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Servo Ventilation Therapy for Sleep Disordered Breathing Resource Center

Activity One

 

Activity Title

Sleep Apnea and Cardiovascular Disease
Virend Somers, MD, PhD

 

Program Goals

Obstructive sleep apnea occurs when breathing is obstructed during sleep because of upper airway collapse during inspiration. Apnea may often be prolonged with severe oxygen desaturations to levels as low as 70%. These levels of hypoxemia together with the other accompaniments of obstructive apneas elicit a number of neural, humoral, vascular and inflammatory changes that have acute and chronic cardiovascular effects.

Acute chemoreflex activation by hypoxemia results in sympathetic vasoconstriction and dramatic surges in blood pressure at night. This may contribute to the non-dipping phenomenon seen in patients whose blood pressures do not fall appropriately at night. The hypoxemia together with the vasoconstriction, sympathetic activation and CO2 retention may often elicit nocturnal cardiac ischemia.

These nocturnal changes can also carry over into daytime cardiac and vascular abnormalities. The long-term cardiovascular consequences of sleep apnea include an increased risk of development of both new hypertension and resistant hypertension. Other abnormalities linked to the presence of untreated sleep apnea include an increased predisposition to incident atrial fibrillation, recurrence of atrial fibrillation, worsening heart failure, and increased risk of stroke. OSA may also trigger nocturnal angina, nocturnal myocardial infarction, appropriate ICD shocks for ventricular arrhythmia, and a greater likelihood of sudden death, especially during the night time. Treatment of obstructive sleep apnea has been shown to have a mild to modest blood pressure lowering effect not only at night but also during the daytime. Observational data also suggest that treating OSA can prevent recurrence of atrial fibrillation, both after electrical cardioversion and after pulmonary vein isolation, and reduce risk of MI. However definitive evidence of any benefit of OSA treatment on cardiovascular outcomes awaits the completion of appropriately powered randomized controlled intervention trials.

Target Audience

This activity is intended for healthcare professionals involved in the management of patients with sleep disordered breathing. This especially applies to the following clinical and research fields: Sleep Medicine, Pulmonary Care Medicine, Sleep Technology, Respiratory Therapy, Nursing and Nurse Practitioners, and Physician Assistants.

Learning Objectives

After completion of this activity, participants will be able to:

  1. Review the relationship between obstructive sleep apnea and cardiovascular diseases.
  2. Explain the mechanisms linking nocturnal hypoxemia and obstructive apneas to structural and functional cardiovascular changes.
  3. Describe the possible contribution of OSA to hypertension, atrial fibrillation, myocardial infarction, and sudden death.

Faculty

CHAIRMAN

Virend Somers, MD, PhD 
Alice Sheets Marriott Professor 
Department of Cardiovascular Medicine 
Mayo Clinic
Rochester, MN

CONTRIBUTING FACULTY

Michael Arzt, MD 
Professor of Internal Medicine, Sleep and Ventilation
University Hospital Regensburg
Germany

T. Douglas Bradley, MD
Professor of Medicine
University of Toronto
Toronto, Ontario, Canada

Winfried Randerath, MD 
Professor of Medicine
Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care
Bethanien Hospital
University of Cologne

Renaud Tamisier, MD, PhD
Professor of Medicine
Centre Hospitaliser Universitaire Michalon
Grenoble, France

Christine Won, MD
Associate Professor of Medicine
Yale University School of Medicine
New Haven, CT

Educational Activity Agenda

 Sleep Disordered Breathing and Cardiovascular Disease

  • Front Matter and Registration (3 minutes)
  • Faculty Introduction, Presentations and Roundtable Discussions (110 minutes)
  • Post Test, Evaluation, and Credit Application (10 minutes)

Release and Expiration Dates

Enduring Archive Release Date: August 31, 2016
Enduring Archive Expiration Date: August 31, 2018

Disclosure of Conflicts of Interests

Global Education Group requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

Faculty Disclosures

The faculty reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Virend Somers, MD

  • Consultant: Ronda Grey, Res Med, U-Health, Glaxo Smith Kline, Sorin Inc., Respironics, Respicardia
  • Grant/Research: Philips Respironics Foundation

Michael Arzt, MD

  • Grant/Research: ResMed, Philips Respironics
  • Speaker's Bureau: ResMed, Philips Respironics

Douglas Bradley, MD

  • Grant/Research: Canadian Institutes of Health Research, Philips Respironics

Winfried Randerath, MD

  • Grant/Research: Heinen & Lowenstein, Philips Respironics
  • Speaker's Bureau: Weinmann, Inspire, Philips Respironics, ResMed

Pr. Renaud Tamisier

  • Grant/Research Support: ResMed

Christine Won, MD

  • Nothing to disclose

Planners and Managers

The planners and managers reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

GLOBAL EDUCATION GROUP / GANESCO, INC.

