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How To Screen For Sleep Apnea

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Clinical Assessment In Professional Drivers

âï¸? How To Lose Weight With Sleep Apnea – Treatment First! Then Weight Loss.

Required driver medical examinations are commonly performed by occupational/environmental practitioners and screening for OSA should be a common consideration as part of the examination. We propose that clinical evaluation of OSA and its symptoms should begin with early recognition, mainly based on patient report or physician questions about symptoms, risk factors and associated comorbidities. Information given by the patient should, when possible, be supplemented by a bed partner, family member or roommate who may have a different insight into the patient’s sleep behaviour or daytime mood and cognitive functioning. Typical symptoms associated with the condition include snoring, witnessed apnoeas, gasping or choking for air at night, excessive daytime sleepiness, impaired cognition and mood changes . Nocturnal symptoms are generally reported by the bed partner. Snoring is the cardinal one and may be so disruptive that the bed partner can be driven to sleep in another room. An absence of snoring does not exclude OSA diagnosis, but virtually all patients snore. A bed partner may also report a witnessed apnoea that is followed by loud snoring or gasping at the end of the apnoeic episode and this usually serves as the trigger for seeking medical attention.

Common symptoms of OSA

A proposed clinical care pathway of OSA diagnosis in professional drivers.

Other Tests For Sleep Apnea

  • EEG to measure and record brain wave activity
  • EMG to record muscle activity such as face twitches, teeth grinding, and leg movements, and to look for REM stage sleep. During REM sleep, intense dreams often happen as the brain has heightened activity.
  • EOG to record eye movements. These movements are important in determining the different sleep stages, particularly REM stage sleep.
  • EKG to record heart rate and rhythm
  • Nasal airflow sensor to record airflow
  • Snore microphone to record snoring activity

Identifying And Evaluating Tools For Clinical Screening Of Osa

The TF identified screening tools based on the work already published in the AASM’s Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea by evaluating whether the tools that were initially reviewed for the diagnosis of OSA in the publication could be used for OSA screening and the USPSTF’s review, Screening for Obstructive Sleep Apnea in Adults. For a list of identified tools see in the supplemental material. The TF evaluated whether the screening tools were used in the appropriate target populations , validated among the target OSA patient populations , and functional in a clinical setting .

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Signs And Symptoms Of Sleep Apnea

Family members or bed partners often pick up on the signs of sleep apnea first. Many people with sleep apnea don’t know they’re snoring and gasping for breath at night. If you have any of the following signs, see your doctor:

  • daytime sleepiness
  • loud snoring followed by silent pauses
  • gasping or choking during sleep
  • morning headache
  • poor concentration or memory loss
  • lowered sex drive

Snoring by itself doesn’t necessarily mean that you have sleep apnea. It is true that loud snoring is common in people with this disorder, but there’s a big difference between simple snoring and sleep apnea.

Untreated sleep apnea can cause serious health problems. If it’s not treated, sleep apnea can lead to:

  • high blood pressure
  • work-related injuries

How To Treat Obstructive Sleep Apnea

Asian boy wearing Sleep Apnea Diagnostic medical device ...

Sleep apnea is a serious sleep disorder that needs to be treated. Your medical provider or a sleep doctor can help you select a treatment plan that is right for you. Depending on the treatment, she may work in collaboration with other members of the sleep team, including dentists, psychologists, physician assistants, nurses and technologists. Your plan may include any combination of these treatments:

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The Emergence Of Dental Sleep Medicine To Treat Osa

Maxillomandibular advancement devices and other forms of oral appliance therapy have been recently accepted as first-line treatments for sleep apnea, as well as upper airway resistance syndrome and chronic snoring.

The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine made joint recommendations last year showing support for OAT approaches. Oral appliances has been shown to be just as effective as continuous positive airway pressure therapy in treating sleep apnea and leading to healthy patient outcomes.

