           |
||||
 |
Snooze Newzzz Letter from the President — March 2007 Welcome Fellow Sleep Technologists! Well, spring is already here and this summer will be fast approaching. The 5th Annual New England Polysomnographic Society (NEPS) Conference will than be here in no time. This year the NEPS annual conference will be in the very beautiful city of Portsmouth, New Hampshire August 23 and 24, 2007. Last year, more than 200 participants attended making it the biggest year to date. I am confident that this year will exceed last year in attendance. Our educational committee members, chaired by Paul Donnellan are working hard at giving us great speakers with interesting topics. Over past years as a NEPS member I can report that we are moving in the right direction. Thanks to the hard work of a very dedicated volunteer board and assorted helpers, this organization has taken a giant step forward in the past few years. Our mission of providing local educational opportunities for Polysomnographic Technologists and the ability to network and learn from one another is alive and well. We have been working hard to improve/develop the Web page and its forum for members to interact. This will be similar to other national forums, but regional. There will be good opportunities to network and advertise openings at your sleep facility. Theresa Shumard has taken over the NEPS Web page development, and Jessica Steadman the newsletter. They are doing a fantastic job. Be sure to check out the updates on our site. I am looking forward to seeing you all in August. Sincerely, Pediatric Sleep Corner As more sleep laboratories are performing polysomnographic evaluations on children, there is an increasing awareness and subsequent body of research providing objective evidence on the consequences of disturbed sleep in this population. This research provides a new outlook as to why it is important to study children and accurately portray and interpret their polysomnographic findings. The following is a summary and review of recent research on children suggesting a link between sleep disturbances and deficits in cognition, mood, behavior and performance that can affect academic success and daytime functioning. Recent research on the consequences of pediatric sleep disorders illuminates the potential relationship with Attention-Deficit/Hyperactivity Disorder (ADHD or ADD). According to the National Institutes of Health, the incidence rate of ADHD is estimated to be between approximately 3% and 5 % of school aged children, though these rates can vary widely depending upon the geographical location and populations sampled. ADHD is characterized by at least two of the following behaviors:
ADD is sometimes used as a generic term for these impairments, but ADHD more accurately communicates that the attention deficit disorder may take different forms: either inattentive or hyperactive/impulsive. Although children are more often the ones diagnosed and treated with ADHD, we now know that these behaviors can persist into adulthood. While everyone may exhibit some of these signs and symptoms from time to time, a person with ADHD is likely to have more of these symptoms consistently since early childhood. Symptoms generally are present in at least two settings such as school and home and can cause significant impairment in daily functioning. The cause of ADHD remains unknown. As an ADHD child matures into a teenager and then an adult, he or she often gains self-control over hyperactivity symptoms. The lack of hyperactivity in an adult with ADHD may be the reason that more adults do not recognize that they have, or still have ADHD. While the hyperactivity may diminish over time, inattentiveness usually remains consistent. Some of the symptoms of ADHD are commonly seen in sleepy adults such as ignoring details, the inability to sustain attention or listen, distractibility, forgetfulness and memory problems. However, the manifestation of excessive daytime sleepiness (EDS) often seen in the adult with sleep disruption is commonly absent in children except in the more severe cases of obstructive sleep apnea (OSA). Differences in the fragmented nature of sleep in children as compared to adults may have several causes that emphasize the importance of accurately evaluating this population. Adopting a clear consensus for scoring apneic events, periodic limb movements in sleep (PLMS) and a clear definition of cortical arousal in children could have major implications for correlational analyses and enable sleep clinicians and researchers to provide a more thorough understanding of the effects of sleep disorders in the pediatric population. Behavioral problems including ADHD and poor school performance have now been documented in children with suspected poor sleep. In a recent comprehensive literature review the effects of 5 clinical categories that included sleep disordered breathing (SDB) were analyzed. ADHD was frequently listed as one of the major effects documented for SDB in addition to impaired attention, hyperactivity and behavioral disturbances. The evidence-based conclusions are made more compelling in those studies documenting improvement in school performance and attention following treatment by either adenotonsillectomy or CPAP administration suggesting a causal relationship. Other studies have supported these findings for primary or habitual snoring in children. It was found that even primary snoring, snoring that does not meet the criteria for OSA, in children was associated with significant alterations in respiratory arousal and REM percentage compared to non-snoring control subjects. There is also evidence that even after the resolution of snoring, adverse academic outcomes can still be present several years later and that academic compromise from SDB during this critical phase may be partially irreversible. Further support for the potential relationship between ADHD symptoms and SDB was found when polysomnographic evaluations were conducted on children whose parents reported ADHD symptoms. In these children, REM sleep was disturbed and may have contributed to the severity of their daytime behavioral manifestations. Those children with parentally reported significant ADHD symptoms were not more likely to have SDB but SDB was found to be highly prevalent in children with parentally reported mild ADHD symptoms. Perhaps this finding is additional support for the notion that ADHD can be a daytime manifestation of sleep alteration for a subset of children. These studies seem to suggest that a sleep evaluation to rule out SDB be performed as close as possible to the onset of symptoms since early detection can at least partially ameliorate one or more aspects of impaired neurocognitive function with appropriate treatment. The frank cortical arousals and fragmented sleep architecture usually associated with sleep-related problems in adults with EDS are not as obvious or frequent in pediatric populations. It seems apparent that instability in the sleep-wake system of children has some predictive value for children with ADHD. An increase in the instability of sleep onset, sleep duration and true sleep was found in boys with ADHD as compared to a control group when measured by actigraphy and sleep diaries. It is important for sleep professionals and the community as a whole to have an increased awareness of the effect pediatric sleep disturbances has on the daytime functioning of children; including the apparent link with ADHD and other potential consequences. Disturbed sleep in children and adults can affect cognition, mood, behavior and performance but these effects can also adversely influence academic