sleep center organisiation and managment
DESCRIPTION
Türk Toraks Derneği 11. Annual Congress FEMTOS Session 23 - 27 April 2008 Maritim Pine Beach Resort - Antalya. Sleep Center Organisiation and Managment. Doç. Dr. Sadık Ardıç SB Dışkapı Eğitim ve Araştırma Hastanesi Göğüs Hastalıkları ve TBC Kliniği - PowerPoint PPT PresentationTRANSCRIPT
Sleep Center Organisiation and
ManagmentDoç. Dr. Sadık Ardıç
SB Dışkapı Eğitim ve Araştırma Hastanesi Göğüs Hastalıkları ve TBC Kliniği
Uyku Hastalıkları Tanı ve Tedavi Merkezi
Türk Toraks Derneği 11.Annual Congress
FEMTOS Session23 - 27 April 2008
Maritim Pine Beach Resort - Antalya
Dr. Karacan’ın örgütlenmesi doğru, benim ki doğru değil. Sleep Disorders Centers,Baylor College of Medicine, 10.9.1992
Sleep Center Organisiation and Managment
• Sleep Disorders Center(SDC)
• In these centers, All of Sleep Disorders are been diagnosed and treated.
• SDC is managed by Medical Sleep Specialists which have studied sleep medicine
Sleep Center Organisiation and Managment
• Sleep Disorders Center is described as a unit which is an individual and a separate location..
• Personnels which work in SDC,respect the ethics of sleep disorders.
Sleep Center Organisiation and Managment
• Medical Director(MD)• Medical Director has been a Medical
Doctor.
• Medical Sleep Specialists:• The certificate intends to show that the
named person is able to carry out the diagnosis and differential diagnosis of sleep-related diseases, as listed in ICSD-2 (2), and their management.
Sleep Center Organisiation and Managment
Other Personnels• Sleep Technician (ST)• ST is able to carry out the organization,
logistics, preparation, recording, observation, analysis & evaluation and documentation of
polysomnography(PSG) and other investigations carried out in the SMC.
• ST is responsible for the correct instruction and care of the patients
Sleep Center Organisiation and Managment
Other Personnels• Sleep Technician (ST)
• ST is able to score the polysomnographic record by manually
• ST must receive a training during a full time equivalent period of the described time in an accredited Sleep Disorder Center
Sleep Center Organisiation and Managment
Rooms;• Rooms; minimum bedroom
surface of 10-12 m2 is recommended.
• SDC has two bedrooms at least.
Sleep Center Organisiation and
Managment• The following criteria must be met for
the approval of a polysomnographic bed:
• Only those beds that are located in
single bedrooms and ,• in which the polysomnograph allows
recording of all relevant biosignals will be approved as polysomnographic beds.
Sleep Center Organisiation and Managment
• The bedrooms must be equipped to allow Professional diagnosis and therapy in the field of sleep medicine to be carried out and to enable both nocturnal examinations and assessment of daytime sleepiness
Sleep Center Organisiation and Managment
• The rooms must be sound and light attenuated and equipped with temperature and ventilation controls.
• To enable daytime assessments, such
as the multiple sleep latency test (MSLT), the rooms must be adequately darkened.
Sleep Center Organisiation and Managment
• Adequate sanitary facilities must be available near the bedrooms.
• Each bedroom should be equipped with a suitable video monitoring system.
• A two-way communication system must be installed which allows the patient and night duty technician to communicate with each other, and to enable biosignal calibration.
• Disabled people should be examined in
these rooms
Control Room• It is been at the same floor which the bed rooms are.
•Its location must be The central of Sleep Lab,
•Its distance to each room must be equal
Sleep Center Organisiation and Managment
Control Room• A two-way communication system must be installed which allows the patient and night duty technician to communicate with each other, and to enable biosignal calibration.
Sleep Center Organisiation and Managment
•Control Room•A separate room, which is also sufficiently large and •Which ensures undisturbed working conditions, must be available for the monitoring equipment and the technical/nursing staff.
Sleep Center Organisiation and Managment
Sleep Center Organisiation and Managment
Laboratory Guide Manuel(LGM)
• There must be a LGM which has to be described all of procedure and application in SDC.
• This book describes all of the dailly procedure in SDC.
• This book is a reference book for sleep technician(ST) who apply for every thing and problems in SDC.
Sleep Center Organisiation and Managment
• Laboratory Guide Manuel(LGM)
• It has to show all of the details of tests which PSG,CPAP titration, MSLT,Epileptic follow up
• It has to show all procedures when the patient is accepted SDC.
• SDC must follow the national sleep society guide manuel.
Baylor Collage of Medicine,Sleep Disorders Center Houstun-Texas, USA- 1992
PSG has AC channels and DC channels. At the same time DC channels are able to record.
Equipment:
Each Room has to be connected PSG which has sixteen channels (6 EEG, EOG, 3 EMG)
Uyku Laboratuvarı Standartları
Sleep Center Organisiation and Managment
Equipment:
• PSG has Respiratory channels,oxymeter, ECG,leg EMG,body position sensor, microphone
• Polisomnographic records(all nights)has to be evaluated 30 or 60 second epochs.
