Patient Name: Bob Bruxism
Date of Birth: 9/11/1976
Study Date: 11/10/2010
PORTABLE SLEEP MONITORING REPORT
PATIENT INFORMATION:
This 34 year old male was referred for a type 3 portable sleep study. The study was conducted using the Nox T3 home sleep testing device. The test was conducted to investigate the possibility of sleep disordered breathing.
The study included the following channels: EKG, EMG, Nasal-Oro pressure, snoring, thoracic and abdominal RIP effort belts, actigraphy, oximetry, heart rate and body position.
IMPRESSION:
There was bruxism, snoring, apneas and hypopneas associated with arterial oxygen desaturations. The number of bruxism events was 45 providing ABI of 0.9. The overall apnea/hypopnea index (AHI) was 17.5. The supine apnea/hypopnea index was 17.5. The mean arterial oxygen saturation was 94%. The lowest arterial oxygen saturation was 86%.
Findings are consistent with severe sleep related bruxism 327.53 moderate obstructive sleep apnea syndrome 327.23.
Impression
Findings are consistent with
1. Sleep Related Bruxism.
The Bruxism count was 45 events, an average of 5.2 per hour
The ABI (Apnea Bruxism Index) was 0.9. (range 0.0 to 1.0)
2. Moderate Obstructive Sleep Apnea.
RECOMMENDATIONS:
3. Proper sleep hygiene should be reviewed.
4. Consider behavioral therapy such as weight reduction as appropriate for this patient.
5. Consider advising patient against the use of alcohol or sedatives in so much as these substances can worsen excessive daytime sleepiness and respiratory disturbances of sleep.
6. Consider advising patient against participating in potentially dangerous activities while drowsy such as operating a motor vehicle, heavy equipment or power tools in so much as it can put them and others in danger.
7. Consider advising patient of long term consequence of OSA if left untreated, need for treatment & close follow up.
Recommendations:
8. Since the ABI is relatively high, consider a dental consultation for an oral appliance.
9. This patient has moderate OSA. Therapeutic options include:
a. The patient may benefit from the use of a nocturnal mandibular repositioning appliance. If that line of therapy is to be pursued, the patient should be evaluated by a dentist specialized in the treatment of sleep related breathing disorders taking into account the presence of Bruxism.
b. An ENT consultation which may be useful to look for specific causes of obstruction and possible treatment options.
c. Consider treatment with nasal continuous positive airway pressure (CPAP). If the patient chooses CPAP therapy, a nocturnal PSG with CPAP titration is recommended. As an alternative, an Auto PAP with pressure range 5-20 cmH20 with download is an option.
DISEASE MANAGEMENT CONSIDERATIONS:
Perioperative complications are more likely during surgery or recovery as a result of general anesthesia, sedatives and/or narcotic pain relief medication in a patient with significant untreated OSA. Routine follow-up efficacy testing should be performed when non-CPAP therapies are prescribed since weight gain, age, alcohol consumption, and/or time spent sleeping supine can increase OSA severity.
Thank you for the referral of this patient. If we can be of further assistance, please feel free to contact us.
Sincerely,
______
Chandra Matadeen-Ali, MD
Diplomate ABIM-Sleep Medicine
11/14/2010