University of California San Diego. She
completed her M.D. and M.P.H.T.M.
at Tulane University, and her training
in Internal Medicine, Pulmonary &
Critical Care, and Sleep Medicine at the
University of Maryland School of Med-
icine. Her research interests include
ambulatory models of sleep care, health
access, peri-operative risk related to
sleep disordered breathing, and the
relationship between PTSD and sleep
apnea. She is a member of the VA Sleep
Network steering committee, a group
of VA sleep providers working together
to promote high quality clinical care, to
standardize programmatic processes,
and to develop multisite collaborative
sleep research. A self-proclaimed food-
ie, oenophile, and craft beer enthusiast,
her other interests include full and half
marathons, yoga, and travel.
Chad Hagen, MD
Dr. Hagen is Director of the Oregon
Health and Science University Sleep
Disorders Program. He maintains a
busy academic sleep clinical practice,
teaches residents and sleep medicine fel-
lows while continuing research related
to sleep disordered breathing syndrome
definition and disease detection.
Ali El Solh, MD
Dr. Solh is Professor of Medicine,
Division of Pulmonary, Critical Care
& Sleep Medicine, School of Medicine
and Biomedical Sciences, University at
Buffalo. He is an attending physician at
Buffalo General Hospital and Veterans
Affairs Medical Center, Pulmonary
Service. Dr. El Solh is the Director of
the Medical Intensive Care Unit at
Erie County Medical Center, and also
Director of the Western New York
Respiratory Research Center at the
University at Buffalo.
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AASM Membership Sections Newsletter
■
Issue # 4
American Academy
of Sleep Medicine
24
twenty years. While in-lab testing is available, more than 95% of
Veterans referred for evaluation undergo home sleep testing using
a type III recorder, with raw data manually scored and reviewed
on site for interpretation. Our experience has shown positive
testing rates of greater than 90% overall. Even when the diagnosis
of OSA is of low pretest probability positive testing rates exceed
75% in our population. Once a diagnosis of OSA has been made,
patients are started on aPAP therapy as a long-term plan of care.
Minimal CPAP is determined by a validated formula and further
adjusted based on data from smartcard download at the follow up
visit. We have evolved from in-lab titrations, to limited 3-night
auto-titrations with subsequent fixed CPAP, to aPAP as we have
gained experience and learned about how best to deliver high
quality care. Currently our program cares for more than 14,000
active CPAP users. This process has minimized the number of
visits required in sleep clinics and reduced the backlog and wait
times for Veterans to be seen. Efficiency in establishing a diagno-
sis of OSA is improved, and more attention is subsequently spent
on improving PAP adherence and management of co-morbid
insomnia, inadequate sleep hygiene and parasomnias.
VA sleep providers have the fortune of being able to focus on
patient-centric care not dictated predominantly by payer policies.
While the San Diego VA’s experience may not fit all practices,
the hope is to inspire confidence in the strategy of ambulatory
management of OSA, which has worked successfully for our
program for many years. There are significant opportunities for
comparative effectiveness, outcomes, and health services research
when different models of care are explored, and there is much to
be learned by sharing these experiences.
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