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Physician Resources2019-03-15T11:58:05+00:00

Physician Resources

As you may know from your experience, it can sometimes be difficult to focus on a multifaceted field such as the many diseases associated with sleep in a patient with multiple co-morbidities. Our expertise and interest in such diseases helps our practice to focus on these conditions in-depth and keep morbidity under control.

We will work with you to ensure quality health care for your patient in timely manner, including faxing all consultative notes to your office and remaining in constant communication so that you are well aware of the patient’s treatment course.

Working together with medical professionals in the community is part our culture. We understand how important it is for your patients to know that the physicians you refer to are competent and will provide personalized attention. We look forward to the opportunity to collaborate with you on the care of your patients.

To refer a patient for a sleep consultation, please fax the form below and the patient demographics/face sheet, a copy of the patient’s insurance card(s) and H&P/last office visit note to: (239) 303-4093.

Sleep Consultation Order
Why Bariatric Surgery Patients Need Preoperative Sleep Evaluation?
Why Sleep Evaluation in Cardiac Patients Helps them Stay Out of the ER
Metabolic Syndrome and Sleep – What You Need to Know
Early Diagnosis/Treatment of Sleep Disorders With Neurology

Imtiaz Ahmad, MD, MPH, FCCP

Education & Training

Imtiaz Ahmad, MD, board certified in Internal Medicine, Pulmonary Medicine and Sleep Medicine, started his medical training in the State University of New York Health Science Center in Brooklyn, NY to complete residency in Internal Medicine and fellowship training in Pulmonary and Critical Care Medicine at the University of Mississippi Medical Center. Upon completion of fellowship, he went on to Harvard to obtain advanced degree and training in clinical research and healthcare management. He also received Masters in Public Health degree from Harvard School of Public Health. He received his medical degree from Dhaka Medical College with outstanding achievement and scholarship.

Current Position

Dr. Ahmad is the Medical Director of Somnas. Here, he focuses on the diagnosis, management and treatment of sleep disorders, as well as conducting clinical research in these fields. He is also the Medical Director at Allergy Sleep & Lung Care. 

Board Certifications

  • Pulmonology
  • Internal Medicine
  • Sleep Medicine

Clinical Expertise

  • Pulmonology
  • Sleep Medicine
  • Asthma/Allergy

Past Positions

  • Abbott Laboratories – Medical Director Abbott Park, IL
  • Sepracor, Inc. – Consultant Marlborough, MA

Professional Associations

  • American College of Chest Physicians
  • American Academy of Sleep Medicine
  • Society of Critical Care Medicine

Latest in Sleep Medicine News

Cannabis, Cannabinoids, and Sleep: a Review of the Literature.

PURPOSE OF REVIEW:

The current review aims to summarize the state of research on cannabis and sleep up to 2014 and to review in detail the literature on cannabis and specific sleep disorders from 2014 to the time of publication.

RECENT FINDINGS:

Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with PTSD and may improve sleep among patients with chronic pain. Research on cannabis and sleep is in its infancy and has yielded mixed results. Additional controlled and longitudinal research is critical to advance our understanding of research and clinical implications.

Author: Babson KA, Sottile J, Morabito D

Source: https://www.ncbi.nlm.nih.gov/pubmed/28349316

Obstructive sleep apnea: focus on myofunctional therapy

PURPOSE:

Orofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action.

METHODS:

We conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were “obstructive sleep apnea” in combination with “myofunctional therapy” OR “oropharyngeal exercises” OR “speech therapy”. We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). The primary outcomes of interest for this review were objective measurement derived from PSG and subjective sleep symptoms. The secondary outcome was the evaluation of orofacial myofunctional status.

RESULTS:

Eleven studies were included in this review. The studies reviewed reveal that several benefits of OMT were demonstrated in adults, which include significant decrease of apnea-hypopnea index (AHI), reduced arousal index, improvement in subjective symptoms of daytime sleepiness, sleep quality, and life quality. In children with residual apnea, OMT promoted a decrease of AHI, increase in oxygen saturation, and improvement of orofacial myofunctional status. Few of the studies reviewed reported the effects of OMT on the musculature.

CONCLUSION:

The present review showed that OMT is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure. However, randomized and high-quality studies are still rare, and the effects of treatment should also be analyzed on a long-term basis, including measures showing if changes occurred in the musculature.

Source: https://www.ncbi.nlm.nih.gov/pubmed/30233265

Obstructive sleep apnea: Who should be tested, and how?

Patients who have risk factors for obstructive sleep apnea (OSA) or who report symptoms of OSA should be screened for it, first with a complete sleep history and standardized questionnaire, and then by objective testing if indicated. The gold standard test for OSA is polysomnography performed overnight in a sleep laboratory. Home testing is an option in certain instances.

Common risk factors include obesity, resistant hypertension, retrognathia, large neck circumference (> 17 inches in men, > 16 inches in women), and history of stroke, atrial fibrillation, nocturnal arrhythmias, heart failure, and pulmonary hypertension. Screening is also recommended for any patient who is found on physical examination to have upper-airway narrowing or who reports symptoms such as loud snoring, observed episodes of apnea, gasping or choking at night, unrefreshing sleep, morning headaches, unexplained fatigue, and excessive tiredness during the day.