Dental patients also stand to benefit from having this assessment from an oral health perspective, which is good news for dentists; sleep apnea is also commonly associated with the following dental concerns:

  • bruxism

  • periodontal disease

  • TMJ dysfunction

  • pediatric orthodontics

Practitioners of dental sleep medicine now find themselves a critical point along a patients continuum of care. It simply makes sense from the perspectives of dentists, patients, and public health advocates that OSA become a regular part of the dental screening process at every visit.

What Are Symptoms Of Obstructive Sleep Apnea

The most common symptom of sleep apnea is snoring. However, not everyone who snores has sleep apnea. Snoring is likely to be a sign of sleep apnea when it is followed by silent breathing pauses and choking or gasping sounds. People with sleep apnea often have daytime sleepiness or fatigue.

Common symptoms of sleep apnea include:

  • Loud or frequent snoring
  • Irritability

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Obstructive Sleep Apnea Symptoms

The most obvious and common sign sleep apnea is loud snoring, however not everyone who snores has sleep apnea. People who have sleep apnea often experience extremely loud snoring which is followed by long periods of deafening silence when breathing stops.

Other signs and symptoms that may occur during the day or overnight include:

  • Excessive sleepiness during the day, leading to difficulty focusing and concentrating
  • Waking up in the middle of the night short of breath
  • Breathing cessation throughout the night, which is usually observed by someone else
  • Dry mouth and sore throat in the morning
  • Chest pain upon waking up
  • Morning headaches
  • Mood instability including frequent bouts of depression, anxiety, or excessive irritability
  • Insomnia, problems staying asleep, and/or restless sleep
  • Hypertension

Typically, adults and children will differ in symptoms. For example, the hallmark of obstructive sleep apnea in adults is excessive daytime sleepiness, to the point where the individual may fall asleep for short periods of time throughout regular daily activities.

Obstructive sleep apnea symptoms can be present for years without the person knowing they have the disorder. Many people will experience issues for only a short period of time, with symptoms disappearing after weight loss, surgery, or other lifestyle changes. Symptoms may also be the result of a respiratory infection, congestion, throat swelling, etc.

Functionality Of Outcome Assessment Tools

Easy At-Home Test To Diagnose Sleep Apnea

Most of the assessment tools were not associated with a known cost . The tools were available predominantly through face-to-face, paper, and electronic platforms. All the tools have the capability for manual scoring, and most tools have electronic scoring options. Most of the tools did not require completion by providers, caregivers, and staff, which allowed for full patient-report administration. Flesch-Kincaid readability for the tools ranged from second to eleventh grade, and reported duration of completion ranged from 1 minute to 10 minutes.

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Use Of Common Sleep Apnea Assessment Tools:

  • The Epworth Sleepiness Scale. This subjective questionnaire is short and simple, but can reveal how sleepy a patient is and can reliably identify those who may be at risk for sleep apnea
  • STOP-Bang. This is another quick and reliable assessment instrument that helps to identify patients who are more likely to have sleep apnea
  • GASP. This is Sound Sleep Healths own sleepiness assessment tool, a questionnaire the patient fills out to determine their risk factors for sleep breathing disorders

How To Get Rid Of Sleep Apnea

If youve been diagnosed with sleep apnea or even suspect you may have it, you probably know that its important to have it treated before it leads to other, more serious health conditions. The good news is that most cases of sleep apnea can be easily treated. The even better news is that many cases of obstructive sleep apnea can be completely cured. If you arent sure how to get rid of sleep apnea, dont stress because we have provided information on how to cure sleep apnea, as well as sleep apnea treatments without CPAP equipment.

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How Dentists Can Help Identify Undiagnosed Osa

Dental practitioners are in an excellent position to screen for sleep apnea to help identify these undiagnosed OSA patients. They:

  • have direct observational access to the physiological structures of their patients upper airways

  • are already screening chair side for other health conditions that can be easily spotted during a dental visit

  • may see these patients more frequently than primary care physicians will, with nearly one quarter more likely to see a dentist than a doctor over any given time period

A recent study followed dental hygienists in a community-based practice to see if OSA screening could yield reliable indicators for referrals.

