2017 CSS Conference
 

Primary Care Education Course

Accreditation

College of Family Physicians of Canada

This program has been certified by the College of Family Physicians of Canada and the Alberta office for up to 6.25 Group Learning credits.

Royal College of Physicians and Surgeons of Canada – Section 1:

This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada, and accredited by the University of Calgary Office of Continuing Medical Education and Professional Development. Participants can claim up to a maximum of 6.25 study credits.”

Primary Care Course - Schedule at a Glance
28/04/2017
8:00 am - 4:00 pmPrimary Care Education Course
8:01 am - 8:05 amIntroduction and Greetings
8:05 am - 8:30 amInsomnia Guidelines
8:30 am - 9:10 amEpidemiology and Burden of Insomnia
9:10 am - 10:00 amDiagnosis and Treatment of Insomnia
10:00 am - 10:20 amHealth Break & Exhibits Open
10:20 am - 10:45 amPrimary Care CBT for Insomnia
10:45 am - 11:00 amPanel Discussion
11:00 am - 11:50 amDiagnosis and Treatment of Obstructive Sleep Apnea
11:50 am - 12:30 pmCardiovascular Consequences of Obstructive Sleep Apnea
12:30 pm - 12:40 pmPanel Discussion
12:40 pm - 1:40 pmLunch & Exhibits Open
1:40 pm - 2:20 pmSleepiness and Society
2:20 pm - 2:50 pmPediatric Obstructive Sleep Apnea
2:50 pm - 3:10 pmHealth Break & Exhibits Open
3:10 pm - 3:30 pmPediatric Insomnia
3:30 pm - 3:50 pmWorkshop on Adolescent Delayed Sleep-Wake Phase Disorder (DSPD)
3:50 pm - 4:00 pmPanel Discussion
Primary Care Education Course
Friday, April 28, 2017
7:00 amRegistration Open
8:00 am - 4:00 pmPrimary Care Education Course
This is a one-day continuing medical education event for family physicians, pediatricians, psychologists and allied medical professionals that aims to address their education needs in terms of the evaluation, diagnosis and management of sleep. 

Chronic insomnia is very prevalent in the community and will be reviewed from both an adult and pediatric perspective. The latest TOP Insomnia Guidelines will be introduced along with cutting-edge treatment considerations and consequences of untreated insomnia. The prevalence of obstructive sleep apnea in the community is increasing and the impact on quality of life and its interaction with other medical and psychiatric disorders are well known. The local best practices on diagnosing obstructive sleep apnea and treating it from a personalized sleep medicine perspective with all modalities including CPAP, Dental Appliance and Surgery will be reviewed. The relationship of obstructive sleep apnea and cardiovascular disease will be discussed including the latest interventional SAVE study that challenges some of these concepts. An update on obstructive sleep apnea in pediatrics is welcomed as the prevalence of childhood obesity makes this on ongoing health issue. The sleepy teen will be also be tackled by the program understanding the prevalence, pathophysiology and clinical implications of delayed sleep phase in teens. The issue of sleepiness in society and its impact will be expertly reviewed in the context of long work hours, a 24/7 society, insufficient sleep and sleep disorders.

Program Learning Objectives:
  1. To be able to be able to diagnose and treat patients presenting with the complaint of insomnia in the context of the potential consequences of the condition and  to utilize tools that may be available in a primary care clinic or through collaboration with specialists in the community.
  2. To be able to effectively communicate the importance and the proper conduct of a cognitive behavioral therapy program for insomnia.
  3. To understand the significance of insufficient sleep in the community and to advocate for proper sleep behaviors and for patients to seek management of excessive daytime sleepiness.
  4. To understand the conditions of hypersomnolence and their potential consequences and to manage the diagnosis and treatment of the causative conditions.
  5. To understand the consequences of sleep disordered breathing in the adult and pediatric populations and the proper diagnosis and management of these conditions.
  6. To be able to identify and treat the causes of insomnia in childhood including primary insomnia and circadian rhythm disorders.

Sponsored by   

8:00 am - 8:05 amIntroduction and Greetings
Robert Cohen M.D., CCFP, Somnologist (European Sleep Research Society), Sleep Physician, Centre for Sleep & Human Performance
8:05 am - 8:30 amInsomnia Guidelines
Charles Samuels M.D., CCFP, DABSM, Medical Director, Centre for Sleep & Human Performance
The Alberta Medical Association Toward Optimized Practice (AMA TOP) Insomnia Clinical Practice Guidelines are the only formal guideline designed for Primary Care Practitioners in Canada and form the basis of what will be a national clinical practice guideline for the diagnosis and management of insomnia. The guideline update began in 2014 and was released in early 2016 and was a collaborative effort including experts in various areas of insomnia diagnosis and management from across the country. Dr. Samuels has chaired the project from the beginning in 2006/2007 and will give a practical presentation on how to implement the guideline into a busy primary care practice and adapt the guideline to various primary care practitioner settings.

