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Case Recognition, Screening and Treatment

Terms in this set (33)

High level OAT flow diagram
Screeen

Consult

Dx test

Diagnose

Exam/impression.bite registration

Device delivery/advancement

Efficacy test
High level OAT flow diagram - Screen
ESS

STOP BANG

Observations (scalloped tongue, large tonsils, etc)
High level OAT flow diagram - Consult
Need for test

Referral or treat
High level OAT flow diagram - Dx test
Refer or order

Home sleep test or polysomnogram
High level OAT flow diagram - Diagnose
Always a physician

NEVER you
High level OAT flow diagram - Efficacy test
PO2

HST

Subjective
What you need to know about tests
AHI

ODI

%t below 90% SPO2

NADIR lowest SPO2

HR resting

HR average

HR highest
What you need to know about tests - AHI
Requires reduction of flow of ≥ 30% for 10 sec + drop in SPO2 of 3% or 4% (>65 yo)
What you need to know about tests - AHI

Scale
Normal: 0-5

Mild: 5-15

Moderate: 15-30

Severe: >30
What you need to know about tests - ODI scale
Normal: 0-5

Mild: 5-15

Moderate: 15-30

Severe: >30
What you need to know about tests - % t below 90% SPO2
0% ideal

10% is a lot
What you need to know about tests - NADIR lowest SPO2
90% ideal, 85% is very low
What you need to know about tests - HR resting
Wide range
What you need to know about tests - HR average
Includes events
What you need to know about tests - HR highest
During events
Reduce AHI to below __________ or below ____________ and a _________ reduction
5

10

50%
Reduce or eliminate the subjective signs and symptoms
EDS

Snoring

Having trouble losing weight
How long should the oral device be worn?
7 day 7 nights

7 hours/night

49-50 hours/week
American academy of sleep medicine defines compliance as
5 nights/week

7 hours/night
In medicine, compliance is defined as...
4.5 hours/night

5/7 nights
Minimize side effects
Jaw joint pain

Excessive mouth dryness / salivation

Tooth movement / bite changes

Muscle tenderness
Flip
...
AHI = 24/hour

SPO2 < 89% for 13.5 min
What should be noted in this chart
Based on AHI, moderate SA in NREM and severe in REM
What should be noted in this chart
ODI = 5.01

Pulse oximetry measures time in bed, not just sleeping time

This number is probably smaller than actual
What should be noted in this chart
No

STOP BANG = 2 (snoring + male)

Low risk of OSA

Wouldn't test patient, instead would recommend over the counter and positional therapy
Should a sleep test be recommended?
No you have to conduct a sleep test to rule out OSA first
Can you treat snoring without a sleep test?
No

Upper airway resistance syndrome
Does this patient have OSA?
No
Is treatment recommended?
Yes ≥ 4 STOP BANG = high risk

92% have OSA
Is the patient at high risk for OSA?
AHI = 14

Mild OSA

Choice between oral appliance or CPAP
What does the patient's AHI tell us?
1/2 way into 11 mm range (can go forward or retrude from there)
What is the U0 L0 position?
AHI = 3

ODI = 2.6
What improvements were seen?
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