How we diagnose Obstructive Sleep Apnea

This is part 2 of a 3 part serious on Obstructive Sleep Apnea

In the last article on Obstructive Sleep Apnea, we discussed what obstructive sleep apnea is and why it is important to treat it.

In this article, we will talk about how obstructive sleep apnea is diagnosed.

Let us first talk about the signs and symptoms of obstructive sleep apnea (OSA)

One of the most common signs of OSA is loud snoring. Your bed partner also complains that you may have breathing pauses during sleep and that you may gasp for air during sleep. You may also suffer from morning headaches and you may also wake up with a dry mouth in the morning. These are all physical symptoms, but it does not stop there. Your daytime functioning may also be impaired.

During the day, you may also feel excessively tired and you may even struggle to concentrate. Many patients complain that they even fall asleep behind the steering wheel. You may also suffer from frequent awakenings during sleep. But what about when you are sleeping alone and you just don’t know if you suffer from OSA?

Luckily, there are screening test questionnaires that you can complete which are validated and trusted in the sleep health industry. The first one is the STOP-BANG questionnaire. It is an accurate screening questionnaire for obstructive sleep apnea. You can complete this questionnaire free here.

Another questionnaire is called the Epworth Sleepiness Scale (ESS). This is a tool that is often used by sleep health practitioners to screen for excessive daytime sleepiness. You can also complete it here for free.

When and why to consult your doctor.

This is important: Unfortunately, OSA is still underdiagnosed all over the world. So it is your responsibility to inform your doctor that you have signs and symptoms of OSA. This is especially important if you suffer from any of the following:

  • High blood pressure (especially if it is not under control)
  • Any blood sugar problems (especially Type 2 diabetes millitus)
  • If you are overweight and has a BMI of more than 30
  • If you have a neck circumference of more than 40cm

What will happen when you tell your doctor that you think you have sleep apnea?

Your doctor will refer you to a sleep clinic or a sleep lab of his or her choice. The sleep lab or sleep clinic will perform a sleep study or polysomnogram. During this study, trained, registered medical sleep professionals will conduct the study either at your residence, in a hospital, or in a comfortable sleep laboratory, whichever is indicated.

Yes, it is true, traditional sleep study equipment does make you look like “Robocop” with lots of wires and sensors. Just remember that this equipment was made to sleep with and is not as uncomfortable as you may think. There are also sleep study equipment available that are much more comfortable and also very reliable when testing for OSA. The equipment that is used depends on the sleep clinic or sleep lab of what is best for you with your circumstances.

What you can expect during the sleep study

Once you have the equipment on your body you can go to sleep when you want. You are totally mobile so that you can go to the toilet or kitchen or move freely around your environment.

When you are ready to go to sleep, you can fall asleep naturally, like every other night. While you are asleep the equipment will record some very important physiological tracers. This includes

  • Your airflow. The normal room air that moves from your mouth and nose down to lungs and back again. It takes the form of a small canula in your nose that detects airflow. With this we can measure the type of breathing you have during the night and also, very importantly, we can measure any possible airway obstruction or resistance.
  • Blood oxygen saturation. The oxygen levels in your blood stream is also an important apect to trace, because we want to see you much oxygen you loose if there is an airway obstruction or resistance while you breath during sleep. It takes the form of a small device that is put on one of your fingers and it can also measure your pulse rate during sleep. We call it a pulse oxymeter.
  • Thoracic and abdominal respiratory effort. This is also an important tracer because it tells us the level of breathing effort. It can also help us to distinguish between the type of sleep apnea you may suffer from.

We can also measure body movement and sleep stages for extra information if it is indicated.

Once you wake up and get out of bed the next morning, the equipment is taken off, downloaded, and analyzed by either a trained doctor or neurophysiologist.

Once the data is analyzed a final report with diagnoses and recommendations is sent to your referring doctor. The report must contain at least the following:

  • Apnea Hypopnea Index (AHI). This is our measurment of the level of severity of your sleep apnea. It is devided into mainly 4 parts and measures the partial or total sesation of airflow for at least 10 seconds in an hoiurs time
    • Normal: AHI is from 0 to4,9
    • Mild Apnea: AHI is from 5 to 14,9
    • Moderate: AHI is from 15 to 29,9
    • Severe: AHI is more than 30 events per hour.
  • The type of sleep apnea: Your apneas may be obstructive in nature, or that can be indications of central sleep apnea or even a combination of obstructive events or central events, which we call mixed sleep apnea
  • Blood oxygen levels: In indication of the mean levels of oxygen during the sleep period will be in the report as well as the mininum levels of oxygen saturation you experienced during your sleep period. It will also include the desaturation index (ODI)

If you had a full polysomnogram the report will also include your sleep staging and possibly also your body positioning during sleep.

A good sleep study report will also contain information indicating any additional possible sleep pathology like restless leg syndrome, periodic limb movement, or the like.

What happens after the sleep study

Please read and understand the following very clearly! After the sleep study, if you are tested positive for sleep apnea (AHI of more then 5), things will happen rather quickly in terms of treatment options. The chances are high that you will be booked for another type of sleep study called a PAP-titration study.

You will be expected to sleep on a special type of PAP machine. PAP stands for “Positive Airway Pressure” and it is exactly what the name entails – positive airpressure is administered down yuir airway while you are asleep by means of a mask. The primary aim is to see what pressure is necessary to keep your airway open. It will also indicate what type of PAP machine is indicated for you. The PAP titration procedure is may also be covered by yur medical insurance.

Here is some advice: Before you are booked for the PAP titration study, please meake sure that you understand absolutely everything on your sleep study report. DO NOT leave leave the sleep clinics/ sleep lab’s rooms if you are unsure of anything. This inludes the severity of your sleep apnea, the type of apneas that you suffer from, and then, most importantly, WHY PAP therapy is indicated. It is true that other forms of therapy are also available, but this is indicated by the type pf sleep breathing siorder you may suffer from. It is also true that PAP therapy works very well for all types of sleep apnea an that is currently the golden standard to treat sleep apnea. An article with different treatmwent options will be part 3 of series of articles about sleep apnea.

In the past few articles about sleep apnea, we established that sleep apnea is dangerous and it needs to be taken care of. In addition, It is the second largest sleep illness in the world and because of this, procedures and protocols are set to successfully treat your sleep apnea.