The gold standard for diagnosis is a Polysomnography (PSG), or, sleep study. This test is performed while the patient is asleep at a sleep laboratory, and monitors brain waves, blood oxygen levels, heart rate and breathing, as well as eye and leg movements. A home monitoring device may be a useful alternative for some patients under the guidance of a knowledgeable sleep professional.
However, the sleep test itself does not provide the location of the obstruction, so evaluation methods of the upper airway are necessary to identify potential sites of collapse that lead to OSA.
Nasopharyngoscopy is an office procedure in which a flexible fiberoptic endoscope is introduced through the nose and throat to observe anatomical structures that narrow the airway and compromise airflow and cause snoring.
Sleep endoscopy is similar to Nasopharyngoscopy, however it is performed under mild sedation (with an hypnotic drug, such as propofol) and it is an outpatient procedure. The objective of this test is to reproduce what occurs to the patient's upper airway in a sleep state, and identify structures and areas causing the obstruction.
Still under our research protocols, imaging methods such as computerized tomography scans (CTs), awake and sleep magnetic resonance imaging (MRI) may provide useful information as well in select candidates. CTs are routinely used in the pre-operative evaluation of patients who undergo any surgery that involves the facial skeleton such as maxillomandibular advancement.
These tools should be used together to establish a diagnosis and guide the physician's decision-making towards the appropriate treatment for each patient.
Left:Narrowed airway in OSA patient | Right:Airway on normal patient
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