Patients were assessed using the STOP-Bang questionnaire . They were also given an overnight pulse oximeter to take home to record trends in nocturnal blood oxygen saturation.

The study revealed that more than half of the patients assessed were found to be athigh risk for having OSA. Followups with sleep specialists further confirmed the accuracy of these findings.When referred to a sleep specialist, a third of the most high-risk candidates followed through on a consultation.

As with screenings for oral cancer and hypertension, OSA screenings can be simple, inexpensive, and shouldnt add much more time to the patients visit to the dentist. Dentists and patients alike stand to gain from OSA screening, especially with dental-related treatments for sleep breathing disorders gaining ground.

Identifying And Evaluating Tools For Clinical Outcome Assessment Of Osa

How to test for sleep apnea at home

To identify OSA outcome assessment tools, the TF conducted a PubMed literature search for studies published between January 2010 and December 2016 with outcomes relevant for assessing OSA before and after intervention. The TF, by consensus, selected this data range, based on the following rationale: this range would incorporate the most recent literature, and the tools that are most commonly used today, while literature published before 2010 would add little incremental value. For a list of identified tools see in the supplemental material.

The TF reviewed whether each tool adequately assessed outcome domains of interest . The TF also reviewed whether each tool assessed specific health or safety outcome measures that have well-established associations to OSA . Finally, the TF evaluated in which patient populations the tools have been studied , functionality of the tools in a clinical setting , and validation of the tool among specific OSA patient populations .

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Using Medicine And Supplements

  • 1Eliminate sedative medicines. Sedatives depress your nervous system, which may stop your brain from telling your body to breathe. If you often use sleeping pills or other sedatives to help you sleep, stop using these medicines. Talk to your doctor about alternatives that will not put you at risk of sleep apnea, such as melatonin or valerian.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source
  • 2Try taking an allergy medicine before bedtime. If your airways are blocked due to allergies, then taking an antihistamine pill or using a nasal spray prior to bedtime may help to open up your nasal passages and make breathing easier. Make sure that you ask your doctor first before starting this treatment.XTrustworthy SourceNational Heart, Lung, and Blood InstituteResearch and education center within the National Institutes of HealthGo to source
  • 3Ask your doctor about modafinil. Modafinil is an FDA-approved drug that may help to combat the daytime fatigue associated with sleep apnea. You need a prescription for modafinil and it should not be used as a replacement for other therapies. Modafinil should be used as part of a treatment regimen that includes using a CPAP device and other sleep apnea treatments. It should be used only after the patient has been consistently using CPAP correctly and its still having problems
  • Modafinil may cause weight gain.
  • Consider taking 500mg of vitamin C daily as part of your treatment regimen.
  • American Sleep Apnea Association

    We envision a world in which most people suffering from sleep apnea are diagnosed, aware, educated and treated. This serious syndrome, when left untreated has a large influence on quality of life and multiple life-threatening implications. Yet it is highly treatable. Unfortunately it is estimated that more than 80% of people suffering from sleep apnea are undiagnosed. To help those living with sleep apnea, we work relentlessly to promote

  • better awareness in the general public and among health professionals and,
  • affordable, convenient and highly effective diagnoses and treatments.
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    Obstructive Sleep Apnea Treatments

    The first line of treatment for obstructive sleep apnea is a change in lifestyle changes. Reducing alcohol intake, losing weight, quitting smoking, and avoiding sedative medications are all starting points for treating sleep apnea . However, lifestyle modifications do not always resolve the issues; therefore, one or more of the below options are considered in treatment plans.

