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esearch papersJournal ofSynchrotronRadiationISSN 0909-0495Received 8 February 2005Accepted 6 May 2005On the refinement of time-resolved diffractiondata: comparison of the random-distributionand cluster-formation models and analysis of thelight-induced increase in the atomic displacementparametersIvan I. Vorontsov and Philip Coppens*Department of Chemistry, State University of New York at Buffalo, NY 14260, USA.E-mail: coppens@buffalo.eduExpressions for the random-distribution and cluster-formation models for lightinducedchanges in crystals studied by time-resolved diffraction are presented.The two models can be distinguished on the basis of differences in the predictedintensities. The light-induced increase in the atomic displacement parameters isanalyzed with both simulated and experimental data sets.# 2005 International Union of CrystallographyPrinted in Great Britain – all rights reservedKeywords: time-resolved diffraction; pump–probe technique; random-distribution model;cluster-formation model.1. IntroductionTime-resolved (TR) diffraction studies using pump–probetechniques at synchrotron sources, in which the crystals areexcited with a laser pulse immediately prior to a probing X-raypulse, are opening a new area of importance in a broad rangeof physical sciences. The effect of laser light on molecularcrystals may involve dramatic and often macroscopic irreversiblechanges such as surface melting and reorganization(Larsson et al., 1998; Reis et al., 2001), solid-state chemicalreactions (Busse et al., 2002; Kawano et al., 2003) and phasetransitions (Nasu, 1997; Larsson et al., 2004; Collet et al., 2003;Guérin et al., 2004). Some of these phenomena cause a drasticchange in the diffraction pattern because of the growth ofdomains of a new crystalline phase. As a result the diffractionpatterns of the initial and photo-induced phases are superimposed,with Bragg spots coinciding only if the change in celldimensions is minimal. On the other hand, in many chemicalconversions, such as light-induced linkage isomerization(Fomitchev et al., 2000; Kovalevsky et al., 2002, 2003) andreversible photoexcitation (Coppens, 2003; Techert &Zachariasse, 2004; Kim et al., 2002; Armaroli, 2001; Coppens etal., 2004a; Coppens, Gerlits et al., 2004), a random distributionof the generated species occurs with preservation of theoriginal crystallographic symmetry. It is conceivable, however,that the distribution of the photoexcited species would not berandom, but that cluster formation occurs. The local disturbanceof the packing owing to excitation of a first moleculecould, for example, sensitize adjacent molecules if the disturbanceis sufficiently large. If the size of such clusters is similaror larger than the coherence length of the X-rays in the crystal,the scattering formalism will be affected.The current paper deals with the situation in which all, orthe large majority, of the ‘dark’ and ‘light-on’ diffraction peaksare superimposed. As the experiments are most sensitivewhen a change in the diffraction pattern is analyzed, thestandard structure refinement algorithms which are based onminimization of an error function defined in terms of thestructure factors F or F 2 are less suitable in time-resolved dataanalysis and new approaches must be developed. We describehere the generalization of earlier equations (Ozawa et al.,1998), incorporated in the program LASER by Ozawa (Ozawaet al., 1998) and by Pillet (Kim et al., 2002), to include both therandom-distribution and cluster-formation models and thepossibility of distinguishing between the two models. Therelative effect of the photo-induced disorder in the randomdistributionmodel and the temperature increase during illuminationare also discussed.2. Response ratios as observables in the refinementprocedureIn the TR experiment data are collected both during laser-onand under dark conditions. The time resolution is limited bythe width of the exciting laser pulse, the width of the probingX-ray pulse and the ability of the X-ray shutter to select one ormore X-ray pulses from the stream provided by the lightsource. When the transient state rapidly reverts to the groundstate a stroboscopic method can be used in which the excitinglaser pulses are repeated thousands of times per second as theframe of data is being collected and the X-ray probe pulses aresynchronized with the excitations (Kim et al., 2002; Coppens etal., 2005). The response ratio (hkl) is defined as the fractional488 doi:10.1107/S0909049505014561 J. Synchrotron Rad. (2005). 12, 488–493electronic reprint

