Sleep Apnea Screening and Treatment
The sleep apnea syndrome is receiving increasing attention from the medical community. Yet his diagnosis on a daily basis is the real puzzle. Very often it is highlighted in relation to a workplace accident or traffic.
1. Alert
Among the elements of the examination and clinical examination, snoring, apnea described by the surroundings, daytime sleepiness, obesity, male gender and systemic hypertension (HT) are suggestive of OSAS.
2. Diagnostic polysomnography
Nevertheless, the final diagnosis is based on a systematic registration night. Polysomnography performed in the sleep laboratory is the gold standard for diagnosis of OSAS. It provides comprehensive information on the evolution of states of alertness and sleep quality of the recorded subject and on the quality of her breathing.
The experts agree that it is unnecessary to record neurophysiological signals routinely as first-line before typical symptoms. A polygraph limited to cardio-respiratory signals, termed ventilatory polygraphy (PV), will be amply sufficient and technically much simpler to implement.
Technically, polysomnography allows simultaneous recording tracks of brain activity (electroencephalogram), extraocular muscles (electro-oculogram) to detect the phase known as “paradoxical” sleep, muscle tuft of chin (electromyogram), and the naso-oral airflow and thoracic and abdominal movements.
The respiratory signal recording aims the recognition of abnormal respiratory events (ERA), apnea, hypopnea, episodes of excessive inspiratory flow limitation, and the definition of obstructive or central character.
The treatment of sleep apnea is in most cases on the establishment of a medical device for continuous positive airway pressure (CPAP or CPAP). This equipment is registered on the list of reimbursable products and services (ISL) for a weekly rental fee.
Support is provided by prior arrangement completed by the attending physician at the first requirement for a probationary period of five months, then once a year in renewals.
This support is provided for patients with daytime sleepiness at least three of the following symptoms: snoring, morning headaches, reduced alertness, libido disorders, high blood pressure (hypertension), nocturia. These symptoms must be associated with an apnea index (A) plus hypopneas (H) per hour of sleep (A + H) greater than or equal to 30, revealed by the polygraph analysis. If this index is below 30, it takes at least 10 microéveils per hour of sleep in connection with an increase in respiratory effort, documented by polysomnographic analysis.
The diagnosis is confirmed, the prescriber will propose a treatment based on a continuous positive airway pressure apparatus.
Two new players will then break into the patient’s life:
- The CPAP device and its share of constraints
- A provider of medico-technical services
4. Accepting the equipment to PPC
Successful treatment depends on acceptance by the patient himself, but also by his entourage of this equipment. In this learning phase, or rather education, the role of provider of medico-technical services is crucial.
- He will ensure proper adjustment of the mask and headgear, and to test more if necessary
- He will teach the patient and his entourage to learn and live with the camera
- He will provide hygiene and safety
- It is to him that the patient or his entourage will appeal if necessary
- He will be the interface between the patient and the prescriber if adjustment difficulties related to the level of pressure appear.
5. The importance of monitoring treatment
During this first phase of education, the provider will be very present to explain the grounds for the treatment, to make, after consulting the prescriber, the adaptations necessary to motivate some to continue treatment, in a word accompany the patient and his entourage for optimal treatment outcomes in place.
Then, when this phase is completed, the claimant will have at heart to meet the specifications related to the establishment of the medical device via at least twice a year to make a statement of compliance and perform operations preventive maintenance required. It was during these passages that he will renew the mask and patient circuit. Of course, always listen to the patient, it will increase the frequency of his visits when necessary. Finally, it should report these actions to the prescribing doctor and also ensure a fine of service, 24 hours and 7 days a x24 7.
6. The brace of mandibular advancement: an alternative to CPAP
The brace of mandibular advancement is a medical device that is placed in the mouth and that can only be tailor-made for your dental impressions. It helps maintain the lower jaw slightly forward position during sleep, thus freeing the passage of air in the pharynx and reduces the clogging phenomenon that generates the so-called obstructive apnea.
7. In which case is the brace a possible treatment?
It is not recognized the High Authority for Health (HAS) as an effective treatment of the syndrome of obstructive sleep apnea (OSA), in specific cases. It should be noted that the recommendation of the HAS does that orthotics. Orthotics universal – sold in pharmacies or by mail are not recommended as they have not proven their efficacy in the treatment of sleep apnea.
The orthosis can be prescribed for treatment of “first intention” for mild and moderate apnea who do not present a major cardiovascular risk, or excessive daytime sleepiness. It remains a second-line treatment – but under certain conditions – in case of failure or refusal of ventilation with CPAP for severe apnea. Finally, it can also be prescribed in conjunction with this CPAP ventilation through frequent travel.
8. How to be fitted with a brace?
The first step is to confirm sleep apnea and make this a recording of sleep. In most cases, ventilatory polygraphy at home is performed. In some cases, overnight polysomnography is performed in hospital. Based on this record, the pulmonologist confirm or reject the sleep apnea syndrome and possibly may prescribe a custom orthotic. It will then make an appointment with a dental specialist trained in this technique which will cover the patient for the realization of a brace. It takes an average of three appointments, with 10 to 15 days apart for good support. Between prescription and use of the device, including adjustment, it can take between 3 and 6 months. Because once the dentist has adjusted the splint, an appointment must be included in a sleep specialist to verify the effectiveness thereof. It will adjust the propulsion from the symptoms (fatigue, snoring), ensure good tolerance of the device and then verify its safety and dental joint. Subsequently, an appointment a year from your dentist is recommended for monitoring.
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Tags: apnea, sleep, sleep apnea