Establishing Effective Interprofessional Care Pathways for Obstructive Sleep Apnea

This educational activity is presented in collaboration with Rush University Medical Center and Academy for Continued Healthcare Learning (ACHL).

Supported by an educational grant from Lilly.

RELEASE DATE

April 15, 2024

Expiration Date

April 15, 2025

ACTIVITY OVERVIEW

Despite obstructive sleep apnea (OSA) being a source of significant morbidity and mortality, it is underdiagnosed and undertreated. Poor patient outcomes stem from inadequate and/or inconsistent screening in high-risk patients, a dearth of sleep specialists to effectively manage all patients, and poor collaboration amongst disciplines to evaluate and manage patients. And while CPAP remains the standard of care for patients with OSA, it is insufficient for a sizeable number of patients and not tolerated by patients with high-risk comorbidities. 

Are you equipped to:

• Recognize typical and atypical presentations of OSA?
• Conduct effective screenings for your patients at high risk?
• Select and interpret the best sleep test for a patient?
• Provide a timely referral for a formative diagnosis to ensure optimal management?
• Coordinate and manage care for your patients with OSA?

Developed by experts specializing in sleep management, this dynamic online slide library allows you to choose topics that are most relevant to your clinical setting and customize an educational activity to improve the quality of care you provide to your patients with OSA. It's time to help your patients get the quality sleep they deserve and reduce the potential for complications!

TARGET AUDIENCE

This activity is intended for multidisciplinary healthcare providers involved in the care of patients with obesity who may also have OSA, including primary care providers pharmacists, dentists, surgeons, endocrinologists, cardiologists, pulmonologists, neurologists, obesity care specialists and advance practice providers.

Learning Objectives

Upon completion of this activity, pharmacists will be able to:

• Implement routine OSA screening for patients with obesity and other OSA risk factors.
• Identify tools that can aid in screening patients for OSA.
• Initiate diagnostic workups for patients with suspected OSA.
• Evaluate results from OSA diagnostic studies.
• Implement multidisciplinary approaches to provide comprehensive management of OSA.

ACTIVITY PURPOSE

Obstructive sleep apnea (OSA) is a chronic disorder characterized by repetitive collapse of the upper airway during sleep. In the United States, OSA is common due to the high prevalence of risk factors, such as obesity and advanced age. The impacts of OSA cause major morbidity and may be life-threatening. Sleep disruptions caused by OSA can lead to impaired vigilance, daytime somnolence, performance deficits, morning headaches, mood disturbances, cognitive dysfunction, impaired workplace productivity, and motor vehicle accidents. (Morsy 2019) OSA is a source of major morbidity and mortality, and providers must be knowledgeable and competent to identify those at risk and provide a timely diagnosis to ensure that patients receive optimal management.

FACULTY

Atul Malhotra, MD (Chair)
Kenneth Moser Professor of Medicine
Chief, Division of Pulmonary and Critical Care
University of California
San Diego, CA

Neomi Shah, MD, MPH, MS (Chair)
Associate Dean for Faculty Career Advancement
The Office of Faculty Development
System Vice Chair of Medicine for Faculty Affairs
The Samuel Bronfman Department of Medicine
Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine
Icahn School of Medicine at Mount Sinai
New York, NY  

Fernanda Almeida, DDS, PhD (Co-chair)
Professor, Faculty of Dentistry
University of British Columbia
Vancouver, Canada

Shana Castillo, PharmD, MBA, RPh (Co-chair)
Associate Professor, Pharmacy Practice
School of Pharmacy and Health Professions
Creighton University
Omaha, NE

FINANCIAL DISCLOSURE

It is the policy of Rush University Medical Center and the Office of Interprofessional Continuing Education (ICPE) to ensure that its CE activities are independent, free of commercial bias and beyond the control of persons or organizations with an economic interest in influencing the content of CE.  All individuals in control of educational content must disclose all financial relationships with ineligible companies in the past 24 months.  An ineligible company is an entity whose primary business is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients. All conflicts of interest, including potential ones, for individuals in control of educational content are mitigated prior to the planning, implementation, or evaluation of the continuing education activity.

