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Introduction of Sleep Apnea Types of Sleep Apnea Airflow Tongue Trachea Normal open airway

of the lungs. Sleep apnea patients would stop breathing during sleep.

It occurs when tissues in the throat collapse and block the air flow in and out of the lungs

2 Introduction of Sleep Apnea Types of Sleep Apnea Airflow Tongue Trachea Normal open airway During normal breathing, the airway is clear and open, allowing air to flow freely in and out of the lungs. Sleep apnea patients would stop breathing during sleep. Such events can happen hundreds of times during sleep and each may last for a few seconds to a few minutes. 3 Types of Sleep Apnea Obstructive Sleep Apnea (OSA) OSA is the most common type of sleep apnea. It occurs when tissues in the throat collapse and block the air flow in and out of the lungs during sleep. Blocked airway CSA is resulted as the central nerve system fails to give proper breathing signals to drive the respiratory efforts. Mixed Sleep Apnea (MSA) MSA is a combination of OSA and CSA. 2

Common Symptoms of Sleep Apnea Snoring, interrupted by pauses in breathing Loss of energy, fatigue Excessive daytime sleepiness Morning headache Loss of concentration, slow in response Irritability

Dangers of Being Untreated Clinical studies indicate that sleep apnea causes oxygen desaturation.

3 Common Symptoms of Sleep Apnea Snoring, interrupted by pauses in breathing Loss of energy, fatigue Excessive daytime sleepiness Morning headache Loss of concentration, slow in response Irritability Forgetfulness Sexual dysfunction Consult a doctor as soon as possible if you have several of the above symptoms. Sleep study may be arranged for further diagnosis if necessary. Dangers of Being Untreated Clinical studies indicate that sleep apnea causes oxygen desaturation. Prolonged deficiency in oxygen can cause damage to the normal function of many organs and increase the risk of developing the followings: Hypertension Stroke Heart failure Fatigue-related vehicle accidents (6 times more likely to have a car accident 1 ) Heart disease (2 times more likely to have a fatal cardiovascular event and 3 times more likely to have a non-fatal cardiovascular event 2 ) 1. Teran-Santos J., Jimenz-gomez A., & Cordero-Guevara, J.(1999). The association between sleep apnoea and the risk of traffic accidents. N engl J Med., 340(11), Marin, J.M., Carrizo, S.J., Vicente, E., & Agusti, A.G. (2005). Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lance, 365(9464),

Therapeutic Options The data from the sleep study (ref. to p.

The most common options are: 1 Continuous Positive Airway Pressure (CPAP) CPAP is a

4 Therapeutic Options The data from the sleep study (ref. to p.9) enables the sleep specialist to determine your treatment options. The most common options are: 1 Continuous Positive Airway Pressure (CPAP) CPAP is a device which delivers pressure to nasal cavity by a mask to prevent the upper airway from collapsing. It is the most effective and common way of OSA treatment which is suitable for mild to severe sleep apnea patient. Upper airway is opened by CPAP 2 BiPAP Oral Appliance Oral Appliance suits for mild OSA patient only. Surgery Physician removes the tissue which blocks the airway, but it may not be suitable for everyone. BiPAP is a bi-level positive airway pressure system that keeps the upper airway from collapsing by putting higher pressurized air during inspiration and helps users exhale by putting lower pressurized air. 5 Modification of the Life Style Obese patients should lose weight and do more exercise. Sleep laterally. Patients should avoid taking alcoholic drinking, and should not use sleeping tablets or sedatives.