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveSleep Disordered Breathing: Definition• Obstructive Sleep Apnea (OSA)– Sleep related blockage or collapse of upper airway leading toabsence of airflow associated with rib cage and abdominalexcursions• Central Sleep Apnea (CSA)– Sleep related cessation of breathing due to reduced neural outputfrom central nervous system respiratory control centers

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not havePrevalence of Sleep Disordered Breathing inCardiovascular Disease• 30% of hypertensive patients– 83% of refractory hypertension• Logan et al, J Hypertension 2001• 50% of heart failure patients– Javaheri, Circulation 1998• 40% pts with systolic HF• 50% pts with diastolic HF• 30% of cardiac disease patients– Schafer et al, Cardiology 1999

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image mayhave been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have todelete the image and then insert it again.Types of DiabetesType 2 Diabetes• Previously called non-insulin dependent diabetesmellitus or adult-onset diabetes• Accounts for 90-95% of all diagnosed cases ofdiabetes• Usually begins as insulin resistance, a disorder inwhich the cells do not use insulin properly• As the need for insulin rises, the pancreas graduallyloses its ability to produce it• Associated with older age, obesity, family history ofdiabetes, history of gestational diabetes, impairedglucose metabolism, physical inactivity, and race/ethnicity

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveAssociation Between Diabetes and OSA• A study by Reichmuth was done to investigate the prevalence andincidence of type 2 diabetes in subjects with SDB• Cross sectional, longitudinal analysis of 1387 patients from theWisconsin Sleep Cohort with confirmed SDB and type 2 diabetes• 14.7% of subjects with an AHI> 15 had a diagnosis of diabetescompared with 2.8% of subjects with an AHI < 5The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. Ifthe red x still appears, you may have to delete the image and then insert it again.♦Arzt Reichmuth et al, AJRCCM;172:1590-1595, 2005

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveGoals of PAP Titration with OSA PatientThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have beencorrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image andthen insert it again.• Eliminate apnea• Eliminate hypopneas• Eliminate desaturations• Eliminate RERAs• Eliminate UARSThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have beencorrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image andthen insert it again.• HOW?– Through PAP therapy

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe Impact of Untreated OSA onCardiovascular SystemThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveCardiovascular mortality and morbidity in OSA• Marin, et al LANCET 2005• Study of 1651 Men, over 10 years– 264 Normal (control group)– 377 Snorers (AHI 30 or AHI> 5 withEDS)– 372 Severe OSA with CPAP Treatment OSA (AHI > 30,CPAP > 4hrs/day)• CPAP compliance objectively measured• Study Fatal and Non-Fatal Cardiac EventsMarin, JM et. al Lancet 2005: 365:1046 - 1053

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveOutcomes of Study• Patients with severe OSA that was left untreated had asignificant increase in CV events (both fatal or non-fatal events)after 10 years– Risk factor: 2.87 higher than norms• Patients with severe OSA had a significant reduction in CVevents when treated with CPAP– Patients who used CPAP > 4 hours per night had a drop inCV riskMarin, JM et. al Lancet 2005: 365:1046 - 1053

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveTreatment of OSA with CPAP• 60 patients with moderate to severe OSA randomized to receive therapeutic or subtherapeuticCPAP for 9 weeks• 16 patients in each group completed the study– An equal amount of patients (14) dropped out of either group for similar reasons– Patients were dropped from study if their medications changed• A total of 15 patients were on anti-hypertensive meds– 8 were on 2 or more meds• Therapeutic CPAP titrated to reduce AHIs by 95%– average pressure 9 cm H 2 0– average compliance 5.5 hrs• Sub-therapeutic group received 3-4 cm H 2 0 sham CPAP– average compliance 5.4 hrsBecker FH., et al., Circulation 2002; 107: 68-73

