New ApneaGraph Spiro
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Transcript of New ApneaGraph Spiro
New Device in OSAS Relevant to the ENT – Surgeon.
Magne Tvinnereim, MD.,Ph.D. Specialist in Otolaryngology Head - & Neck surgery
International Accredited Sleep Specialist CEO, Spiro Medical AS & EuroSleep AS
Disclosure: Company Interests
The Philippines
• How many are the patients ?
• Population – 100 Million
• > 15 % of Population affected from SRBD
• Gives ; > 15 million sufferers
Why an ENT - Matter ? Because the main problems come from
Narrowing of the Throat.
Who is ill ?
Demands (AASM; 2007 / 2013):
OSA = RERA + AHI = oRDI RERA = Respiratory Effort Related Arousals
= Arousals during increased Lung work. OSA = Obstructive Sleep Apnea = AHI + RERA.
(Apnoeas, Hypopneas, Asleep/Awake.) oRDI = Obstructive Respiratory Distress Index.
These parameters give the Complete Diagnosis.
Diagnosing OSAS
Diagnostic Upgrade – 2013, American Academy of Sleep Medicine
Upper Airway narrowing generates increased Respiratory Effort for the Lungs to supply blood oxygen.
In 2013 (AASM) : Respiratory Effort is the most important parameter, measured by the Gold Reference Standard the Oesophageal Pressure
Obstructive Apnoea
Upper airway narrowing during sleep Inspiratory Snoring RERA OSAS resistance Hypersomnia
SRBD ;A Continuum
NormalPhenomenon
PathologicalConsequences
Diagnosis Established
OSAS = AHI + RERA = RDI.
5 < RDI < 15 ; Mild.15 < RDI < 30 ; Moderate.30 < RDI ; Serious.
Which TREATMENT to choose ?
Non Surgical Approaches Nasal / Oral Appliances POSA – Treatment.
CPAP
Surgical Approaches
Site of Phase I Phase II Obstruction ? Upper Lower
Phase III Nose
Multi- Soft Tissue
Level Skeletal Bariatric Surgery
Indications for SRBD Surgery1. Defined disease verified by
whole night recordings (WSDA) : PolySomnoGraphy (PSG)CardioRespiratory recordings
2. Ineffective conservative therapy (CPAP)
3. Treatable airway pathology
Where is the Stenosis?
Upper Airway Passage
Drug Induced Sleep Endoscopy, DISE.
• 1990, Pringle and Croft.• Short, not whole night.• Artificial Sleep• Most occlusion types:
Incorrect distribution.• Can miss Lower and
Multilevel occlusions.
Respiratory Effort
Open Closed
Upper Obstruction
Phase I :Upper obstruction
• The highest pressure gradient is above the soft palate
P2, below soft palate
P0, in oesophagus
Level Diagnosis
The pressure recordings will Always Identify The Lowest Limit of the occlusion. If the pressure recordings say predominantly upper narrowing we can be sure that the problems are above the upper pressure sensor in the pharynx.
Always measures the Lower Limit
Upper Lower Multilevel
Sequential Pharyngeal Multilevel Collapse Worlds First Multple-sensor Pressure Recording.
Level and Snoring
Upper Occlusions at Night - is The Surgeons Delight!
Factors increasing Surgical outcome :
Defining Site of Pharyngeal narrowing.Diagnosing Upper Pharyngeal obstruction.«Light sufferers» :OSAS patients with RDI < 20 – 30.OSAS patients with predominantly RERAs.Patients with BMI < 32Patients without Comorbidities Patients without Comorbidities
Surgical Level Strategy.
Upper: Nasal Surgery Soft tissue Pharyngeal surgery
Lower: Soft tissue Pharyngeal / BOT surgery, Implants.Multilevel: Lateral collapse – mostly Oropharyngeal
To be excluded by ENT-exam or DISE.Then consider;Multilevel Soft Tissue Surgery/BOT-excision.Implants ; ReVent, InspireSkeletal, max/mandib. – genioglossus etc. …
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Spiro Medical Innovation are directed and solved along three development lines:
Exceptional high-tech Catheter development for 2013 required Data Acquisition. World exclusive rights for advanced, newly patented Micro-Pressure-Transducer recording technique and signal processing : Gold Reference Standard diagnostics.
Revolutionary diagnostic Paradigm shift by innovative Algorithm development for demanded Awakening Parameter : ElectroEncephaloGraphy (EEG) are Replaced by a unique Spiro invented awakening parameter – the Spiro Respiratory Effort Related Arousal, sRERA.Patented!
Automated Reproducible SW-Interpretation: Digital numbers.Clinical Treatment application Advisory: Treatment recommendations. Preoperative site of throat obstruction, increasing surgical outcome.
Innovative ENT - Device Solution
Innovation : ApneaGraph® Spiro
OSA : Complete Automated Diagnosis - Level of Obstruction
- Level of Snoring - Gold Reference Standard
Safe – Tolerable – Cost Effective – Covers all AASM - 2013 Criteria.
Changing Habits
Questions?