Successful Factor of Sleep Apnea Treatment and Services CPAP

However, problems such as discomfort, air leakage, cannot

continuous, regular and comprehensive follow up by services

Therapy Commencement Understand the therapy, and educate on

Regular Home Visits Understand the effectiveness and

Telephone Follow Up and Therapy Coaching Understand therapy

5 Successful Factor of Sleep Apnea Treatment and Services CPAP is the most common treatment option for sleep apnea. However, problems such as discomfort, air leakage, cannot get into sleep, may occur during treatment that customers may give up treatment soonly. In fact, a successful treatment depends a lot on a continuous, regular and comprehensive follow up by services provider. Therapy Commencement Understand the therapy, and educate on pathology and device s operation via home visit. Regular Home Visits Understand the effectiveness and progress of treatment, and ensure therapy s compliance. Telephone Follow Up and Therapy Coaching Understand therapy progress and resolve problems. Motivate customers to achieve long term therapy compliance. Annual Report Monitor the therapy progress. Provide coaching for continuous compliance improvement. 5

An overnight sleep study can provide an accurate, comprehensive analysis for

It only takes one night to complete the study.

HOME or in hospital, however, most people choose to conduct the sleep test

It also saves your time from travelling to hospital. 2.

6 What is a Home Sleep Study? Sleep study is the best way to diagnose sleep apnea. An overnight sleep study can provide an accurate, comprehensive analysis for doctors. It is non-invasive, with no pain and no risk. It only takes one night to complete the study. Reasons for having sleep study at HOME 6 Sleep study can be done either at HOME or in hospital, however, most people choose to conduct the sleep test at HOME because: 1. Most people would sleep better at home. It also saves your time from travelling to hospital. 2. A very long waiting queue and rigid testing time at hospital sleep laboratory. 3. Home sleep study allows you to choose the date and time to suit your needs. 4. On-site device setup and collection will be done by experienced technician. You will be able to go to work next morning. 5. A full report will be provided to the medical professional directly for diagnosis as soon as possible.

Choices of sleep study at home: To conduct a sleep study at HOME, you can choose either full sleep study polysomnogram (PSG), wireless or portable sleep

Somnomedics Watch-PAT First Night: PSG : Alice 6 / Alice 5 Wireless PSG Somnomedics / Nox A1 Portable sleep study device : Watch-PAT Polysomnography

Electroencephalogram (EOG) Electroculogram Body Position Leg Movement (SaO 2 ) Oxygen Saturation Level (EMG) Electromyogram (ECG) Electrocardiogram

7 Choices of sleep study at home: To conduct a sleep study at HOME, you can choose either full sleep study polysomnogram (PSG), wireless or portable sleep study device for your sleep study at HOME. Wireless & Portable sleep study device allow you to move around if needed. Somnomedics Watch-PAT First Night: PSG : Alice 6 / Alice 5 Wireless PSG Somnomedics / Nox A1 Portable sleep study device : Watch-PAT Polysomnography parameters of Alice 6/ Alice 5/ Nox A1/ Somnomedics, marked as red dot Portable Sleep Study Device: Watch-PAT, marked as green dot (EEG) Electroencephalogram (EOG) Electroculogram Body Position Leg Movement (SaO 2 ) Oxygen Saturation Level (EMG) Electromyogram (ECG) Electrocardiogram Chest, Abdominal Effort Oral Nasal Flow Snoring If you have any enquiries in sleep study, please contact us at (AHI) Apnea Hypopnea index Sleep Stages (RDI) Respiratory Disturbance Index 7

Second Night: Auto Continuous Positive Airway Pressure (Auto CPAP) Titration If you are diagnosed with sleep apnea, you may need to conduct an Auto CPAP titration to determine the optimal pressure

8 Second Night: Auto Continuous Positive Airway Pressure (Auto CPAP) Titration If you are diagnosed with sleep apnea, you may need to conduct an Auto CPAP titration to determine the optimal pressure for your purchase of CPAP/ BiPAP. You will wear a mask, which is connected to an Auto APAP machine and oximeter during sleep. This device can detect the opt mal pressure, which enable the doctor to prescribe an optimal pressure for your CPAP treatment. Auto CPAP titration records the following parameters Total usage hour Optimal pressure Apnea hypopnea index when using CPAP Oxygen saturation level when using CPAP 8

5.7 Hours Procedures for Sleep Study (PSG) and Therapy 1 2 3 4 5 6 7

sleep specialist to arrange a sleep study.

