ICSD3

OSA

Diagnostic Criteria

(A and B) or C satisfy the criteria

A. The presence of one or more of the following:

1. The patient complains of sleepiness, nonrestorative sleep, fatigue, or insomnia symptoms.

2. The patient wakes with breath holding, gasping, or choking.

3. The bed partner or other observer reports habitual snoring, breathing interruptions, or both during the patient’s sleep.

4. The patient has been diagnosed with hypertension, a mood disorder, cognitive dysfunction, coronary artery disease, stroke, congestive heart failure, atrial fibrillation, or type 2 diabetes mellitus.

B. Polysomnography (PSG) or OCST1 demonstrates:

1. Five or more predominantly obstructive respiratory events2 (obstructive and mixed apneas, hypopneas, or respiratory effort related arousals [RERAs])3 per hour of sleep during a PSG or per hour of monitoring (OCST).

OR

C. PSG or OCST1 demonstrates:

1. Fifteen or more predominantly obstructive respiratory events (apneas, hypopneas, or RERAs)3 per hour of sleep during a PSG or per hour of monitoring (OCST).

Hello Arti,

Currently, polysomnography (PSG) is a reference standard for diagnosing sleep-related breathing disorder, as  indicated by Dr. Zhang.

Researchers  in my institution developed ApneaDx- device that captures breathing sounds with a microphone (during sleep) and calculates an Apnea Hypopnea Index (AHI). This AHI  has been validated against AHI derived from PSG.

Alshaer H, Fernie GR, Maki E, Bradley TD. Validation of an automated algorithm for detecting apneas and hypopneas by acoustic analysis of breath sounds. Sleep Med. 2013 Jun;14(6):562-71

Another possible solution, STOP-bang questionnaire, not objective measure, but shown to be useful in categorizing OSA severity.

Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med. 2011;7(5):459-65B.

Kind regards,

Tatyana

By doing an oveernigt Polysomnography ( sleep study)

Nocturnal Polysomnography (Sleep Study) is the gold standard objective test to diagnose Sleep Apnea.

I agree with my colleague: PSG is the only gold standard. Polygraphy is also effective but could underestimate the OSA severity (i.e if the patient is not sleeping during the night). Any other method may be used as (more or less accurate) screening tools but are insufficient for diagnosis of the disease, its severity and the fine characterization of its nature (Central or complex apnea component may occur). Kind regards.

Dear Colleagues,

I am very much thankful to you all for your kind help through your answers. It will be helpful for me for designing my study.

Best regards, Arti

Gold Standard is overnight PSG. But there are some simple questionnaire to asses  sleep, quality of life and associated issues due to OSA like the ESS or FoSQ.

Epwortth (ESS) is neither sensitive or specific to OSA.  The Berlin and STOP-BANG are sensitive, but not that specific.  Even the best questionnaires are subjective and provide results that are at best 70% specific.  

I suggest you consider an overnight oximetry study to confirm a positive STOP-BANG or Berlin result, Oximetry is relatively inexpensive and using a desat criteria of 3% will eliminate the gross false positive subjects.. 

Here is a link to a good paper:

http://www.ncbi.nlm.nih.gov/pubmed/20127186

I've published several studies using the ARES questionnaire.

Thank you very much for your answer and for providing me with the link. May you please send me some more articles on OSA? Regards, Arti

Arti - all of our papers on OSA can be download on researchgate.

https://www.researchgate.net/publication/47458951_Patients_with_positional_versus_nonpositional_obstructive_sleep_apnea_A_retrospective_study_of_risk_factors_associated_with_apnea-hypopnea_severity

https://www.researchgate.net/publication/5453342_Prevalence_of_probable_obstructive_sleep_apnea_risk_and_severity_in_a_population_of_dental_patients

https://www.researchgate.net/publication/275274446_Assessment_of_Obstructive_Sleep_Apnoea_Risk_and_Severity_in_Truck_Drivers_Validation_of_a_Screening_Questionnaire

Article Patients with positional versus nonpositional obstructive sl...

Article Prevalence of probable obstructive sleep apnea risk and seve...

Article Assessment of Obstructive Sleep Apnoea Risk and Severity in ...

Dear Sir, Thank you so much for providing me with your articles on OSA. Regards, Arti

Dear Dr Daniel

I am really grateful to you for your inputs. I am interested to know , can we use the same questionnaires for mixed dentition patients. Why  am asking this is, because we routinely give mandibular anterior positioning appliances to mixed dentition patients for skeletal discrepancy in our institute. I am interested to know , if additionally we can evaluate how many of them have OSA pre-treatment and if they have , what is the improvement in OSA by giving the appliance. We cannot go in for any invasive technique for the same because the patients have not originally come to use for treatment of OSA but  for correction of  mandibular retrognathism.

Mam we may go for clinical evaluation, history like snoring, HTN etc, cephalometric evaluations but gold standard remains the PSG .

I totally agree with all the above opinions that PSG is the gold standard, but as I understand Dr Aarti would like to do patients in Indian setup, how feasible and cost effective this measure would be is a big question. My related query is that for documenting prevalence, is it possible that we can do screening with  questionnaires   ( Berlin/ARES) before and then the susceptible  ones can undergo PSG.

Second query is , are there screening tools (questionnaires). available for OSA in adolescents and children separately.

Best 

Gold Standard is overnight PSG. Screening tests (questionnaires) can assess risk for the OSA, but can not confirm diagnosis

Dear Ivana

Thank you for your answer. Based on your expertise, kindly tell if there are any parameters within PSG which can be more specific for OSA.. desperately.lookong for a more cost effective and easily available option for diagnosis of OSA for a developing country like mine

The definitive diagnosis of OSA must be made by a physician. Sleep-related breathing disorders constitute a lot of disorders - one of which is sleep apnea. Sleep apnea again can be central sleep apnea (rare) or obstructive sleep apnea. Thus, only with proper history taking, screening questionnaires, clinical examination, proper referral (ENT) for tonsils and adenoids (in growing population) can further examination be undertaken. Patients with history of snoring, gasping respiration, nocturnal awakenings, etc. should be screened as these are common signs and symptoms with OSA.

An in-center sleep study is the gold standard PSG. A cheaper option is out of center sleep study (OCST). Home Study Apnea Testing (HSAT) is one type of OCST. HSAT does not typically include EEG.

The determination of the need for a sleep study, the interpretation of the results, and the diagnosis must be made by physician. An orthodontist can help in the treatment of OSA in collaboration with the physician. Other respiratory functional tests such as expiratory flow volume, inspiratory flow volume, acoustic rhinometry, rhinomanometry can be used to assess respiratory function as well.

I have attached the paper that shows the American Association of orthodontists stand on the team approach and the role of orthodontists for OSA. I have also attached my recent paper on the effect of expansion on airway and the future directions with this treatment methodology.

https://pubmed.ncbi.nlm.nih.gov/31256826/

Article Long-term effects of mini-screw–assisted rapid palatal expan...