The Dental Sleep Medicine Paradigm Diagnostic Sleep Interpretation

“Changing Lives, One Breath at a Time”

Pat Mc Bride, BA,RDA,CPSGT, CCSH, Sleep ClinicianBoard of Directors American Academy of

Physiological Medicine and DentistrySleep Scoring and Reporting 2016

Disclosures AAPMD, ATS Consultant for:

CA Centers for Sleep Disorders

Respiratory Medical Group John Muir Physicians and Surgeons

Contra Costa Sleep Centers Faculty Member for Metz Sleep Continuum Hang Orthotropic Post Doctorate Residency

Staff Writer for “Talk About Sleep” Dental Sleep Practice Journal

Private Clinical Practice Practice Management & Consulting for Sleep

How Do we Score Sleep?

⦿ Scoring a sleep study is divided into 4 parts: ⦿ 1)  Scoring sleep stages ⦿ 2)  Scoring respiratory events ⦿ 3)  Scoring arousals ⦿ 4)  Scoring periodic limb movements

Scoring and Staging Basics

⦿ Read between the lines ⦿ EEG takes precedence over EOG & EMG ⦿ Pattern Recognition ⦿ Sleep architecture ⦿ Score sleep stages in 30 second sequential epochs (from

Lights Out to Lights On) ⦿ Assign a stage to each epoch ⦿ •If 2 or more stages exist in a single epoch, assign the

stage comprising the greatest portion of the epoch (majority rules).

Wake

N1

N1

N2

N3

REM

EOG changes in REM Sleep

TRANSITIONING IN AND OUT

Obstructive Apnea

Central Apnea

Mixed Apnea

Hypopnea

RERA respiratory effort related arousal

UARS

No Desat = Nothing Wrong Failed philosophy and myopic thinking

Orphan Syndrome

IFL Noted on PES Study

Cheynes-Stokes Chemoreflexive Breathing

Arousals

Arousal in REM

PLM’s / Periodic Limb Movement

PLM

PSG vs HST Understanding what you DO and DON’T Get

Treatment Tolerance

Testing and Reporting Issues⦿ Slow turn around time for results⦿ Interpreters failing to review raw data⦿ PSG analysis by automated scoring algorithms⦿ Tweaking analysis to under score data⦿ Tweaking analysis to meet reimbursement

criteria⦿ Failure to report/count RERAS⦿ Poor/incomplete reporting to Physicians and

Dentists

System Fails the Patient⦿ Under testing children⦿ Inappropriate set up for children’s testing⦿ Lack of sufficient knowledge to refer⦿ Access to PES⦿ Access to care– is HST the answer?⦿ Thin Fit Females⦿ The insomnia Patient⦿ The daily Headache Patient

Partnership Fosters Understanding