Preparation for Sleep Test On site setup by technician will be

Auto CPAP Titration* You may need to conduct an Auto CPAP Titration *.

9 5.7 Hours Procedures for Sleep Study (PSG) and Therapy Seek Advice For suspecting sleep apnea case, seek the advice of a sleep specialist to arrange a sleep study. Reservation Confirm the date, time, place (hospital or home). Preparation for Sleep Test On site setup by technician will be arranged*. Auto CPAP Titration* You may need to conduct an Auto CPAP Titration *. (Page 8) CPAP Treatment An optimal pressure will be given for you to purchase CPAP / BiPAP device. (Page 8) Report Download Services provider will download and review compliance CPAP / BiPAP report for you. Seek Advice Consult with doctor regularly and seek for doctor s comment. Regular Follow-up 8 Regular coaching calls and home visits by service provider for troubleshooting and patient education. Three Night Summary View Details Optional 9

10 Notes for the Sleep Study Maintain your daily activities and avoid taking naps (unless it is part of your usual routine) on the day of your sleep study. Avoid consuming food and beverages containing caffeine such as coffee, tea and coke after lunch. Also limit your water intake after dinner. Do not have any beverages containing alcohol within six hours of your bedtime. However, if it is part of your usual routine, you may, but please inform our technician. You should take a shower / bath, wash and dry your hair before your sleep study. Please do not use any hair products. For Gentlemen : Shave before the test. Beards and mustaches are Okay. For Ladies : No cosmetics. Please remove nail polish, nail stickers or other decorations on your fingernail. Please inform your doctor if you are under any medication and the prescribed dosage. Please do not take sleeping pills as sleep enhancing medication may affect the outcome of your study. Please wear comfortable sleeping clothing for the sleep study. Shirt which opens in the front is most preferable If you want to change your appointment or have any enquiry, please contact us at Private Hospital with Sleep Test Hong Kong Baptist Hospital Precious Blood Hospital St. Teresa s Hospital Hong Kong Adventist Hospital Canossa Hospital Matilda Hospital Hong Kong Sanatorium and Hospital St. Paul s Hospital Tsuen Wan Adventist Hospital Union Hospital Evangel Hospital

STOP-BANG Questionnaire STOP-BANG The Stop-Bang Questionnaire is a test used to assess the risk of having an OSA (a). It consists of eight simple Yes/ No questions.

11 STOP-BANG Questionnaire STOP-BANG The Stop-Bang Questionnaire is a test used to assess the risk of having an OSA (a). It consists of eight simple Yes/ No questions. STOP-BANG Questionnaire Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? Do you often feel tired, fatigued or sleepy during daytime? Has anyone observed you stop breathing during your sleep? Do you have or are you being treated for high blood pressure? BMI more than 35kg /m (Non-Asian adults) or 30kg /m (Asian adults)? Weight ( kg) (BMI) = Age over 50 years old? Neck circumference greater than 15.7 / 40cm? Gender male? YES Result No. of Yes 5-8 : It seems that you have a high risk of OSA. 3-4 : It seems that you have an intermediate risk of OSA. 0-2 : It seems that you have a low risk of OSA. (a) Chung F, Subramanyam R, Liao P. et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea, Br J Anaesth. 2012;108(5): (b) Validation of the STOP-BANG Questionnaire among Patients Referred for Suspected Obstructive Sleep Apnea. (n.d.). Retrieved from 11

Pneumonia - Traditional Chinese

Pneumonia - Traditional Chinese Pneumonia When you have pneumonia, the air sacs in the lungs fill with infection or mucus. Pneumonia is caused by a bacteria, virus or chemical. It is not often passed from one person to another. Signs