How is Obstructive Sleep Apnea (OSA) diagnosed?
For proper diagnosis of Obstructive Sleep Apnea (OSA) or other forms of sleep disordered breathing an overnight sleep test is necessary. The test consists of placing sensors on the body to measure certain body functions such as breathing, blood oxygen saturation, respiratory effort, body position, and brain activity. Different types of sleep tests use different sensors (also called channels) and the methods for obtaining sleep information differ slightly between tests.
Traditionally sleep tests have been conducted by an attended study in a sleep facility, rather than in the patient’s home. These attended studies are called Polysomnographs (PSG) and have been used for many years for the diagnosis of sleep disorder breathing, Obstructive Sleep Apnea, and other sleeping disorders. Recently home testing has become approved by the American Academy of Sleep Medicine for diagnosis of Obstructive Sleep Apnea. There is much debate in the medical community about which type of test is the most preferable, and below we discuss each type of test and the advantages and disadvantages of each:
- Polysomnograph (PSG)
- This type of sleep test has been the standard of care for many years. These tests are performed in a sleep laboratory while “attended” by medical professionals (usually sleep technicians). Typically 16 specific measurements (channels) are recorded while the patient is constantly monitored throughout the night by sleep technicians.
- The advantage to a Polysomnograph (PSG) test is that it usually measures many different bodily systems (such as EEG for brain activity), and often measures more unique body signals than Home Sleep Testing (HST). These additional measurements may give physicians more information to help with diagnosis. Since these tests are constantly monitored by technicians, if there is equipment malfunction during the night, such as a sensor coming loose ,it can be addressed immediately without having to repeat the test. Also, if CPAP is used during the PSG it can be applied and adjusted by the technicians while the patient is sleeping.
- The disadvantages to the Polysomnograph (PSG) are convenience, costs, access to care, and quality of sleep during the test. You must travel to a sleep lab to have the sleep test, and the test is often very expensive. It is obviously more desirable and easier to have a sleep test completed in the comfort of your own home. Patient’s are also more less likely to have a typical night’s sleep in a sleep lab (compared to sleeping in your own home). PSG testing can be expensive, whether or not you have medical insurance. Home Sleep Testing (HST) addresses many of the disadvantages of PSG testing.
- Home Sleep Test (HST)
- In 2009 the American Academy of Sleep Medicine (the foremost clinical group for health issues related to sleep) approved the usage of portable sleep testing for diagnosis of Obstructive Sleep Apnea (OSA) and other forms of sleep disorder breathing. According to the new clinical guideline, home sleep testing must be performed with a Level III portable sleep device that is is capable of measuring at least four different systems on the patient. The Home Sleep Test (HST) may be given to the patient by a trained technician, but diagnosis and interpretation of the results of the test must be made by a board-certified sleep physician. After instructions are given to the patient on how to attach the device, the patient takes the device home and wears it in their own home overnight. The device is returned to the sleep specialist who then interprets the results and gives a diagnosis. The home sleep recorders utilized by Dental Sleep Solutions® dentists are all clinically approved for home use, and diagnostic tests are evaluated by board-certified sleep physician.
- The advantages to Home Sleep Testing (HST) are patient convenience, easy access to care, decreased cost, and a more typical night of sleep recorded in the comfort of the patient’s home. It is obviously easier and more convenient for the patient to sleep in their own home than having to go away to a facility to obtain a sleep study. Furthermore patients are more likely to have a typical nights sleep in their own bed than in a foreign setting. Cost is greatly reduced using Home Sleep Testing (HST) and access to care is greatly improved.
- The major disadvantages to Home Sleep Testing (HST) is that they measure fewer channels than a full PSG, which could potentially result in less accurate diagnosis. Also if the home sleep device is not properly placed on the patient, or if it comes off during sleep, then the test may have to be repeated. Furthermore, CPAP adjustment is not possible with home sleep testing unless an Auto-PAP device is utilized. However, the convenience, accuracy, and low cost of Home Sleep Testing (HST) makes it an ideal choice for most patients.
The decision on which type of testing should be used for a particular patient can sometimes be a controversial issue in the medical community. One type of testing may not be appropriate for everyone. Someone who has symptoms of Obstructive Sleep Apnea (OSA) but has no other medical or sleep concerns may be accurately diagnosed with a Home Sleep Test (HST), while someone with a complicated medical and sleep history may be better suited to be test with a full Polysomnograph (PSG). Along with your physician, your Dental Sleep Solutions® dentist can help you determine which test might is best for your particular situation.
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