Resource Center Title

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Servo Ventilation Therapy for Sleep Disordered Breathing Resource Center
Activity Five

 

Activity Title

Opioid-Induced Central Apnea and Treatment Emergent Sleep Apnea
- Christine Won, MD

 

Program Goals

Two important presentations of central sleep apnea (CSA) are opioid-induced CSA (Op-CSA) and treatment-emergent CSA (TE-CSA). TE-CSA is relatively rare and usually resolves over time. Physicians should be aware of these two important versions of CSA, the similarities and differences in their risk factors, symptoms, disease courses, and treatment recommendations. Importantly, although continuous positive airway pressure (CPAP) should be avoided in patients with Op-CSA, as CPAP may worsen a patient’s sleep disordered breathing, in TE-CSA there is a recommendation for intervening with CPAP, although only with back-up. In both presentations, if CPAP is employed, it should be initiated as bilevel PAP with a back-up rate or if available as adaptive servo-ventilation (ASV). CSA itself represents a poorly understood entity to recognize and treat. At the present time the consensus favors treating the breathing disorder, especially if the patient is symptomatic, based on the limited evidence-base for treating CSA in general. However, although there is a consistency in that the majority of central events tend to occur during NREM, not REM, sleep, other CSA manifestations differ slightly between Op-CSA and TE-CSA and there is an educational need for some knowledge of these differences.

The purpose of this educational activity is to review the proper use of BiPAP with back-up and autoSV for the treatment of sleep disordered breathing, including TE-CSA and Op-CSA. Emphasis will be placed on proper patient and therapy selection, especially in those patients who are opioid users.

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 should be able to:

  1. Review the similarities and differences in the diagnosis and treatment of Op-CSA versus TE-CSA. 
  2. Explain the mechanisms for sleep disordered breathing in patients who use opioids.
  3. Describe the indications for which different forms of positive airway pressure (PAP) intervention are recommended for CSA, TE-CSA, and Op-CSA.
  4. Identify the spectrum of risk factors for CSA, TE-CSA, and Op-CSA.

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

 Opioid-Induced and Treatment- Emergent Central Sleep Apnea

  • Front Matter and Registration (3 minutes)
  • Faculty Introduction, Presentations and Roundtable Discussions (90 minutes)
  • Post Test, Evaluation, and Credit Application (10 minutes)

Release and Expiration Dates

Enduring Archive Release Date: May 8, 2017
Enduring Archive Expiration Date: May 8, 2019

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

Lindsay Borvansky

  • 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 1.75 AMA PRA Category 1 Credits™. 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 1.75 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 May 8, 2017 and May 8, 2019.

Participation in this activity should be completed in approximately 1.75 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 credits.
  • 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 1.75 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 1.75 contact hour 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.
"Opioid-Induced Central Apnea and Treatment Emergent Sleep Apnea"

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© 2017 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.