The American Academy of Sleep Medicine suggests three opportunities to screen for OSA1:

  • At routine health maintenance visits
  • If the patient reports clinical symptoms of OSA
  • If the patient has risk factors.

A DISMAL STATISTIC

The prevalence of OSA in the United States is high, estimated to be 2% in women and 4% in men in the middle-aged work force,2 and even more in blacks, Asians, and older adults.3 Yet only 10% of people with OSA are diagnosed4—a dismal statistic considering the association of OSA with resistant hypertension5 and with a greater risk of stroke,6cardiovascular disease, and death.7

CONSEQUENCES OF UNTREATED OSA

Untreated OSA is associated with a number of conditions7:

  • Hypertension. OSA is one of the most common conditions associated with resistant hypertension. Patients with severe OSA and resistant hypertension who comply with continuous positive airway pressure (CPAP) treatment have significant reductions in blood pressure.
  • Coronary artery disease. OSA is twice as common in people with coronary artery disease as in those with no coronary artery disease. In patients with coronary artery disease and OSA, CPAP may reduce the rate of nonfatal and fatal cardiovascular events.
  • Heart failure. OSA is common in patients with systolic dysfunction (11% to 37%). OSA also has been detected in more than 50% of patients with heart failure with preserved systolic function. CPAP treatment can improve ejection fraction in patients with systolic dysfunction.
  • Arrythmias. Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy have been reported to be significantly more common in people with OSA.8 If the underlying cardiac conduction system is normal and there is no significant thyroid dysfunction, bradyarrhythmias and heart block may be treated effectively with CPAP.7 Treatment of OSA may decrease the incidence and severity of ventricular arrhythmias.7
  • Sudden cardiac death. OSA was independently associated with sudden cardiac death in a longitudinal study.9
  • Stroke. The Sleep Heart Health Study6 showed that OSA is 30% more common in patients who developed ischemic stroke. Long-term CPAP treatment in moderate to severe OSA and ischemic stroke is associated with a reduction in the mortality rate.10
  • Diabetes. The Sleep Heart Health Study showed that OSA is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.11

A QUESTIONNAIRE HELPS IDENTIFY WHO NEEDS TESTING

If you suspect OSA, consider administering a sleep disorder questionnaire such as the Berlin,12 the Epworth Sleepiness Scale, or the STOP-Bang questionnaire (Table 1). The STOP-Bang questionnaire is an easy-to-use tool that expands on the STOP questionnaire (snoring, tiredness, observed apnea, high blood pressure) with the addition of body mass index, age, neck size, and gender. The Berlin questionnaire has been validated in the primary care setting.12 The STOP-Bang questionnaire has been validated in preoperative settings13 but not in the primary care setting (although it has been commonly used in primary care).

WHICH TEST TO ORDER?

If the score on the questionnaire indicates a moderate or high risk of OSA, the patient should undergo objective testing with polysomnography or, in certain instances, home testing.1Polysomnography is the gold standard. Home testing costs less and is easier to arrange, but the American Academy of Sleep Medicine recommends it as an alternative to polysomnography, in conjunction with a comprehensive sleep evaluation, only in the following situations14:

  • If the patient has a high pretest probability of moderate to severe OSA
  • If immobility or critical illness makes polysomnography unfeasible
  • If direct monitoring of the response to non-CPAP treatments for sleep apnea is needed.

Home testing for OSA should not be used in the following situations:

  • If the patient has significant morbidity such as moderate to severe pulmonary disease, neuromuscular disease, or congestive heart failure
  • In evaluating a patient suspected of having comorbid sleep disorders such as central sleep apnea, periodic limb movement disorder, insomnia, parasomnias, circadian rhythm disorder, or narcolepsy
  • In screening of asymptomatic patients.

Home testing has important drawbacks. It may underestimate the severity of sleep apnea. The rate of false-negative results may be as high as 17%. If the home test was thought to be technically inadequate or the results were inconsistent with those that were expected—ie, if the patient has a high pretest probability of OSA based on risk factors or symptoms but negative results on home testing—then the patient should undergo polysomnography.14

DIAGNOSIS

The diagnosis of OSA is confirmed if the number of apnea events per hour (ie, the apnea-hypopnea index) on polysomnography or home testing is more than 15, regardless of symptoms, or more than 5 in a patient who reports OSA symptoms. An apnea-hypopnea index of 5 to 14 indicates mild OSA, 15 to 30 indicates moderate OSA, and greater than 30 indicates severe OSA.

BENEFITS OF TREATMENT

Treatment of OSA with CPAP reduces the 10-year risk of fatal and nonfatal motor vehicle accidents by 52%, the 10-year expected number of myocardial infarctions by 49%, and the 10-year risk of stroke by 31%.7 It has also been found to be cost-effective, for men and women of all ages with moderate to severe OSA.15

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About Somnas

Somnas offers state-of-the-art diagnostic options to identify specific sleep disorders and manage them using the latest treatments and therapies with an individualized treatment plan to ensure long-term optimal outcomes. Our practice is focused on helping diagnose and treat daytime sleepiness, difficulty in falling asleep or staying in sleep (insomnia), restless leg syndrome, nightmares associated with acute stress/PTSD, sleep disorder among veterans, and various other sleep disorders. 

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