Rapid Screening for Sleep Apnea

Dr. Halligan

Dr. Halligan

Quite a few tools exist to spot the person with possible sleep apnea. After a brief intake interview I often have patients fill out an Epworth Sleepiness Scale. And that is helpful.

 

The mere appearance of Nexium on the list of current medications is enough to make me evaluate a person for OSA. Acid Reflux is often caused by the struggle to breathe during sleep apnea episodes. That little purple pill may be a giveaway.


eccovisionI use Eccovison acoustic pharyngometer in my practice and I find it valuable, even indispensible.

 

“The cornerstone of many sleep dentistry practices, the Eccovision Acoustic Pharyngometer and Rhinometer provides valuable information about the airway size and stability…The pharyngometer (is) accurate in ruling out patients who would not benefit from oral appliances 95% of the time.”


(Quoted from the Sleep Group Solutions web site http://sleepgroupsolutions.com/2.0/products/17/acoustic-pharyngometer)


Is there an airway collapse? Does protruding the mandible help? How much does it help? What’s the ideal vertical and protrusive position? The pharyngometer can  answer all of those questions. And what if no mandibular position provides a significant improvement? Although some patients may insist that we at least give oral devices a try, I will generally advise against it. Can the pharyngometer rule out those patients who won’t be helped “95% of the time,” as quoted above? Yes. I believe it can.


I’ve looked at a number of questionnaires to aid in rapid screening for sleep apnea, and I recently came across an excellent one. It turns out that among various groups of doctors, the anesthesiologists are exceptionally concerned about sleep apnea patients. Who runs the greatest risk of complications from general anesthesia and post operative difficulty? The patient with sleep apnea.


Here is the questionnaire developed for anesthesiologists and is from the journal Anesthesiology.


STOP-Bang Questionnaire

Is it possible that you have Obstructive Sleep Apnea (OSA)?
Please answer the following questions below to determine if you might be at risk.

Snoring?

Yes | No      Do you Snore Loudly (louder than talking or loud enough to be heard through closed doors)?

Tired?

Yes | No      Do you often feel Tired, Fatigued, or Sleepy during the daytime?


Observed?

Yes | No      Has anyone Observed you Stop Breathing during your sleep?


Pressure?

Yes | No      Do you have or are being treated for High Blood Pressure?


Body Mass Index more than 35?

Yes | No


Age older than 50?

Yes | No


Neck size large?

Yes | No      Do you have a Neck that Measures more than 16 inches / 40 cm around? (measure at Adam’s Apple)

Gender = Male?

Yes | No


Low risk of OSA: Yes to 0-2 questions
Intermediate risk of OSA: Yes to 3-4 questions
High risk of OSA: Yes to 5-8 questions.
Chung F et al. Anesthesiology 2008; 108: 812-821, and Chung F et al Br J Anaesth 2012; 108: 768–775.


If you are treating apnea in your practice, or want to begin, here is an excellent tool. Dentists with busy practices should find this especially useful. This is a proven method for quick and highly accurate screening.


The full article from Anesthesiology is available here: http://sleepmed.com.au/STOP_questionaire.pdf




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