Learning Objectives
  1. Be able to apply the TOP guidelines for patients with insomnia.
  2. Implement a behavioral and pharmacological strategy for insomnia based on the guidelines.

8:30 am - 9:10 amEpidemiology and Burden of Insomnia
Charles M. Morin PhD, Canada Research Chair in Behavioural Sleep Medicine, Université Laval
Chronic insomnia is a prevalent health complaint that carries significant burden for the individual and society. This presentation will summarize the evidence about the long-term consequences of insomnia on quality of life, risks for depression and hypertension, and its impact on disability and absenteeism from work, and on health care costs. 

Learning Objectives: 
  1. To learn about the natural history and prognosis of insomnia 
  2. To identify long-term consequences associated with persistent insomnia
9:10 am - 10:00 amDiagnosis and Treatment of Insomnia
Atul Khullar MD MSc FRCPC (Psychiatry) DABPN (Cert. Sleep Medicine), Medical Director, Northern Alberta Sleep Clinic
The session will review the concept of insomnia as a problem that needs significant attention to multiple parts of the patient's health. Diagnosis and treatment will be reviewed with a strong focus on co-morbidities and how they influence the management plan. Effective utilization of the limited resources in Canada will also be discussed.

Learning Objectives:

  1. Overview of Insomnia management and available therapeutic options
  2. Review the DSM-V changes in the paradigm of insomnia
  3. Review of resources of management for insomnia in Canada


10:00 am - 10:20 amHealth Break & Exhibits Open
10:20 am - 10:45 amPrimary Care CBT for Insomnia
Speaker: Tammy Moroz PhD, CBSM, Sleep Psychologist, FMC Sleep Centre

This session will provide an overview of Cognitive Behavioral Therapy for insomnia (CBT-I), a structured program that helps identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sedative medication, CBT-I addresses the underlying causes of sleep problems. It is recommended as an initial intervention in sleep guidelines and is effective in the treatment of chronic primary and comorbid insomnia, including with older adults and chronic hypnotic users. 

Learning Objectives

  1. Identify the cognitive strategies of CBT-I that recognize and change beliefs that affect the ability to sleep.
  2. Identify the behavioural strategies of CBT-I that modify sleep behaviors to promote consolidated sleep including, stimulus control and sleep restriction.
  3. Identify the relative benefits of CBT-I relative to hypnotic medication.

 

10:45 am - 11:00 amPanel Discussion
Charles Samuels M.D., CCFP, DABSM, Medical Director, Centre for Sleep & Human Performance
Charles M. Morin PhD, Canada Research Chair in Behavioural Sleep Medicine, Université Laval
Atul Khullar MD MSc FRCPC (Psychiatry) DABPN (Cert. Sleep Medicine), Medical Director, Northern Alberta Sleep Clinic
Speaker: Tammy Moroz PhD, CBSM, Sleep Psychologist, FMC Sleep Centre
11:00 am - 11:50 amDiagnosis and Treatment of Obstructive Sleep Apnea
Jerome W. Alonso MD, Medical Director, Canadian Sleep Consultants
Robert Cohen M.D., CCFP, Somnologist (European Sleep Research Society), Sleep Physician, Centre for Sleep & Human Performance

Obstructive Sleep Apnea (OSA) is a very common sleep disorder that can disturb sleep with daytime consequences of sleepiness, fatigue and neurocognitive symptoms. Mood, weight, cardio-metabolic heath, drowsy driving risk and overall quality of life can be impacted by untreated OSA. There is ambulatory and lab based sleep testing available to diagnose OSA with benefits and limitations that should be decided upon after identifying a patient’s pre-test probability for OSA, available resources  and goals of testing  made in the context of known comorbid sleep disorders and medical disorders. The gold standard treatment for OSA remains CPAP therapy. The other treatment options for OSA are dental appliance therapy and surgical management. The treatment of OSA should be individualized to try and best meet the goals of the patient from both health and symptomatic perspectives. 

Learning Objectives:

  1. To be familiar with the prevalence, clinical presentation, anatomical predispositions  and consequences of Obstructive Sleep Apnea (OSA)
  2. To be able to best diagnose OSA with taking into account the pre-test probability, available resources , comorbid sleep and medical disorders and goals of investigation for the patient
  3. To be able to understand the treatment options for OSA including CPAP therapy, dental appliance and surgical management, and best practices of using these treatments in an individualized manner to meet the patient’s goals.

11:50 am - 12:30 pmCardiovascular Consequences of Obstructive Sleep Apnea
Sachin R. Pendharkar MD FRCPC, Associate Professor, University of Calgary

Obstructive sleep apnea (OSA) is a common chronic medical condition characterized by intermittent airway obstruction, sleep disruption and sympathetic activation. OSA has been associated with a number of risk factors for cardiovascular disease as well as adverse cardiovascular outcomes. In this session, the pathophysiologic and epidemiologic basis for these associations will be reviewed. Furthermore, the role of OSA treatment, including recent controversies arising from large randomized trials, will be discussed.

