1. Diagnosis of Sleep Apnea
Caglar CUHADAROGLU
Acıbadem University

2. What has been changed? Sanscrits- Stiuation of human being
Ibn Sina- Avicenna- Law of Medicine
Robert Macknish- Phylosophy of Sleep
Charles Dickens- Pickwick Paper

3. Same Clinical evaluation
Symptoms
History
Physical Examination

4. Changed Laboratory
Questionaires
Event definitions
Diagnostic technics

5. Symptoms Snoring Witnesess Apnea Unsatisfied sleep Daytime sleepiness
Memory loss
Headache
Failure in school performance
Epworth Slepiness Scale

6. Questionaires Sleep Questionnaires STOP-BANG Questionnaire
Berlin Questionnaire
Wisconsin Questionnaire

7. STOP-BANG Questionnaire
S: Snoring
T: Tired
O: Observed
P: Pressure (Hypertension)
B: Body Mass Index > 35 Kg/M2
A: Age > 50 years
N: Neck circumference >17” in M >16” in F
G: Gender= Male
Low Risk : Yes to questions Intermediate Risk : Yes to questions High Risk : Yes to questions or Yes to 2 or more of 4 STOP questions + male gender or Yes to 2 or more of 4 STOP questions + BMI > 35kg/m2 or Yes to 2 or more of 4 STOP questions + neck circumference > 17 inches in M or 16 inches in F

8. Examination
Obesity
Upper respiratory system

10. Event Definitions

12. Hypopnea

14. RERA
Score a RERA event if there is increased respiratory effort/ flattening of inspiration for ≥10 seconds leading to an arousal but the event does not qualify as an apnea or hypopnea.

15. Hypoventilation
Score a respiratory event as hypoventilation during sleep if EITHER of the below occur:
a. There is an increase in the arterial PCO2 (or surrogate) to a value >55 mmHg for ≥10 minutes.
b. There is ≥10 mmHg increase in arterial PCO2 (or surrogate) during sleep (in comparison to an awake supine value) to a value exceeding 50 mmHg for ≥10 minutes.2

16. Cheyne Stokes Breathing
Score a respiratory event as Cheyne-Stokes breathing if BOTH of the following are met:
There are episodes of ≥3 consecutive central apneas and/or central hypopneas separated by a crescendo and decrescendo change in breathing amplitude with a cycle length of ≥40 seconds.
There are ≥5 central apneas and/or central hypopneas per hour of sleep associated with the crescendo/decrescendo breathing pattern recorded over ≥2 hours of monitoring.2

17. Cheyne Stokes Breathing
Crescendo- Decrescendo pattern
10 Seconds
Cheyne Stokes Breathing

18. Sleep Studies Polisomnography Type portable devices Sleep Staging
Cardiorespiratory parameters
RERA
RDI
Expensive
Gold standart
Type portable devices
Cardiorespiratory parameters
Cheap
Less scoring time
AHI

20. Definition