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveResults:• CPAP group: Approximate 10mmHg drop in mean blood pressure– predicts a 37% reduction in risk for CHD– 56% reduction in risk for stroke• No relevant change in blood pressure occurred with sub-therapeuticCPAPThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x stillappears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveTreatment of OSA & Refractory HTN• 16 of 19 refractory HTN patients had underlying OSA• 11 patients participated in CPAP trial• CPAP titrated to approx. 9 cm H 2 0• Blood pressure and baroreflex sensitivity were studiedon and off CPAP• 24-hour blood pressure was evaluated at baseline andafter 2 months of CPAP therapyLogan AG., et al., Eur Respir J 2003; 21: 241-247

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveResult: Treatment of OSA & Refractory HTNAfter 2 monthsChronic CPAPBaseline24 hour BP sys(mmHg) 147.2±3.3Daytime BP sys (mmHg) 149.9±3.4Night-time BP sys (mmHg) 137.9±4.2ChronicCPAPp value136.2 ±3.8

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveTreatment of OSA and Benefit Atrial Fibrillation• Study included 488 patients from CardiacClinicThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restartyour computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.• Untreated OSA doubled the risk ofrecurrence of atrial fibrillation• Authors suggest patients with AF should bescreened for OSAThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer,and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.Gami et al., Circulation 2004;110:364-367

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveStudies that Evaluate Treatmentof OSA in Patients with DiabetesThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to deletethe image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveAssociation Between Diabetes and OSABackground Data• Observational study of 25 patients with stable OSA and Type IIdiabetes• Evaluated hemoglobin and blood glucose levels for 72 hours beforetreatment of OSA with CPAP and after 90 days of CPAP treatmentfor OSA• Segmented patients’ CPAP compliance > 4 hours per night < 4 hours per nightBabu,A, Herdegen, J., et al. Arch. Intern. Med. 2005: 165:447-452

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveAssociation Between Diabetes and OSAThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the redx still appears, you may have to delete the image and then insert it again.Babu,A, Herdegen, J., et al. Arch. Intern. Med. 2005: 165:447-452

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveAssociation Between Diabetes and OSAThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.Babu,A, Herdegen, J., et al. Arch. Intern. Med. 2005: 165:447-452

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveAssociation Between Diabetes and OSA• Dose response observed between CPAP treatment for OSA andglucose control CPAP compliance (> 4 hours) better control of glucose levelsand less number of days with elevated glucose levels HbA1c reduction seen with CPAP treatment of OSA may slowthe development of vascular, circulatory and neurologicalconsequences of diabetes• The study results demonstrate the importance to diabetic OSApatients of effectively treating their OSA. Effective treatment of OSAwith CPAP is associated with metabolic improvement in OSApatients with Type II diabetes.• Findings suggest that SDB is causally related to impaired glucosehomeostasis.Babu,A, Herdegen, J., et al. Arch. Intern. Med. 2005: 165:447-452

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have beencorrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and theninsert it again.How Can You Use This Information?What role do you play?

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveSDB Impact on the Cardiovascular System• Both OSA & CSA occur commonly in patients withcardiovascular disease and HF and may contribute todisease progression.• May also impede effects of other recommended StandardMedical Management techniques.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveDevelop Effective Screening StrategyIdeal:1. According to International Diabetes Federation,health professionals working in both type II diabetesand SDB adopt clinical practices to ensure that apatient presenting with one condition is considered forthe other 12. According to JNC-7, all patients with newly-diagnosedHTN or refractory HTN should be screened for sleepapnea 21Shaw, JE et al., Diabetes Research and Clinical Practice 2008; 2-122Chobanian, AV et al., J Hypertens 2003; 42: 1206-1252