Learning Objectives:

At the end of the this session, the participant will be able to:

  1. Describe the pathophysiology of obstructive sleep apnea (OSA) and how it may contribute to the development of cardiovascular disease.
  2. Describe the epidemiology of cardiovascular risk factors in patients with OSA and associated clinical outcomes.
  3. Discuss the potential benefit of OSA treatment on cardiovascular risk, including current clinical controversies.
12:30 pm - 12:40 pmPanel Discussion
Jerome W. Alonso MD, Medical Director, Canadian Sleep Consultants
Robert Cohen M.D., CCFP, Somnologist (European Sleep Research Society), Sleep Physician, Centre for Sleep & Human Performance
Sachin R. Pendharkar MD FRCPC, Associate Professor, University of Calgary
12:40 pm - 1:40 pmLunch & Exhibits Open
1:40 pm - 2:20 pmSleepiness and Society
Allan I. Pack M.B.Ch.B., Ph.D., FRCP, John Miclot Professor of Medicine. Director, Center for Sleep and Circadian Neurobiology, Chief, Division of Sleep Medicine Perelman School of Medicine at the University of Pennsylvania

Sleepiness is common in our society.  There are multiple causes for this.  These include chronic insufficient sleep and sleep disorders which are very prevalent.  Inadequate sleep leads to multiple adverse consequences, some of which are behavioral, e.g., increased risk of crashes, but others are cardiometabolic.

This presentation will review the basic biology of sleep and circadian rhythm and discuss different types of insufficient sleep.  The consequences of these will be described.  The role of the common disorder—obstructive sleep apnea—will also be discussed.

Sleepiness can be dealt with by a change in public policy—the Sleep Revolution—described by Adriana Huffington.

The overall objectives are as follows:

  1. To explain the mechanism of sleep/circadian biology and relevance to sleepiness in our society.
  2. To describe different types of sleep deprivation, causes and consequences.
  3. To familiarize the audience about obstructive sleep apnea—risk factors, diagnosis and treatment, and consequences.
  4. To discuss public policy initiatives to address the issue of sleepiness in our society.

2:20 pm - 2:50 pmPediatric Obstructive Sleep Apnea
Joanna E. MacLean MD, PhD, FRCPC, Assistant Professor, University of Alberta; Stollery Children’s Hospital
Pediatric obstructive sleep apnea is a common sleep disorder affecting 3% of children. In addition to disrupting sleep, pediatric obstructive sleep apnea leads to difficulties with attention and learning, metabolic disturbance, and increased risk for hypertension. For children with obstructive sleep apnea in Canada, there continues to be variable access to appropriate diagnostic testing and often long wait times for adenotonsillectomy, one of the mainstays of treatment. 

At the end of this session, participants will be able to: 
  1. Understand the current epidemiology and important contributing factor for pediatric obstructive sleep apnea; 
  2. Evaluate options for the assessment of pediatric obstructive sleep apnea and determine when referral to sleep specialists is needed; and 
  3. Assess treatment options for pediatric obstructive sleep apnea.
2:50 pm - 3:10 pmHealth Break & Exhibits Open
3:10 pm - 3:30 pmPediatric Insomnia
Adetayo Adeleye MD, MSc, FRCPC., Clinical Lecturer, Alberta Children’s Hospital; University of Calgary.
Pediatric insomnia, most often expressed as bedtime resistance and or night time awakenings is common in toddlers and preschool children. These same behaviors may persist into school age when appropriate limits which emphasize sleep as a priority are not in place.

Following this presentation, participants will be able to:
  1. Identify some of the common causes of pediatric insomnia.
  2. Understand management strategies that promote sleep for the child and family. 
  3. Recognize risk factors that should prompt further evaluation.
3:30 pm - 3:50 pmWorkshop on Adolescent Delayed Sleep-Wake Phase Disorder (DSPD)
W. Joseph Askin M.D., F.C.F.P., Somnologist (European Sleep Research Society), Sleep Physician, Centre for Sleep and Human Performance
Following a case presentation, participants will be able to: 
  1. Discuss the “two-process model” of homeostatic and circadian regulation of sleep and wakefulness. 
  2. Outline the diagnostic criteria for and proposed pathophysiology of DSPD 
  3. Recommend various management options to patients with DSPD
3:50 pm - 4:00 pmPanel Discussion
Joanna E. MacLean MD, PhD, FRCPC, Assistant Professor, University of Alberta; Stollery Children’s Hospital
Adetayo Adeleye MD, MSc, FRCPC., Clinical Lecturer, Alberta Children’s Hospital; University of Calgary.
W. Joseph Askin M.D., F.C.F.P., Somnologist (European Sleep Research Society), Sleep Physician, Centre for Sleep and Human Performance