Ashley Marostica, RN, MSN

  • Nothing to disclose

Amanda Glazar, PhD

  • Nothing to disclose

Andrea Funk

  • Nothing to disclose

Laura Gilsdorf

  • Nothing to disclose

Gail Varcelotti, BS, RRT, FAARC

  • Nothing to disclose

CME Provider Accreditation Statement

This activity is provided by Global Education Group.     

Physician Accreditation Statement - CME

Global Education Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. 

*This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation - CME

Global Education Group designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education

Global Education Group is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's COA.  

This educational activity for up to 2.0 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Global Education Group

For information about the physician accreditation for this activity, please contact Global Education Group at (303) 395-1782, or inquire@globaleducationgroup.com.

How to Obtain CME/CE Credit

Attendees are expected to view the entire activity before attempting to take the test and/or complete the activity evaluation. Successful completion will lead to the issuance of a certificate for AMA PRA Category 1 Credit™ or nursing credit. To receive credit, the course must be completed between August 31, 2016 and August 31, 2018.

Participation in this activity should be completed in approximately 2.0 hours. Please follow these steps in order to receive CME/CE credit for viewing the webcast:

  • Read all of the CME/CE accreditation information above.
  • View the complete electronic (web) activity.
  • Click on the link to apply for CME/CE credit.
  • Complete the online registration (registration is free).
  • Complete the online test and/or evaluation. Participants must receive a test score of at least 75% and answer all evaluation questions to receive a certificate.

After successfully completing the online test and/or evaluation, your application will be immediately processed and you will be given the opportunity to download a personalized CME/CE certificate for participation in this activity. 

Should you have any CME/CE questions regarding this activity, please contact:

Global Education Group
5575 S. Sycamore Street, Suite 200
Littleton, CO 80120
Phone: 303-395-1782
Fax: 303-648-5311
Email: inquire@globaleducationgroup.com
Web: www.globaleducationgroup.com

 

Credit Designation - AARC

This Non-traditional program has been approved for 2.0 contact hour Continuing Respiratory Care  Education (CRCE) credit by the American Association for Respiratory Care; 9425 N. MacArthur Boulevard, Suite 100, Irving TX 75063

How to Obtain AARC / CRCE Credit

Attendees are expected to review all academic materials before attempting to apply for credit. Successful completion of this activity will lead to the issuance of a certificate for 2.0 contact hours of CRCE approved continuing education.

To receive credit, please follow these steps:

  • Complete the online registration (registration is free).
  • Review all of the academic materials provided.
  • Click on the CRCE link to apply for credit.
  • Complete the online test and/or evaluation. Participants must receive a test score of at least 70% and answer all evaluation questions to receive a certificate.
  • Qualified applicants will be provided with an online (printable) CRCE certificate based on their attendance and satisfactory completion of this academic activity.

Fee Information

There is no fee for this educational activity.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) does not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Policy on Privacy and Confidentiality

Global Education Group protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. Global Education Group and our joint sponsors will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

Global Education Group, CHEST, Elsevier, and Dane Garvin Ltd. maintain physical, electronic and procedural safeguards that comply with federal regulations to guard your non-public personal information.

Medium Used

This program has been made available online.
"Sleep Apnea and Cardiovascular Disease"

System Requirements

To view this educational activity you will need a web browser with Javascript and either Flash or HTML5 enabled.  Nearly all modern web browsers will work.

Commercial Support Statement

This online Resource Center is supported by an Educational Grant from Philips Respironics, Inc.

Copyright

Copyright© 2016 by the American College of Chest Physicians. All Rights reserved. Permission for accreditation use granted to Global Education Group (Global). Web interface provided by Dane Garvin Ltd.