    How Will My Doctor Screen For Sleep Apnea

    Sleep Apnea (Part 2): Screening for Sleep Apnea

    Your doctors first goal will be to determine whether your snoring is benign or a symptom of sleep apnea. This may be determined by speaking with you and your partner about your symptoms. If you do not have a partner who can confirm snoring or breathing interruptions, your doctor may request a sleep study.

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    Avoid Alcohol And Smoking

    Lifestyle changes can improve your health and encourage better sleeping habits. Consider quitting smoking and limiting your alcohol intake to reduce sleep apnea complications.

    Alcohol relaxes the throat muscles that control your breathing. This can lead to snoring and an interrupted sleep cycle. It can also lead to inflammation in your airways, blocking your airflow.

    Similar to alcohol, tobacco use can also contribute to inflammation and swelling in your airways. This can worsen your snoring and your sleep apnea.

    A identified smoking as a risk factor for developing sleep apnea. The study noted that people with sleep apnea may have a predisposition to smoking as well, so treating sleep apnea may help in quitting smoking.

    Data Analysis And Statistics

    Sample Size Estimation.

    The calculation of sample size was performed according to the method reported by Obuchowski.Briefly, the two separate calculations of sample size were performed based on either estimated sensitivity, the precision of sensitivity, expected power, a type I error, and estimated prevalence; or specificity, the precision of specificity, expected power, type I error, and prevalence. The bigger number of the two is chosen as the sample size. Based on the literature on the Berlin questionnaireand the prevalence of OSA,a sensitivity of 0.88, a precision of 0.09, an OSA prevalence rate of 24%, a type I error of 0.05, and a power of 0.8 were used to calculated sample size. The result was 208. The number calculated based on a specificity of 0.80 was much smaller than 208. So 208 was initially chosen as the sample size. From the pilot study data, the sensitivity was 0.72 and the prevalence was 0.7. If the other parameters were kept the same, the sample size would be 137. However, a prevalence of 0.7 is very high. It may be biased because of the small number of patients in the pilot study. If, for safety, 0.55 were taken as the prevalence, the adjusted sample size would be 170.

    Data Analysis.

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    Alter Your Sleep Position

    Though a small change, altering your sleep position can reduce sleep apnea symptoms and improve your nights rest. A 2006 study found that more than half of obstructive sleep apnea cases are dependent on position.

    have shown sleeping on your back called the supine position can worsen symptoms. For some adults, sleeping on the side can help breathing return to normal.

    However, a found that children with sleep apnea sleep better on their backs.

    Discuss body positioning and your sleep apnea symptoms with your doctor to evaluate your options for treatment.

    Validation Of Outcome Assessment Tools In Clinical Settings And Various Populations

    AASM releases position statement on home sleep apnea testing

    While none of the assessment tools were validated sufficiently to warrant a recommendation, the FOSQ best met most of the validation metrics for assessing OSA . Most of the remaining tools were not designed specifically to assess patients with OSA, and thus, did not meet the validation metrics deemed important in assessing the OSA population. Only the Calgary Sleep Apnea Quality of Life Index , Sleep Apnea scale of the Sleep Disorders Questionnaire , and Symptoms of Nocturnal Obstruction and Related Events tools were developed for assessment of patients with OSA.â However, even these OSA-specific tools lacked many of the domains of interest and supporting evidence in validating their use in specific target populations .

    Most of the assessment tools generally have been used in both men and women, multi-national populations, and have involved middle-aged and elderly individuals . The ESS, FOSQ, and Pittsburgh Sleep Quality Index have been studied extensively across a wide variety of demographic groups. The ESS has been widely studied in a variety of populations including general medical, cardiac, obese, stroke, type 2 diabetes mellitus, and preoperative bariatric surgery candidates . The PSQI also has been examined in various clinical populations including cardiac, general medical, and obese populations. The Beck Anxiety Inventory, Brief Fatigue Inventory, ESS, FOSQ, and PSQI have been studied in minorities.

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