Patient Safety Toolkit: Primary Care and Obstructive Sleep Apnoea
How should we deal with sleep apnoea? How should health practitioners manage sleep apnoea? An informational leaflet from http://www.aaahc.org features some basic information regarding obstructive sleep apnoea management.
When OSA is suspected based on screening, but there is concern about the accuracy of these tests, referral for attended or portable polysomnography (PSG) is advised.
Portable monitors (Type II), which record the same information as facility-based polysomnography (Type I), have high positive likelihood and low negative likelihood of identifying AHI ratings suggestive of OSA, and are usually less expensive alternatives to Type I monitoring. PSG is required by Medicare and Medicaid for CPAP (Continuous Positive Airway Pressure) treatment.
Patient education consists of communicating and explaining the diagnosis, severity, and prognosis, the risk factors and opportunities to decrease risk and severity and treatment.
Patient education is especially important because patient compliance is relatively low (less than 50% for CPAP).
Treatment options include CPAP, which is associated with significant cardiovascular and pulmonary hospitalization reduction and improved quality of life. It also requires care and maintenance of equipment. There is evidence that CPAP is superior to oral appliances.
Oral appliances, which are not as effective as CPAP, and require dental management of patients, but may be appropriate for mild to moderate OSA.
Other interventions that do not have the same support of evidence as the preceding two include weight loss or bariatric surgery adjunctive to other treatment, for obese patients, medications to treat underlying medical conditions (for example, nasal topical corticosteroids), and various oral, maxilliofacial, and otolarygological surgeries for obstructive anatomy or if CPAP is inadequate.
Modafinil for residual excessive sleepiness may be given.
Avoidance of alcohol, sedatives/opioids may be done.
Sleep with head raised and on the patient’s side may be done.
Use of OSA screening instruments may be considered by primary care providers. Examples of these are the: Epworth Sleepiness Scale (high scores for this and AHI are predictive of better compliance with CPAP use), modified Mallampati Scale and Pittsburgh Sleep Quality Index.
Read more here:
Image Courtesy of patrisyu / freedigitalphotos.net
Somnowell Inventor - Visiting Professor Simon Ash FDS MSc MOrth BDS
Prof. Ash is the inventor of the highly successful SOMNOWELL Chrome device for snoring and sleep apnoea.
The Somnowell Chrome is made to exacting standards in the Somnowell laboratory under the supervision of Visiting Professor Simon Ash. Prof. Ash and his master technicians create each Somnowell Chrome device using their wealth of experience and expertise.
Prof. Ash works at the forefront of his profession. He is a Consultant and Specialist Orthodontist with over 30 years clinical experience, with a special interest in sleep related breathing disorders, TMJD, and bruxism. He currently works in Harley Street London and two private hospitals in London as part of a multi-disciplinary team managing snoring and sleep apnoea, and is Visiting Professor of Orthodontics at the BPP University.
The Somnowell mandibular advancement appliance is also recommended by:
- Sleep Centres
- ENT Surgeons, Sleep Physicians, Respiratory, Physicians
- Orthodontists, Dentists
- General Medical Practitioners