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__NOTOC__
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{{Sleep apnea}}
{{Sleep apnea}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.


==Overview==
==Overview==
The diagnosis of sleep apnea is obtained by a polysomnogram or a home-based portable monitor. Other tests include and EEG, EMG, EOG, ECG, a nasal airflow sensor, and a snore microphone.


==Sleep Apnea Other Diagnostic Tests==
==Sleep Apnea Other Diagnostic Tests==


===Polysomnogram (PSG)===
===Polysomnogram (PSG)===
*Also known as a sleep study


*Full-night, attended, in-laboratory polysomnography is considered the gold-standard diagnostic test for OSA
*Full-night, attended, in-laboratory polysomnography is considered the gold-standard diagnostic test for OSA
*It involves monitoring the patient during a full night's sleep:
*It involves monitoring the patient during a full night's sleep:
:*Brain activity
:*Brain activity
:*Eye movements
:*Eye movements
 
:*Heart rate
:*Heart rate:*Blood pressure:*Amount of oxygen in the blood:*Air movement through the nose while breathing, snoring, and chest movements
:*Blood pressure
 
:*Amount of oxygen in the blood
:*Air movement through the nose while breathing, snoring, and chest movements
*Split-night, attended, in-laboratory polysomnography  
*Split-night, attended, in-laboratory polysomnography  
 
:*This involves the diagnostic portion of the study performed during the first part of the night only
*: This involves the diagnostic portion of the study performed during the first part of the night only
 
:*Those patients who are diagnosed with OSA during the first part of the night and choose positive airway pressure therapy can have their positive airway pressure device titrated during the second part of the night
:*Those patients who are diagnosed with OSA during the first part of the night and choose positive airway pressure therapy can have their positive airway pressure device titrated during the second part of the night


===Home-Based Portable Monitor===
===Home-Based Portable Monitor===
*The portable monitor will record some of the same information as a PSG
*The portable monitor will record some of the same information as a PSG
*The results of this device can help determine whether to do a PSG


===Sleep Studies===
===Other tests===
*EEG (electroencephalogram) to measure and record brain wave activity
*EMG (electromyogram) to record muscle activity to determine REM stage sleep
*EOG (electro-oculogram) to record eye movements to determine REM stage sleep
*ECG (electrocardiogram) to record heart rate and rhythm.
*Nasal airflow sensor to record airflow
*Snore microphone to record snoring activity


Measure how well the patient sleeps and how the body responds to sleep problems
==References==


Oximetry, which may be performed overnight in a a patient's home, is an easier alternative to formal sleep study ([[polysomnography]].
* In one study, normal overnight oximetry was very [[Sensitivity and specificity|sensitive]] and so if normal, sleep apnea was unlikely.<ref name="pmid8357109">{{cite journal| author=Sériès F, Marc I, Cormier Y, La Forge J| title=Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. | journal=Ann Intern Med | year= 1993 | volume= 119 | issue= 6 | pages= 449-53 | pmid=8357109 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8357109  }} </ref> In addition, home oximetry may be equally effect in guiding prescription for automatically self-adjusting [[continuous positive airway pressure]].<ref name="pmid15486338">{{cite journal| author=Whitelaw WA, Brant RF, Flemons WW| title=Clinical usefulness of home oximetry compared with polysomnography for assessment of sleep apnea. | journal=Am J Respir Crit Care Med | year= 2005 | volume= 171 | issue= 2 | pages= 188-93 | pmid=15486338 | doi=10.1164/rccm.200310-1360OC | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15486338  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15989309 Review in: ACP J Club. 2005 Jul-Aug;143(1):21] </ref>
*Another study found that overnight oximetry, defining abnormal as 15 or more 4% desaturations/hour, was very [[Sensitivity and specificity|specific]], but not [[Sensitivity and specificity|sensitive]].<ref name="pmid8539678">{{cite journal| author=Ryan PJ, Hilton MF, Boldy DA, Evans A, Bradbury S, Sapiano S et al.| title=Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnoea syndrome: can polysomnography be avoided? | journal=Thorax | year= 1995 | volume= 50 | issue= 9 | pages= 972-5 | pmid=8539678 | doi= | pmc=PMC1021311 | url= }} </ref>
* Sensitivty of overnight oximetry is improved by using a 3% desaturation in oxygen.<ref name="pmid22009031">{{cite journal| author=Nigro CA, Dibur E, Rhodius E| title=Accuracy of the clinical parameters and oximetry to initiate CPAP in patients with suspected obstructive sleep apnea. | journal=Sleep Breath | year= 2012 | volume= 16 | issue= 4 | pages= 1073-9 | pmid=22009031 | doi=10.1007/s11325-011-0603-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22009031  }} </ref> and lowering the ODI to 5 per hour.<ref name="pmid1346422">{{cite journal| author=Douglas NJ, Thomas S, Jan MA| title=Clinical value of polysomnography. | journal=Lancet | year= 1992 | volume= 339 | issue= 8789 | pages= 347-50 | pmid=1346422 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1346422  }} </ref>
* Oximetry may identify some patients whose outcomes are not improved by adding polysomnography.<ref name="pmid17283346">{{cite journal| author=Mulgrew AT, Fox N, Ayas NT, Ryan CF| title=Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. | journal=Ann Intern Med | year= 2007 | volume= 146 | issue= 3 | pages= 157-66 | pmid=17283346 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17283346  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17909239 Review in: Evid Based Med. 2007 Oct;12(5):148]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17764136 Review in: ACP J Club. 2007 Sep-Oct;147(2):45] </ref>
==References==
{{Reflist|2}}
{{Reflist|2}}


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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Primary care]]
[[Category:Primary care]]
[[Category:Needs content]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Revision as of 18:08, 7 July 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

Overview

The diagnosis of sleep apnea is obtained by a polysomnogram or a home-based portable monitor. Other tests include and EEG, EMG, EOG, ECG, a nasal airflow sensor, and a snore microphone.

Sleep Apnea Other Diagnostic Tests

Polysomnogram (PSG)

  • Also known as a sleep study
  • Full-night, attended, in-laboratory polysomnography is considered the gold-standard diagnostic test for OSA
  • It involves monitoring the patient during a full night's sleep:
  • Brain activity
  • Eye movements
  • Heart rate
  • Blood pressure
  • Amount of oxygen in the blood
  • Air movement through the nose while breathing, snoring, and chest movements
  • Split-night, attended, in-laboratory polysomnography
  • This involves the diagnostic portion of the study performed during the first part of the night only
  • Those patients who are diagnosed with OSA during the first part of the night and choose positive airway pressure therapy can have their positive airway pressure device titrated during the second part of the night

Home-Based Portable Monitor

  • The portable monitor will record some of the same information as a PSG
  • The results of this device can help determine whether to do a PSG

Other tests

  • EEG (electroencephalogram) to measure and record brain wave activity
  • EMG (electromyogram) to record muscle activity to determine REM stage sleep
  • EOG (electro-oculogram) to record eye movements to determine REM stage sleep
  • ECG (electrocardiogram) to record heart rate and rhythm.
  • Nasal airflow sensor to record airflow
  • Snore microphone to record snoring activity

References

Template:WH Template:WS

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