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speciAl feAture Sleep Talking By Michael Ferguson iN the e x aM RooM B ECAUSE SLEEP DISORDERS can lead to life-threatening complications, early diagnosis and treatment are ideal. Unfortunately, many of these disorders can easily be overlooked during routine physical exams, says Stephen Swierczek, RRT, RPSGT, Administrative Director of Sleep Laboratories at St. Joseph's Hospital. With this in mind, providers at the Sleep Lab at St. Joseph's Hospital avail patients of expedited access to sleep studies to confirm or rule out such conditions. "A major portion of the population goes undiagnosed and untreated for sleep disorders," Swierczek says. "Our aim is to reduce the number of sleep disorder-related comorbidities, as well as the incidence of heart disease, stroke and diabetes — all potential complications of obstructive sleep apnea." One major reason these conditions go undiagnosed is that frequently, the potential link between symptoms such as morning A sleep study patient rests comfortably in the Sleep Lab facility. 6 | Central New York MD News ■ MDNEwS.COM headaches and obstructive sleep apnea is not apparent. Upon identifying certain issues during a physical examination, the provider should follow up with specific questions regarding sleep patterns to paint a complete portrait that includes the patient's likelihood of having obstructive sleep apnea. what to Look For Sherif El Bayadi, MD, FCCP, FAASM, Medical Director of affiliated Sleep Centers at Oneida and Carthage, explains that a little detective work can yield supporting evidence if physicians suspect sleep apnea. Enlarged tongue, tonsils or soft palate — observed in concert or individually — may crowd patients' airways and contribute to increased likelihood of obstructive sleep apnea, Dr. El Bayadi says. Neil Widrick, BS, RRT, RPSGT, RPFT, Manager of Sleep Laboratories at St. Joseph's Hospital, adds that, while examining physical structures, it's advisable to consider the patient's neck size. Genetically inherited larger necks — greater than 17 inches for men and 16 inches for women — may contribute to airway obstructions while patients sleep, due to increased pressure on the throat. "The areas that produce snoring, which are the areas we worry about closing during sleep apnea, are in the neck," Widrick says. "The more weight patients have on their throats, the higher the probability of the airway collapsing at the back of the throat. Breathing cessation or snoring is the result." Additionally, medical conditions such as systemic hypertension, resistant hypertension, atrial arrhythmia, obesity and diabetes often accompany obstructive sleep apnea — and suggest a greater likelihood of the condition, Dr. El Bayadi says. Because many signs of obstructive sleep apnea aren't readily identifiable upon physical By Michael Ferguson examination, he emphasizes the importance of taking time to talk with patients regarding their sleep habits. Asking the Right Questions This past March, St. Joseph's Hospital opened a new, American Academy of Sleep Medicine-accredited, 16-bed sleep laboratory at its North Medical Center Complex in Liverpool, N.Y. According to its specialists, taking detailed patient histories that include the following questions can help primary care physicians identify signs of sleep apnea: + Are you excessively tired during the day? For example, discovering that patients cannot make it through an afternoon movie without falling asleep may signify excessive daytime sleepiness often associated with obstructive sleep apnea. + Do you snore? Bed partners are the best evidentiary sources for signs of obstructive sleep apnea. If the person who shares a bed with the patient is present at the exam, his or her input can be invaluable. Obstructed airways that produce snoring can worsen into fully obstructed airways, preventing patients from breathing, possibly ending in death. + Do you t a l k in your sleep? Additionally, asking bed partners if the patient verbalizes while sleeping may provide evidence of parasomnias, Dr. El Bayadi notes. "Verbalization can be normal in some circumstances, but at the right time of night and associated with excessive movement during sleep and with certain findings on physical exams and patient histories, it might be abnormal," Dr. El Bayadi says. "In these cases, it is PHOTOS © FRANCiSCAN COMPANieS When is a headache just a headache, and When is it a sign of a sleep disorder? learn the questions to ask and When to refer to an accredited sleep lab.