Sleep Apnea

Sleep Apnea Diagnosis, Avoiding Misdiagnosis

Posted on 06. Dec, 2009 by admin in Problems and Pitfalls of Identifying Sleep Apnea

The following are 10 rules for avoiding misdiagnosis:

1. Select an accredited sleep center and be evaluated by a physician who has specialized in sleep disorders.

How can you know if the sleep center and the physician are accredited? Call the American Academy of Sleep Medicine (AASM) in Rochester, Minnesota (507-287-6006), and ask them for the nearest accredited sleep specialist or sleep center, or find a list of accredited sleep centers on their web site http://www.aasmnet.org. Or you can ask whether a particular sleep lab has been accredited by the AASM or whether a particular physician is “board certified” as a specialist in sleep disorders.

If you live in an area without accredited sleep labs, or if you belong to an HMO that is not associated with an accredited sleep center, you may be able to find a good sleep lab that is not accredited. In that case, ask your HMO or your state medical society to refer you to a physician who has had formal training in the treatment of sleep apnea. Ask for evidence that you are being treated by a physician who is trained in sleep disorders. If it is clear that your HMO does not have access to a trained physician, consider appealing to the administration and obtain a referral to the nearest accredited sleep lab.

Accreditation is the consumer’s best signpost for locating a competent sleep center. A physician earns accreditation in sleep disorders medicine by passing a rigorous two-day examination. To be sure you are being treated by someone who is a certified sleep expert, ask the following question: “Have you passed the examination for sleep specialists given by the American Board of Sleep Medicine?” If you are hesitant about asking your doctor this question directly, you can telephone his office and ask his receptionist the question. If she does not know the answer, ask her to find out and call you back.

2. Be sure that your sleep study is performed at night or during your usual sleep hours.

If you are told to “stay awake all night and then come into the laboratory in the morning to have your sleep test,” find another sleep center.

If you are a shift worker and are accustomed to sleeping during the day, either have your study during the day or switch back to sleeping at night for at least three nights before going into the lab for a sleep study at night.

3. If you are sleepy while driving and working, be sure that a Multiple Sleep Latency Test (MSLT) is performed on the day following your nighttime sleep study.

An MSLT will establish the severity of your daytime sleepiness. It also will help rule out other causes of sleepiness (e.g., other sleep disorders) and provide a baseline to refer to if fatigue and sleepiness continue after the apnea has been treated.

4. Be sure that you have had a recent thorough physical examination and laboratory studies, preferably with your own physician, who knows your past health problems and has all your records available.

This will avoid duplication of tests.

5. Be sure you have a thorough examination of your throat, preferably by an ear, nose, and throat specialist (also known as an ENT specialist or otolaryngologist) who is experienced with sleep apnea.

6. If CPAP is recommended, be sure you are studied with CPAP in the sleep laboratory, so that the proper air pressure can be established to control your obstructive apnea.

This may mean spending a second night in the laboratory. If CPAP is prescribed for you and you are simply told to “go home and try it out,”  find another sleep center.

7. If surgery, oral devices, medications, or weight loss are prescribed for you, be sure to have a sleep study to establish a baseline, so that it can be determined whether you are benefiting from the treatment, and if so how much.

People often feel better after treatment begins and think they are “cured” when, in fact, they are only partially improved. Further treatment or careful follow-up may be necessary.

8. If you are diagnosed as having obstructive apnea but you believe that you have other reasons for feeling tired or drowsy or for having restless sleep, be sure to discuss them with your physician. It is possible that sleep apnea may not be the most important cause of your symptoms.

A trial with CPAP in the sleep lab is a good way to find out how many of your problems are caused by sleep apnea. CPAP safely eliminates any sleep apnea that you may have, and you can then be the judge of whether you feel better or still have troublesome symptoms. If you are in doubt about how important sleep apnea is in causing your drowsiness, return to the laboratory for a trial with CPAP.

The opposite is also true: you may believe that you have fairly serious sleep apnea symptoms even though your sleep test may say that your apnea is too mild for treatment. If this is the case, you may be one of those individuals who is very sensitive to sleep disruption from apnea. Discuss this possibility with your doctor. A trial with CPAP would be very helpful in letting you judge how much improvement you feel after the apnea is eliminated.

9. If sleep studies show that your apnea is well controlled but you continue to be sleepy, feel fatigued, or experience sleep disturbances, be sure that your doctor has considered and ruled out other conditions that might be causing those symptoms.

As many as 20 percent of patients with sleep apnea have other undiagnosed sleep disorders that may not be obvious until the sleep apnea is diagnosed.

10. Be sure that stress factors, depression, sleep habits, and drug and alcohol use have been thoroughly discussed with you

Unless the physician carefully questions you about these areas, they may continue to be problems that neither you nor your doctor fully understands! Two case studies show how unexpected factors can strongly affect the results of treatment for sleep apnea.

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Tags: Misdiagnosis, Sleep Apnea Diagnosis