Steering Committee
Profiles
Christine Won, MD,MS, (Chair)
Dr. Won is the Director of the
Yale Sleep Center, and Director of
Yale’s Women’s Initiative in Sleep
Health (WISH). She is an active
member of the AASM having
recently served three years on the
AASM Education Committee,
and on the CPAP Adherence
Education Task Force in 2010.
She is active in the local sleep
community, serving on the Board
of Directors of the Connecticut
Sleep Society. She is an Assistant
Professor of Medicine in the
section of Pulmonary, Critical
Care and Sleep Medicine at Yale
University, and the Associate
Program Director for the Yale
Pulmonary and Critical Care
fellowship program. Prior to this
she was an Assistant Professor
in the section of Pulmonary and
Critical Care at UCSF, and served
as their Associate Director for the
Sleep program. She completed
her sleep, pulmonary and critical
care training and undergraduate
education at Stanford University.
Katie Sarmiento, MD, (Vice
Chair)
Dr. Sarmiento is the Director of
Pulmonary Sleep Medicine at the
VA San Diego Healthcare System
and an Assistant Professor at the
2013 - 2014
chair
Christine Won, MD, MS
vice-chair
Katie Sarmiento, MD
members
Chad Hagen, MD
Ali El Solh, MD
AASM Membership Sections Newsletter
■
Issue # 4
23
Sleep Related Breathing
Disorders
Case Report: An Ambulatory Model of Care for a
High Risk Population—The VA Sleep Experience
Katie Sarmiento, MD, VA San Diego Healthcare System
Due to the high prevalence
of sleep disordered breathing
(SDB) in Veterans, practicing
sleep medicine within the VA
Healthcare System poses both
unique opportunities and
challenges to providers. There
are approximately 580 dedicated
sleep medicine providers within
the VA, consisting of physicians,
nurse practitioners, physician
assistants, sleep technologists,
and respiratory therapists.
The estimated prevalence of
obstructive sleep apnea (OSA) is
approximately 17%, with diag-
nostic rates steadily increasing
with improved awareness among
referring specialists and primary
care providers. In 2012 there
were more than 150,000 unique
visits for SDB and more than
120,000 positive airway pressure
(PAP) units distributed. One of
the greatest challenges is meeting
this ever-increasing demand for
services with limited resources.
While VA sleep providers strive
to adhere to guidelines from the
AASM and meet compliance
standards outlined in Medicare
Local Coverage Determinants,
programs ultimately often have
to be creative in their diagnostic
and management strategies to
keep up with demand. In many
ways this has resulted in the VA
being on the forefront and having
longstanding experience with
what is considered relatively new
in the private sector: an ambula-
tory model of sleep care based on
home sleep testing and auto-ti-
trating PAP (aPAP) therapy.
Each VA Medical Center has
developed its own approach
to diagnosis and management,
tailored to the needs and resourc-
es at that site. At the San Diego
VA, ambulatory management
has been the norm for more than
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this newsletter are solely those of the authors and not of the AASM or of its officers, members or
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its officers, members and employees disclaim all responsibility for any injury to persons or property
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