The Journal of the Korean dental association (대한치과의사협회지)

The Korean Dental Association (대한치과의사협회)
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The diagnosis of sleep related breathing disorders and polysomnography

수면호흡장애의 진단과 수면다원검사

  • Park, Ji Woon (Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University)
  • 박지운 (서울대학교 치의학대학원 구강내과진단학교실 및 치학연구소)
  • Received : 2015.03.07
  • Accepted : 2015.03.23
  • Published : 2015.04.01
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Abstract

Sleep related breathing disorders(SRBDs) are a group of diseases accompanied by difficulties in respiration and ventilation during sleep. Central sleep apnea, obstructive sleep apnea(OSA), sleep-related hypoventilation, and hypoxemia disorder are included in this disease entity. OSA is known to be the most common SRBDs and studies show its significant correlation with general health problems including hypertension, arrhythmia, diabetes, and metabolic syndrome. The diagnostic process of OSA is composed of physical examinations of the head and neck area and also the oral cavity. Radiologic studies including cephalography, CT, MRI, and fluoroscopy assist in identifying the site of obstruction. However, polysomnography(PSG) is still considered the gold standard for the diagnosis of OSA since it offers both qualitative and quantitative recording of the events during a whole night's sleep. The dentist who is trained in sleep medicine can easily identify patients with the risk of OSA starting from simple questions and screening questionnaires. Diagnosis is the first step to treatment and considering the high rate of under-diagnosis for OSA the dentist may play a substantial role in the diagnosis and treatment of OSA which will eventually lead to the well-being of the patient as a whole person. So the objective of this article is to assist dental professionals in gaining knowledge and insight of the diagnostic measures for OSA including PSG.

Keywords

References

  1. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387-94. https://doi.org/10.1378/chest.14-0970
  2. American Academy of Sleep Medicine. International Classification of Sleep Disorders, ed 3. Westchester, IL: American Academy of Sleep Medicine, 2014.
  3. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39. https://doi.org/10.1164/rccm.2109080
  4. Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006;28(3):596-602. https://doi.org/10.1183/09031936.06.00107805
  5. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071-8.
  6. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25(9):735-41. https://doi.org/10.1016/j.ehj.2004.02.021
  7. Schwarting S, Netzer NC. Sleep apnea for the dentist: political means and practical performance. Presented at Sleep Utah 2006 (0556), Annual Meeting of the APSS. Salt Lake City (UT), June 2006.
  8. Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales. J Clin Sleep Med. 2011;7(5):467-72. https://doi.org/10.5664/JCSM.1308
  9. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5. https://doi.org/10.1093/sleep/14.6.540
  10. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  11. Sohn SI, Kim do H, Lee MY, Cho YW. The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath. 2012;16(3):803-12. https://doi.org/10.1007/s11325-011-0579-9
  12. Lee CH, Mo JH, Choi IJ, Lee HJ, Seo BS, Kim DY, Yun PY, Yoon IY, Won Lee H, Kim JW. The mandibular advancement device and patient selection in the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2009;135(5):439-44. https://doi.org/10.1001/archoto.2009.31
  13. Hoey LM, Fulbrook P, Douglas JA. Sleep assessment of hospitalised patients: a literature review. Int J Nurs Stud. 2014;51(9):1281-8. https://doi.org/10.1016/j.ijnurstu.2014.02.001
  14. Lurie A. Obstructive sleep apnea in adults: epidemiology, clinical presentation, and treatment options. Adv Cardiol. 2011;46:1-42. https://doi.org/10.1159/000327660
  15. Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, Caldarelli D.Laryngos cope. Clinical predictors of obstructive sleep apnea.1999;109(12):1901-7.
  16. Finkelstein Y, Wexler D, Horowitz E, Berger G, Nachmani A, Shapiro-Feinberg M, Ophir D. Frontal and lateral cephalometry in patients with sleep-disordered breathing. Laryngoscope. 2001;111(4 Pt 1):634-41. https://doi.org/10.1097/00005537-200104000-00014
  17. Fuerderer S, Eysel-Gosepath K. Retro-pharyngeal obstruction in association with osteophytes of the cervical spine. J Bone Joint Surg Br. 2004;86(6):837-40. https://doi.org/10.1302/0301-620X.86B6.14933
  18. Tsai WH, Remmers JE, Brant R, Flemons WW, Davies J, Macarthur C. A decision rule for diagnostic testing in obstructive sleep apnea. Am J Respir Crit Care Med. 2003;167(10):1427-32. https://doi.org/10.1164/rccm.200112-110OC
  19. Bailey DR, Attanasio R. Screening and comprehensive evaluation for sleep related breathing disorders. Dent Clin North Am. 2012;56(2):331-42. https://doi.org/10.1016/j.cden.2012.01.007
  20. Guilleminault C, Riley R, Powell N. Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment. Ches.t 1984;86(5):793-4. https://doi.org/10.1378/chest.86.5.793
  21. Tsuchiya M, Lowe AA, Pae EK, Fleetham JA. Obstructive sleep apnea subtypes by cluster analysis. Am J Orthod Dentofacial Orthop 1992;101(6):533-42. https://doi.org/10.1016/0889-5406(92)70128-W
  22. BohlmanME, Haponik EF, Smith PL, Allen RP, Bleecker ER, Goldman SM. CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea. AJR Am J Roentgenol. 1983;140:543. https://doi.org/10.2214/ajr.140.3.543
  23. Alsufyani NA, Dietrich NH, Lagravere MO, Carey JP, Major PW. Cone beam computed tomography registration for 3-D airway analysis based on anatomic landmarks. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(3):371-83. https://doi.org/10.1016/j.oooo.2014.05.027
  24. Thakkar K, Yao M. Diagnostic studies in obstructive sleep apnea. Otolaryngol Clin North Am. 2007;40(4):785-805. https://doi.org/10.1016/j.otc.2007.04.005
  25. Kakkar RK, Hill GK. Interpretation of the adult polysomnogram. Otolaryngol Clin North Am. 2007;40(4):713-43. https://doi.org/10.1016/j.otc.2007.04.003
  26. Chen H, Lowe AA, Bai Y, Hamilton P, Fleetham JA, Almeida FR. Evaluation of a portable recording device (Apnea- Link) for case selection of obstructive sleep apnea. Sleep breath 2009;13(3):213-9. https://doi.org/10.1007/s11325-008-0232-4
  27. Patel MR, Davidson TM. Home sleep testing in the diagnosis and treatment of sleep disordered breathing Otolaryngol Clin North Am. 2007;40(4):761-84. https://doi.org/10.1016/j.otc.2007.04.012