C4A1
O2A1
C3A2
O1A2
ROG
LOG
CHIN-EMG
EKG
RLEG
LLEG
EEG: Zemin; nispeten düşük voltaj, karışık frekans, Uyku iğciği 12-14 cps (>0.5 sn) K Kompleks
EOG: Arasıra SEM, EMG: Tonik aktivite düşük düzeyde
EEG: Nispeten düşük voltaj, karışık frekans, Teta aktivitesi, yavaş Alfa, testere dişli dalga
EOG: Fazik REM, EMG: Tonik supresyon, fazik dönemler
Sleep Center Organisiation and Managment
• Minimum montage for standard sleep medicine polysomnography
• 6 EEG (e.g. F4-M1,C4-M1,O2-M1 or F3-M2, C3-M2, O2-M2)• 2 EOG• 3 mentalis/submentalis EMG• SaO2• Snoring signal• Body position sensor• Nasal pressure/flow signal (thermistors are no longer acceptable as a single recording method in adults)• Validated method of respiratory effort• 2 EMG, tibialis anterior• ECG, one channel• Video monitoring with possibility of recording
POLİSOMNOGRAPHY
•EEG, EOG, EMG EEG, EOG, EMG (Submental)(Submental)•Oro-Nasal Oro-Nasal AirflowAirflow•Respiratory Respiratory Effort Effort ChannelsChannels•OxymeterOxymeter•ECGECG•EMG (Tibial)EMG (Tibial)•Body Position Body Position SensorSensor•MicrophoneMicrophone
Sleep Center Organisiation and Managment
Recording in SMC,
• In SMC, the ongoing recording should be monitored by trained technical or nursing staff who MD is responsible from .
• SDC has to have atleast two Sleep
Technicians who has their knowledge of and experience in sleep medicine. Each ST is responsible from two patient.
Sleep Center Organisiation and Managment
Recording in SMC,• Polysomnography (PSG) technologists for
nocturnal and diurnal recordings are required to ensure the proper, artefactfree functioning of the recording devices, to detect problems and resolve them.
• This makes their presence during the entire recording process an absolute necessity.
• Between Night and Daytime technicians’s
working schedule will be planned consistenly
Sleep Center Organisiation and Managment
• Diagnostic tests• Additional diagnostic tests that are routinely
performed at the SMC should be listed here, e.g.
• Physical examination• Clinical investigations (e.g. laboratory
analyses, radiology, pulmonary function tests, etc.)
• MSLT, • MWT• Sleep diary
Sleep Center Organisiation and Managment
• Diagnostic tests• Sleep questionnaires [e.g. Pittsburg Sleep
Quality Index(PSQI), Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS), etc.]
• Psychological and personality questionnaires (e.g. MMPI, etc.)
• Neuropsychological examinations (vigilance, psychometric and cognitive tests)
• Other.
EEG 10-20 SystemJasper 1958
Sleep Center Organisiation and Managment
In polisomnography which parameters are been recorded?
Sleep Parametres
• EEG• EOG• EMG• EKG
EEG -Recommended
a. F4-M1b. C4-M1c. O2-M1
F3, C3, O1 and M2 derivations are placed backup electrods If there is necessary to use backup channels for PSG record.
a. F3-M2b. C3-M2c. O2-M2
LOCLOC
ROCROC
EOG; Recommended
E1-M2 (E1;Left outer cantus lower 1 cm)
E2-M2 (E1;Right outer cantus above1 cm)
Sleep Stages
• W: ‘’Wakefullness’’• N1: ‘’NREM 1’’• N2: ‘’NREM 2’’• N3: ‘’NREM 3’’ (NREM3 and 4
combined)• R : ‘’REM’’- 30 sn epoch- If there is multiple sleep stage in an
epoch,that the longer stage is scored .
Sleep Center Organisiation and Managment
In polisomnography which parameters are been recorded?
• Respiratory parameters
• Oro-nasal airflow• Respiratory Effort(Thoracic and Abdominal effort)• Oxygen Saturation• Snoring and respiratory sounds• CO2 measurement• Intra thoracic effort
Sleep Center Organisiation and Managment
In polisomnography which parameters are been recorded?
• Other Parameters
• Position
• Limbs Movements (EMG)
• Nocturnal Penile Tumescence (NPT)
• Body Temperature
• Oesophageal pH
Sleep Center Organisiation and Managment
• Scoring Evaluation of Polisomnographic Records
• Sleep related parameters• Sleep latency• Sleep Stage Time• Percentage of Sleep Stage• Total Sleep Time• Sleep Efficiency Index• Behavioral and Bioelectrical Arousal Index
Sleep Center Organisiation and Managment
• Scoring Evaluation of Polisomnographic Records
• Respiratory Parameters• Apnea and/or Hypopnea Index• Effort Index• Abnormal Respiratory Event Index• Abnormal Respiratory Events Time• Minimum 02 level• ECG variations• Maximum Intrathoracic Pressure
Sleep Center Organisiation and Managment
• Scoring Evaluation of Polisomnographic Records
• Correlation between sleep and respiratory Parameters
• Relationship between sleep sateges and respiratory events
• Relationship between body position and respiratory events
Sleep Center Organisiation and Managment
• Scoring Evaluation of Polisomnographic Records;
• VisualManuel
• Automatic Scorring.
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