The IPCE identifies the presence or absence of relevant financial relationships for all individuals in control of content including but not limited to planning committee members, course directors, invited presenters/authors, and staff through a standardized disclosure form.  If a financial relationship is identified for the person in control of content, conflict mitigation strategies will be used to mitigate the financial relationship before they assume their role.

The following financial relationships have been provided:
Fernanda Almeida, DDS, PhD
Advisor Clinical Advisory Board – Somnomed

Shana Castillo, PharmD, MBA, RPh
No financial relationships to disclose

Atul Malhotra, MD
Consultant: Eli Lilly, Jazz Pharmaceuticals, Livanova, Zoll 

Neomi Shah, MD, MPH, MS
Advisor: Bresotec:
Consultant: Respicardia 

Off-label statement      
Discussion of Off-Label, Investigational, or Experimental Drug/Device Use: antiobesity medications for treating OSA

Unapproved Uses of Drugs/Devices: In accordance with requirements of the FDA, the audience is advised that information presented in this continuing medical education activity may contain references to unlabeled or unapproved uses of drugs or devices.  Please refer to the FDA approved package insert for each drug/device for full prescribing/utilization information.

Staff and Reviewer Disclosures
Rush University Medical Center and the Office of Interprofessional Continuing Education staff members, ACHL staff members, and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.

ACCREDITATION STATEMENTS

In support of improving patient care, Rush University Medical Center is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity is being presented without bias and with commercial support.

Rush University Medical Center designates this application-based Internet Enduring Material for a maximum of 3.0 contact hour(s) for pharmacists. ACPE Universal Activity Number: JA0000275-0000-24-306-H01-P

Method of Participation

Learners must successfully complete the posttest and fill out the evaluation within a maximum of 60 days of participation. Participation statements will be issued immediately upon completion. To receive Credit, you must provide your date of birth and NABP number. All Credit information will be uploaded into CPE monitor within 30 days.

For questions, contact Katie Hacias at khacias@achlcme.org.

Agenda

Content is displayed in these sections:

OSA Burden of Disease/Epidemiology (20 minutes)

• Sleep-disordered breathing: OSA, central sleep apnea, or sleep-related hypoventilation
• Prevalence
• Pathophysiologic mechanisms of OSA
• Burden

Screening At-Risk Patients for OSA (40 minutes)

• Endotypes
• Benefits of treatment
• USPSTF report and screening
• Identifying patients at high risk
• Taking a comprehensive sleep history
• Oral examination
• Laboratory tests
• Available clinical tools and questionnaires

Confirming a Diagnosis of OSA (30 minutes)

• Healthcare burden of undiagnosed OSA
• Definitions of OSA
• Diagnostic approaches
• When to refer to sleep specialist

Management Approaches (10 minutes)

• Indications for treatment of OSA
• Sleep hygiene
• Weight loss
• Positive airway pressure
• Oral appliances
• Surgical approaches
• Use of shared decision-making in treatment selection
• Defining treatment success
• Role of multidisciplinary team when first-line therapy is not effective

Care Coordination (10 minutes)

• Patient barriers in care
• Roles of providers
• System-based solutions to facilitate coordination
• Assembling a multidisciplinary sleep team
• Addressing lack of access to specialist care

Role of Pharmacists (20 minutes)

• Benefits of pharmacist screening
• Presentation
• Identification: when to refer patient
• Management
• Identifying barriers to therapy
• Potential adjunctive therapies

Disclaimer

The content for this activity was developed independently of any ineligible company. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantor(s).

This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

This CME/CE activity might describe the off-label, investigational, or experimental use of medications and/or devices that may exceed their FDA-approved labeling. Physicians should consult the current manufacturers’ prescribing information for these products. Rush University Medical Center and ACHL require the speaker to disclose that a product is not labeled for the use under discussion.

Hardware/Software Requirements

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