CPAP/Bi-level Support Group, www.cardinalsleep.com Ottawa