Diagnosis of obstructive sleep apnea is not simple because there can be many different reasons for disturbed sleep. Sleep Apnea can only be diagnosed by a medical doctor; however, a dentist with special training can help discover a person at risk for sleep apnea. Using her advanced training, Acoustic Technologies, and team of medical physicians consisting of Sleep Specialists, ENTs, Internists, and Oral Surgeons; Dr. Planer can ensure the best possible treatment and complete diagnosis of Sleep Apnea.
Once a diagnosis is determined and the degree of the severity of sleep apnea is assessed, the patient has several options for treatment. The following may be recommended: weight loss, CPAP (Continuous Positive Air Pressure), oral appliance therapy or surgery. In February 2006, the American Academy of Sleep Medicine released its recommendations that treating mild to moderate obstructive sleep apnea with an oral appliance is a viable option for patients. Oral appliances may be used in limited cases of severe sleep apnea when a patient can not tolerate a CPAP or in conjunction with CPAP to help reduce the pressure to a tolerable level.
Questionnaire for "Candidate Status"
In order to begin the patient evaluation, we will provide several questionnaires. These questionnaires are designed to determine if someone is at risk for sleep apnea. The Epworth Sleepiness Scale is universally used by all sleep physicians to determine your daytime fatigue level. The additional questionnaire is to help Dr. Planer assess your overall medical history as it relates to sleep disorder breathing. It is also important to assess your TMJ prior to placement of an oral appliance. There are many different appliance designs and some of the mandibular advancing appliances that are used in the treatment of sleep apnea can affect a person's jaw joint. It becomes important to diagnose any dysfunction in the TMJ that may exists.
Acoustic Reflection Technology
The Eccovision provides a means to thoroughly and accurately assess the patient's airway. Completely painless and non-invasive, the Eccovision emits sound waves through a self-contained central processing unit comprised of two tools: the rhinometer and pharyngometer. They map the patient's nasal passages and pharyngeal airway, respectively, via a technique called 'acoustic reflection'. The results are on-screen graphs directly correlating to the physical dimension of the patient's nasal passages and pharyngeal airway. According to Hood Labs, the manufacturer of the Eccovision, the acoustic reflection technique 'utilizes a patented, state-of-the-art acoustic signal processing technology to provide graphical representations of airway patency as a function of distance from the airway opening'.
The Rhinometer test is performed first, in order to check the nasal passages. This tool helps to rule out any obstruction or enlargement in the turbinates as the cause of a sleep disordered breathing problem. The Rhinometer uses acoustic reflection to map the nasal passages, searching out any obstruction or enlargement.
As for the airway itself, the Pharyngometer is used. This tool sends sound waves down the throat, noting the diameter, collapsibility, and problem spots. The Pharyngometer is used to map the cross-sectional diameter of the oral airway and measure its stability. This allows the dentist to discover existing points of obstruction as well as optimal breathing position. The Pharyngometer is also instrumental in determining successful oral appliance therapy.
The Watch-PAT 200 is a self-contained, unattended sleep study device that is worn on the wrist and uses a non-invasive finger mounted probe to measure the PAT signal. The automatic algorithm of this special software detects respiratory events based on the PAT signal amplitude, pulse rate changes (derived from the PAT signal), and oxygen saturation. The Actigraph together with additional signals is used for sleep wake staging. The software issues a detailed report with sleep-wake and respiratory events statistics. Dr. Planer will use this technology to help determine the efficiency of an oral appliance.