Sleep Apnea Diagnosis

Examination & Testing for Sleep Apnea

While many cases of sleep apnea are relatively easy to spot, all patients who suspect they have sleep apnea must take a physical exam in order to be properly diagnosed before receiving treatment. There are many methods of correctly diagnosing sleep apnea, and we are medically trained to perform or refer our patients accordingly. Please follow the links below to find out more about the different procedures and options for obtaining a medical diagnosis of sleep apnea, or contact our office with your questions.

Medical History & Pysical

ExaminationPhysical Examination

 

Important information to capture on Examination

Chief Complaint:

Chronic Fatigue, Load Snoring, Restless sleep with Frequent Awakening – what duration?

History of Present Illness: 

  1. Difficulty maintaing sleep with frequent awakenings
  2. Load snoring
  3. Witnessed apnea
  4. Early morning headaches
  5. Daytime somnolence
  6. Excessive body movements during sleep
  7. Restless Legs
  8. Previously diagnosed with Sleep Apnea
  9. Non compliance on Cpap. ( dates, DME company, compliance report helpful)

Examination:

  1. BMI
  2. Neck Size (helpful)
  3. Uvula size
  4. Mallampati Index

Medical History:

  1. Congestive Heart Failure
  2. Atrial Fibrillation
  3. Coronary Artery Disease
  4. Hypertension
  5. Stroke
  6. Obesity
  7. Diabetes

Testing:

  1. Epworth score
  2. AHI

Polysomnography (PSG)

A Polysomnography is an overnight sleep test performed in a sleep lab.   The study measures Nasal/oral airflow,  EEGEMG, EOG, Snoring, Pulse Ox, body position and EKG.  Video cameras monitor you while the test is performed.  During the night, respiratory technicians are available to assist you.  Most sleep labs offer individual sleep rooms with televisions and internet connections.  The patient generally arrives at the lab around 9 pm.  All the patient needs to bring is their sweats or bed clothing along with their toiletries.  No creams or makeup should be worn because it interferes with the leads.

Titration Study

A Titration study is performed after a patient has been diagnosed with Obstructive Sleep Apnea.  It is done to determine the correct Cpap pressure setting.  During this study you will be connected to a computerized Cpap device that is managed by the Respiratory Technician.  All the sensors used during the PSG study are utilized during this test as well.  The pressure first begins at the lowest level and then gradually increases until the airway obstruction is resolved.  Cpap can be ordered based on these settings.

Split Sleep Study

A Split Sleep Study is performed to diagnosed Obstructive Sleep Apnea.and then to determine the correct Cpap pressure setting.  During this study you will be connected to a computerized Cpap device that is managed by the Respiratory Technician.  All the sensors used during the PSG study are utilized during this test as well.  The pressure first begins at the lowest level and then gradually increases until the airway obstruction is resolved.  Cpap can be ordered based on these settings. The advantages are that only one test can provide the same the same information as the two individual tests. (CPAP & Titration study).  The disadvantage is that some patients never get into deep sleep before the titration study   Because of the reduced sleep time available for dianostic portion of the test,  the results can  sometimes underestimate the severity of condition.

Home Sleep Monitoring

Home Sleep Monitoring is done using a device that your airflow, oxygen saturation, snoring and body position.  Generally it does not include an EEG that determines the presence of sleep.  For most patients, especially the more severe ones, this test will adequately determine whether sleep apnea is present.  In patients that have additional comorbidities: cardiopulmonary issues, restless leg syndrome, or insomnia; an in lab test is preferred.

Sleep Profiler

Sleep Profiler is a device that measures your brain waves while you sleep.  It is designed to determine the quality of your sleep via sensors on the forehead.  It can describe the amount of Rem Sleep, Light Sleep, Awakenings and even levels of snoring.  It is extremely helpful in diagnosing Insomnia and Hypersomnia.

Matrix Oral Appliance Titration

The Matrix system consists of a remote controlled mouth piece that is managed by the respiratory therapist during a routine Polysomnography sleep test.  The goal of this study is to determine the most optimum jaw position that can resolve the Obstructive Sleep Apnea.  Using these measurements, the doctor can then adjust the patient’s oral appliance.

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