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    New Test Predicts Obstructive Sleep Apnea

    Is your husband or wife's snoring keeping you awake, and, if so, do you think it's a serious problem? A new simple test may distinguish between snoring and a more serious condition called obstructive sleep apnea (OSA). Researchers from Calgary, Alberta, Canada, presented the results of their study on May 8 at the International Conference of the American Thoracic Society conference in Toronto, Canada.

    In normal people, sleep decreases respiration and slows their metabolism. But if breathing ceases because of an obstruction in the upper breathing passages, or the muscles of the throat are unable to keep passages open, a person wakes suddenly and periodically during sleep, a condition called OSA.

    About four percent of men and two percent of women suffer from OSA. Brief and frequent lapses in breathing cause changes in levels of their blood gases: carbon dioxide levels increase and oxygen levels decrease. Apnea causes erratic and sometimes rasping noises, similar to snoring, as the person struggles to breathe and the brain responds by triggering breathing mechanisms in the diaphragm and chest. As a result, the person may wake up as often as 150 times an hour for about 10 seconds each time, long enough to take a few breaths and correct blood gas levels. People with the condition often wake up in the morning exhausted, as OSA disrupts critical sleep stages.

    Traditionally, apnea is diagnosed with laboratory sleep studies that are expensive and time and labor intensive. Presenting his team's results in Toronto, Dr. Willis H. Tsai of the University of Calgary and Alberta Lung Association Sleep Center, says that, "We wanted to develop a simple method to determine if someone has sleep apnea, or, more importantly, rule it out so they don't have to undergo a sleep study."

    The researchers tested 75 people that had been referred to the Canadian sleep center to evaluate their OSA. Patients were excluded if they had insomnia, severe chronic obstructive pulmonary disease, or restless leg syndrome.

    Tsai and his colleagues looked at well-known risk factors including age, hypertension, witnessed sleep apneas, body mass index and neck circumference. "But the difficulty for doctors is to integrate risk variables into a predictable decision rule to determine sleep apnea."

    Tsai found he could simplify predictive variables into three measurements: the cricomental space (the distance between the underside of the chin and the Adam's apple), the pharyngeal grade (the extent of narrowness at the back of the throat) and the presence of a dental overbite. If the space was less than one and a half centimeters, the pharynx was narrow and an overbite was present, then the risk of OSA increased.

    "We believe this is a simple, low-tech method to diagnose the condition. And if you know you have diagnosis, you can start treatment early."
    If the patients had more than 10 apneas per hour, then they were diagnosed with OSA. Also, if patients had all three predictive variables, researchers could predict OSA in 96 percent of them.

    Sleep apnea is more common in men than women, in people that snore and in obese people.

    Doctors are currently using Dr. Tsai's test at the University of Calgary and the Alberta Lung Association Sleep Center.



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