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1. Full Polysomnography
This is the most detailed assessment for patient suspected to have sleep apnea. It is a very comprehensive test. After the patient is connected with all the sensors, the patient will sleep as usual and when he wakes up in the next morning, all the dad will be collected and then analyzed. The test can be done at home or in hospitals.
The assessment of sleep apnea by sleep study will tell us whether the patient has central or obstructive sleep apnea, the severity of the conditions, its relation with various sleep stages and associated desaturation, changes in heart rate, snoring and leg movement.
1. Endoscopic Assessment
The endoscopic examination is a very important part in the assessment of patient suspected or diagnosed to have obstructive sleep apnea. The endoscopic examination typically start with the examination of the nasal cavity, then the velopharynx and lastly the hypopharynx. This will allow the identification of any significant nasal, velopharyngeal or hypopharyngeal pathology that may contribute or cause the obstructive sleep apnea and will also help our consultant to decide on the treatment plan for each individual patient
1. PAP Machine
The PAP machines are commonly divided into the simpler CPAP (continuous positive airway pressure) machine and the more sophisticated BiPAP (bi-level positive airway pressure) machine. The CPAP machines are further divided into fixed pressure machine and auto pressure machine. These machines pumps air through tubings and a nasal mask or face mask to keep your airway open. Other accessories including chin strap and humidifier will give further help in special situations.
The fixed pressure CPAP machine delivered a fixed and usually higher pressure than the patient usually needed constantly. It is a cheaper and yet effective machine that can keep the airway open. To define the fixed pressure to be used, another night of sleep study with the PAP machine attached will be needed.
The auto pressure CPAP machine comes with a computer that can adjust and titrate the airway pressure needed to keep the airway open at that particular time. Thus the patient will not receive a higher than needed pressure most of the time and gives extra comfort and ease, and hence a better compliance.
1. When to consider surgical management
Surgical management is regarded as the second line treatment of OSA patients, reserved for those who could not tolerate PAP machines therapy, or those who want a one-off solution to the OSA problem without resorting to everyday uses of PAP machines.
The advantages of surgical management is that it offered a almost one-off treatment options that could potentially have long lasting effects in treating obstructive sleep apnea. Unlike PAP machines which can overcome almost any kinds of obstructions in the airway, the surgical patients must have the locations and patterns of obstruction correctly identified and properly dealt with before a good results would be expected. So it poses a more challenging goal in making the right diagnosis of what is causing the obstruction, and making the right choices of surgical procedures that correctly deal with the specific type of obstruction.
Furthermore, surgical management is regarded as successful with a reduction of 50% or more in the RDI, and abolishing almost all of the desaturation episodes. More than 80% of patients will be able to experience marked symptomatic improvement. The reduction in RDI although is not complete, can convert the moderate and severe OSA into the mild to moderate severity. Since the mortality rate of heart attacks and stroke are very high in patient suffering from severe OSA, yet the mortality rate is similar between normal and mild OSA patients, so surgical management is still considered as a good and safe management options for OSA patients.