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveHallmark OSA Signs and Symptoms• Excessive daytimesleepiness (EDS)unexplained by other factorswith• Loud disruptive snoringor• Nocturnal choking/gasping/snortingor• Nocturnal pauses inbreathingThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the fileagain. If the red x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveAdditional Signs/Symptoms of OSA• Recurrent nocturnalawakenings• Un-refreshing sleep• Daytime fatigue• Impaired concentration/memory loss• Mood/behavioral changes• Morning headaches• Loss of sexual interestThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the fileagain. If the red x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveRisk Factors for OSA• HTN - Refractory HTN– increased healthcareutilization• Ethnicity• Family history OSA• Body Mass Index (BMI) > 30• Large neck circumference• Physical characteristics– crowded airway– facial characteristicsThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and thenopen the file again. If the red x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveStandard Questions to Ask All Patients?The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have beencorrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and theninsert it again.• Do you snore?• Have you been told you quitbreathing or pause your breathingduring sleep?• Do you awake from sleepchoking, snorting or gasping forbreath?• Take into consideration HTN, BMI• If needed, ask about otherphysical characteristics, signs andsymptoms

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveMethods of Screening for OSA• Epworth Sleepiness Scale– 8 questions answered on a scale of 0 – 3• 0 = would never doze• 3 = high chance of dozing– Score > 10 represents daytime sleepiness• Epworth Sleepiness Scale does not identify cause of sleepiness– May include sleep apnea, but also insomnia, lack of time to sleep, etc.• Patient with sleep apnea may have normal value

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveEpworth Sleepiness ScaleUse the following scale to choose the most appropriate number for each situation:0 = would never doze1 = slight chance of dozing2 = moderate chance of dozing3 = high chance of dozingIt is important that you choose a number (0 – 3) for each of the situations listed below.Situation Chance of Dozing (0 – 3)Sitting and Reading 0 - 1 - 2 - 3Watching television 0 - 1 - 2 - 3Sitting, inactive in a public place, for example, a theater or meeting 0 - 1 - 2 - 3As a passenger in a car for an hour without a break 0 - 1 - 2 - 3Lying down to rest in the afternoon when circumstances permit 0 - 1 - 2 - 3Sitting and talking to someone 0 - 1 - 2 - 3Sitting quietly after lunch without alcohol 0 - 1 - 2 - 3In a car, while stopped for a few minutes in traffic 0 - 1 - 2 - 3Total ScoreThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe Berlin QuestionnaireThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart yourcomputer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.• Simple, self-administeredpatient questionnaire• Asks patients to report theirsymptoms• Questionnaire is specific toOSA• Identifies patient at high riskfor OSA who is likely to benefitfrom diagnosis

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe Berlin QuestionnaireThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.• Uses 10 questions to assess:• Presence & frequency ofsnoring behavior• Wake-time sleepiness orfatigue• History of HTN &/orobesity• Persistent or frequent symptomsin 2 of 3 categories indicates ahigh likelihood of OSA

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveFollow-UpThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If thered x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveEnsure Patients Receive Effective Therapy• Look for– Acceptance– Tolerance– Response• Enhance patient education• Proactive in addressingnon-tolerance and nonresponseThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart yourcomputer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveDemonstrate Outcomes with EffectiveTherapy• Provide documentation of benefits of effectivetherapy– Usage patterns– Functional Outcomes of Sleep Questionnaire– Clinical assessment during follow up

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.Patterns of UsageFOSQ TrendPrescription Zone

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.Encore ReportPatterns of UsageFOSQ TrendPrescription Zone

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed.Your computer may not haveSummary• Understand link between OSA and co-morbidconditions, such as CVD and type II diabetes• Apply this knowledge to help your patients:– improve medical management of patients whosuffer from OSA and co-morbid conditions• Work together to increase screening, diagnosis andtreatment of OSA

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed. Your computer may not have enough memoryto open the image, or the image may have been corrupted. Restart yourcomputer, and then open the file again. If the red x still appears, you may haveto delete the image and then insert it again.