The Physicians' Page for Snoring and Sleep Apnea Information and Treatment
 

The Sleepy Patient

Patients with daytime somnolence can best be identified with the Epworth or Berlin questionnaires. Ideally, these patients require polysomnography (PSG) in a sleep lab. Unfortunately in the lower mainland of B.C., we only have 4 such labs, with significant wating times(depending on priority). As a result, we are using overnight oximetry in the patient's home to establish the likelihood of significant sleep apnea in a somnolent patient. The following algorithm indicates how we currently manage these patients. The Centre emphasizes that this is far from ideal, and if patients live elsewhere, or are willing to travel elsewhere, we encourage them to have a polysomnogram undertaken before presenting to us. Ontarians for instance have virtually no wait at all for PSG.

More recently, home sleep studies involving oximetry, airflow and chest movement  (so called "level 3" studies) have been introduced in the USA as a practical and cost effective means of diagnosing OSA without recourse to a sleep lab. In Canada this has not yet been accepted by the Provincial Insurance agencies, although it can be done as a privately purchased investigation, or when covered by the patient's third party insurance. The algorithms below do not allow for home polysomnography.

• "Sleepiness in BC" Algorithm Diagram (HTML) 
• "Sleepiness in BC" Algorithm (PDF) 
    

In the following text a reference is made by a number like this (1). See reference list at the bottom of each page. Here are some definitions and statistics relating to the more common symptoms and treatments:

• Sleep Disordered Breathing 
   
• Habitual Loud Snoring 
   
• Obstructive Sleep Apnea in Children
   
• The Pillar Implant Procedure
   
• Radiofrequency Palatal Myoplasty (RPM), Also known as somnoplasty
   
• Laser Assisted Uvulotpalatoplasty (LAUP)
   
• Uvulopharyngopalatoplasty (UPPP) 
   

News

• New Surgical Procedures for Snoring and Obstructive Sleep Apnea
   
• News In Sleep Disordered Breathing
   
• Driving Risks in Obstructive Sleep Apnea (OSA)
   
• Intergrated Care For Sleep Disordered Breathing
   
• The Relationship Between Sleep Apnea and Obesity
   
• BCMA guidelines for the Assessment and Management of Obstructive Sleep Apnea in Adults (59kb PDF) 

Referral 

• Intergrated Care For Sleep Disordered Breathing
   
• Sleep Prescription Form (40kb PDF)
   
• CanSleep Services Inc.