achievement and social interactions that can have potentially long-term consequences for children. The clear vulnerability in the pediatric population illustrates the urgent need for sleep professionals to establish standards in monitoring and evaluating children. Promoting awareness of the consequences of pediatric sleep disorders, including the link to ADHD will hopefully lead to early evaluation, treatment and the subsequent enhancement of the quality of children's lives and their families. Patrick Sorensen, RPSGT Educational Opportunities Diagnosing and treating sleep disorders in Children and Adults Educating the Patient with Sleep Abnormalities: Compliance & Health Literacy As caregivers in the field of sleep medicine and technology, you without doubt strive to help patients understand their sleep disorders. You also attempt to help affect positive health outcomes through educating your patients. Understanding health literacy concepts in order to successfully relay basic health communications is fundamental in achieving these goals if patients are to be educated appropriately. If you were given the choice between age, income, literacy skills, employment status, education level and racial or ethnic group, which would you select as the strongest predictor of an individual's health status? According to research provided by the Partnership for Clear Health Communication (PCHC), the answer is health literacy. Low health literacy is a silent epidemic. Health literacy is defined as the ability to read, understand, and effectively use or act upon basic medical instructions and information. According to the Institute of Medicine, nearly half of all American adults (90 million people) have difficulty understanding and using health information. Considering these odds, chances are high that some of your sleep disorders patients are among this group. Furthermore, as a domino effect, the economic consequences of limited health literacy costs $50-$73 billion per year when patients receive further care as a result of not properly complying to initial illness treatment regimens. Other consequences of low literacy skills include medication errors, improper and unsafe use of home medical equipment and missed appointments, just to name a few. You may not even know that these patients are in your practice because they are often embarrassed or ashamed to admit they have difficulty understanding what you are telling them. Many times patients with low literacy skills use well-practiced coping mechanisms that effectively mask their problem of not understanding well or not being able to read well. Instructing Sleep Disorders Patients The PCHC, recommends the following pointers for educating patients:
After you've established an environment conducive to learning, perform the rest of your patient education in steps. If you think about and plan what you are going to say to a patient, it allows for you to present information and let it flow in a logical order. Teach one step at a time, clearly identifying each step. For example, begin with "I am going to teach you about... Here are three things you need to know. First, you should... Second, you need to... and third, you must..." When you need to introduce an unfamiliar term, teach the correct pronunciation, explain what it is and give an example. If you need to use an abbreviation or acronym, explain it and give an example. It is also a good idea to reinforce your verbal instruction with other instructional tools. Give out written information people can refer to at a later time, encouraging them to share this information with others. Draw simple line drawings to illustrate key concepts. Suggest that patients take notes. You can verify understanding by having the patient repeat the important information back to you. Communicating by using a professional demeanor and using a positive and supportive approach are good practices. Address patients formally, and do not use their first name unless specifically invited to do so. Create a "shame-free" environment—if the patient appears to have difficulty learning new information, let the person know that many people find it hard to understand. Fine-tune your teaching to accommodate a patient's learning style and special needs. To reduce confusion, consistently use the same terms regardless of whether you are speaking or writing. Find out how a patient prefers to learn—by reading, listening, viewing, doing or a combination of these ways. Regulate your pace, and make sure you do not present information too quickly so the patient can keep up. Note any special needs such as hearing or visual impairments, and adapt accordingly. Speak distinctly, not necessarily loudly. Shouting is unpleasant and not helpful; it distorts the lip movements, making lip reading more difficult, and may interfere with a hearing aid's ability to pick up usable sounds. Use a slower rate of speech, but don't exaggerate pronunciation to the point that you distort individual words. Find a quiet environment in which to communicate. It is even more difficult for a person with limited hearing to understand you when there is competing noise, such as the hum. In future newsletter articles, tools to help identify at-risk (low literacy level) patients and methods to assist you in the creation of written materials for patient education will be addressed. Many guidelines are available to address key issues for the development of appropriate materials. In general, these guides suggest that it is important to address language, organization (presentation of ideas, grouping of like ideas, highlights of key points, summaries, and, in general, attention to what people want to know as well as what professionals think they ought to know) and layout and design. It may be challenging for you to think about incorporating the items we have discussed here, and you may feel that you do not have enough time in your already demanding work schedule to perform these extra tasks and material. It's helpful to realize that once you're accustomed to performing them on a regular basis, you'll be surprised how little time it really takes. Besides, you probably entered a health profession because you receive satisfaction in caring for patients and want to see them get well. Improving your health communications with low-literacy-level patients goes a long way in accomplishing just that by having appropriately informed patients that can effectively carry out discharge instructions. Theresa Shumard Occupational Opportunities Sleep HealthCenters®, the largest provider of sleep services in Massachusetts, is hiring skilled sleep technologists for all Boston area locations (Bedford, Malden, Newton, Boston, Weymouth, Beverly). We are recruiting technologists at all levels and have a planned track of progression for technologists wishing to advance in sleep medicine. Sleep technologists are needed for performing polysomnograms (night shifts); part time, per-diem and full time positions are available. Training in polysomnography is offered in a 3 month training program for those with a healthcare background and associates degree or higher or Bachelors Degree in science. Minimum Qualifications excluding the training program: For consideration, please send a resume to William W. Eckhardt BS RPSGT CRT, Director of Education via: Letter to the Editors Your feedback is greatly appreciated. Let us know how we're doing. Any questions, comments or suggestions for the Snooze Newzzz editors may be directed to: Bethany Lamell, RPSGT And if you're you interested in being a Snooze Newzzz editor or submitting an announcement or article, get in touch with us via e-mail!
|
|
||
|
|
|
||