Accepting Ideas that Lead to Improved ENT Care

Sleep Disorder Diagnosis

Sleep disorders which lead to sleep loss affects an estimated 50–70 million Americans and is an under-recognized public health problem. Left untreated, chronic sleep loss not only produces waketime sleepiness/fatigue and diminishes quality of life but also is associated with high blood pressure, cardiovascular and cerebrovascular disease, cognitive disturbances and memory problems, headaches, weight gain, impotency, and depression. Obstructive sleep apnea (OSA), the most common breathing-related sleep disorder, is relatively easy to diagnose and effective treatment is available. However, 80–90% of adults with OSA remain undiagnosed and untreated.  Lack of awareness of OSA and its potential consequences, and limited access to diagnostic facilities are major contributing factors to its poor recognition. To have an impact on improving outcomes of patients suffering from sleep disorders, it is important that ENT physicians serving as the specialty best skilled to recognize, diagnosis, and manage common sleep disorders such as OSA begin to dominate this market. Additionally, it is critical that the individuals treating these disorders gain the ability to better diagnose the region in the anatomy where the obstruction is occurring.


SleepSleep Medicine providers and health insurance companies have finally realized that early detection is more cost-effective and conveniently manageable than the deadly consequences of apnea-related diseases such as obesity, hypertension, heart failure, stroke, sexual dysfunction, and depression. This has led to the growing number of diagnostic sleep disorder procedures performed each year. The three major anatomical regions that need to be evaluated for accessing the extent of the potential obstructions is; the Nasal Cavity, the Soft Palate and the Tongue Base. Only a trained health care provider, such as an otolaryngologist, can examine these regions with and endoscope. In addition to an endoscopic exam, sleep studies are conducted to determine the scale of a patient’s OSA.


There are two major sleep study tests that are widely accepted:


Home Sleep Test


A Home Sleep Test (HST) is conducted at the home of the patient. This test is specifically designed to assist in the diagnosis of sleep disordered breathing, specifically Sleep Apnea. The test is convenient for the patient and many experts agree that testing the patients sleep in their normal home environment offers many advantages to the laboratory setting that is admittedly uncomfortable for the patient.


The process for this test is to have and ENT physician screen patients for sleep abnormalities during their routine or referred visits. When abnormalities are found, the ENT will dispense a take home device that they have available in their office. The patient will take the device home, wear it that evening while they sleep, and return it to the physician's office the next day. Results will be available usually within 24 hours. Based on the results, the ENT physician can (a)  rule out OSA (b) diagnose OSA and discuss a treatment strategy or (c) prescribe further testing or sleep endoscopy to be performed in a sleep laboratory using PSG.


An overnight PSG (Polysomnogram)


This test is conducted in a sleep lab or hospital setting. It requires the patient to stay in the sleep lab of hospital overnight which can be inconvenient. It is an expensive process (hospital setting, sleep technician, often manual scoring) and many sleep centers are operating at full capacity so there is often a 3-4 week wait. It is widely agreed that PSG is a thorough and reliable test when the patient completes the process.


New Diagnostic Procedure:


Real Time Sleep Endoscopy


Whatever type of sleep study is performed, additional information is required to better localize the anatomic site causing obstruction or leading to snoring. Sleep endoscopy involves having patients wear a small camera device placed within the oropharynx by an ENT in the office prior to the sleep study.  As patients begin to begin experiencing an apnea episode and blockage within their breathing pathway, the micro-cameras will capture the images for evaluation of the oropharynx and observe the anatomical obstruction (blockage) of breathing in the soft palate and or tongue base regions. This is not obtainable in any other manner and with any other device other than the SleepVue device from Acceptent.


There are two major reasons that ENT’s need to perform sleep endoscopy: First, to obtain accurate information regarding whether their patients have obstructive blockage of breathing at the palate and/or tongue base regions and second, to determine which specific structures seem to be playing a  role in causing obstructive sleep apnea (OSA). This vital information will allow the otolaryngologist to accurately diagnosis the problem and offer the best treatment outcome for their patients.  This is also true for patients who are considering surgery for the first time and in those who have not obtained ideal results after previous treatment procedures.