David B. Rosen, D.M.D.- Practice Limited to Periodontics & Dental Implants
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David B. Rosen, D.M.D.- Practice Limited to Periodontics & Dental Implants
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Diagnosing Sleep Apnea For many sleep apnea patients, their spouses are the first ones to suspect that something is wrong, usually from their heavy snoring and apparent struggle to breathe. Coworkers or friends of the sleep apnea victim may notice that the individual falls asleep during the day at inappropriate times (such as while driving a car, working, or talking). The patient often does not know he or she has a problem and may not believe it when told. It is important that the person see a doctor for evaluation of the sleep problem. In addition to the primary care physician, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. Several tests are available for evaluating a person for sleep apnea.Diagnostic tests usually are performed in a sleep center, but new technology may allow some sleep studies to be conducted in the patient's home. Sleep apnea is easily diagnosed and must not be ignored. Untreated, sleep apnea can have significant consequences, such as high blood pressure and heart attacks, memory problems, irritability, and depressed mood. Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues. Patients with the typical features of sleep apnea, such as loud snoring,
obesity, and excessive daytime sleepiness, should be referred to a specialized
sleep center that can perform a test called polysomnography. This test records
the patient’s brain waves, heartbeat, and breathing during an entire night. If
sleep apnea is diagnosed, several treatments are
available. Mild sleep apnea frequently can be overcome through weight loss or by
preventing the person from sleeping on his or her back. Other people may need
special devices or surgery to correct the obstruction. People with sleep apnea
should never take sedatives or sleeping pills, which can prevent them from
awakening enough to breathe. Diagnosing patients suspected of or diagnosed with Obstructive Sleep Apnea can involve tests to establish or support a diagnosis of Obstructive Sleep Apnea. These tests measure, relative to a standard, a PSG-derived apnea index (AI, the number of apneic episodes/hour sleep); apnea-hypopnea index (AHI, the total apneas plus hypopneas during total time asleep, divided by the number of hours asleep); or respiratory distress index (RDI)Tests may include sleep monitoring devices, radiologic imaging, laboratory assays, and clinical signs and symptoms used in screening or diagnosing Obstructive Sleep Apnea. The standard sleep lab polysomnogram (PSG) is the gold standard. The best available evidence from the literature suggests the diagnosis of Obstructive Sleep Apnea is still best accomplished with full PSG. Progress has been made in establishing reasonable sensitivity and specificity of tests other than full PSG, and future researchers should focus on building this evidence base. Standardization of terms and diagnostic criteria is an absolute requirement to expedite development and enhance the utility of this literature in the future. Causes for Sleep Apnea Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. In some people, apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether. Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes it to be narrowed. With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea. |
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