Dr. Chenet is an In Network Provider for Highmark, UPMC & Medicare for Oral Sleep Apnea Appliance
 

Diagnosis of Obstructive Sleep Apnea (OSA)

A consultation, including a thorough sleep history and physical exam, is often the first step to diagnosing any sleep disorder including Obstructive Sleep Apnea.  If it is determined you need a more detailed assessment, your primary care physician may refer you for an overnight sleep study (polysomnogram). This test records the patient's brainwaves, heartbeat, respiratory effort, airflow, eye movement, blood oxygen  levels and breathing during an entire  night. Other sleep tests, such as a Multiple Sleep Latency Test (MSLT), may be performed to measure and assess the severity of daytime sleepiness, and to exclude other sleep disorders. In addition to your PCP, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders  may be involved  in making a definitive diagnosis.  Sleep apnea  is easily diagnosed  and must not be ignored.

Terminology upon Testing:

An apnea event
Defined as a cessation of ventilation (breathing) for  I 0 seconds  or longer.
Apnea Diagnosis
Occurs  when a person experiences 30 or more apnea episodes  during a seven  hour sleep  period.
Hypopnea
Occurs  when there is a partial  obstruction somewhere in the airflow.  It involves  a decrease in oxygen  levels in the blood (oxygen
desaturation-uptake of greater  than 4%).
RDI (Respiratory Disturbance Index) I AHI (Apnea-Hypopnea Index)
Average  number of apneas  plus hypopneas combined  per hour of sleep.
UARS-  Upper Airway  Resistance Syndrome
This condition  lies midway  between  benign snoring  and true Obstructive Sleep  Apnea.  People  with UARS suffer  many of the symptoms  of Obstructive Sleep  Apnea  but sleep  testing  results  lack evidence  demonstrating true apneas  or oxygen  desaturation.


Severity  of Apnea Defined  By:

  • Percentage of oxygen desaturation.
  • Complete or partial stoppage of breathing.

                - 5-20 events  per hour = Mild OSA.
                - 20-40 events  per hour=Moderate OSA.
                - 40 events per hour=Severe OSA.

NOTE: Many different factors contribute to the diagnosis  of Obstructive Sleep Apnea . The above  range is only a general  breakdown.  Oth e r parameters  such as lowest oxygen  level obtained  and length of apnea episodes  during  the sleep  testing  procedure  effect the final diagnosis  of this disorder.          .-;        .
- - -- - ---- -- --    ----- -----  --
Who is More Likely to Have Obstructive Sleep Apnea (OSA)

 

  • Being overweight- obesity  is a major  risk factor,  although  thin people can develop  severe  sleep  apnea  also. Nasal congestion  or obstruction- sinus  trouble  or allergies.
  • Large tonsils and/or adenoids, having  a "crowded throat",  a large tongue or small jaw.
  • Family history.
  • Drinking  alcohol
  • TMJ and jaw pain.
  • Bruxism (teeth grinding).
  • Lung disease,  atrial fibrillation and heart failure.
  • Scoliosis  or muscle  weakness.
  • Sedating  medicines  and alcohol.
  • Hypothyroidism and certain other endocrine (hormonal) disorders.
  • Increasing age.
  • Malformation  of the orofacial area (misaligned teeth, jaw, palate).
  • Polycystic Ovarian  Syndrome (PCOS).
  • Menopause.
  • Progesterone/Estrogen deficiency.
  • Anatomy  and physiology  of the airway.
  • Male gender.
  • Neck size> 17 inches in men, and> 15 inches in women.
  • A decrease  in tone of muscles  holding  airway  open.
  • Smoking.
     

Warning Signs for Sleep Apnea:

  • Do you snore heavily?
  • Does your snoring disturb your partner?
  • Has your partner observed you not breathing while you sleep?
  • Do you have high blood pressure?
  • Do you fall sleep at inappropriate times?
  • Are you irritable?
  • Do you wake up with a headache or sore throat?
  • Do you have acid reflux disease?
  • Do you notice a decrease in your sex drive?

If you answered yes to two or more of these questions you may be at risk for Sleep Apnea.

 

Normal Breathing

During sleep you should mainly breathe through your nose. This allows the air to be of better quality and you will actually get more oxygen, which can lead to a better and more restful night’s sleep.

What is Snoring?

Snoring is the sign of a breathing problem. It occurs when the jaw opens and the tongue falls into the back or the throat causing the airway to narrow and forcing air through the smaller opening. This creates sound vibrations in the throat known as snoring. Snoring can seriously affect your quality of life. It can be embarrassing and inconvenient, and can cause problems in relationships. In some cases, snoring is a red flag for a more serious medical problem called obstructive sleep apnea (OSA).

What is Sleep Apnea?


Sleep Apnea is when the airway is completely blocked and air is unable to flow through the airway.  This is also known as Obstructive Sleep Apnea.  The obstruction may occur from the area of the soft palate to below the base of the tongue, causing one to awaken during the night with coughing or a gasping sound, attempting to restore breathing.

Symptoms of Sleep Apnea:

  • Snoring
  • Fatigue or tiredness
  • High Blood Pressure
  • Falling asleep while reading, watching TV or driving
  • Poor Sleep
  • Morning Headaches
  • Cardiovascular disease
  • Wake from sleep coughing, choking or gasping


Disorders associated with Snoring/Sleep Apnea:

  • Diabetes
  • Mood Swings
  • Grinding of the teeth
  • Depression or anxiety
  • Gastric Reflux
  • Heart Attack/Stroke

 

How Do Oral Appliances Help?


Oral appliances are the devices worn in the mouth while sleeping that reposition the lower jaw and tongue to help open the airway.  This is accomplished by tensing the muscles that support the airway, which in turn opens or dilates the airway so air can freely move in and out without resistance or obstruction.

Advantages of these appliances:

  • Posterior support to protect the TMJs
  • Ability to manage teeth grinding
  • Freedom of jaw movement with use
  • Easily modified to accommodate dental work
  • Does not lock or hold the jaw in a set position
  • Helps keep the airway open by preventing the jaw and tongue from falling back during sleep
  • Improves nasal breathing