How a Muti Disciplinary Sleep Clinic Work

Following is a brief outline of a recent clinic day at CSSC.

Patient 1: Young, overall mild sleep apnea but predominant when lying flat in REM sleep according to the sleep study. Endoscopic examination of the airway showed there was base of tongue collapse with no soft palate collapse, no side wall collapse, and previous tonsil surgery. The patient was considered best suited for a mouth guard, less suited for surgery. CPAP would be over-treatment. The patient was referred for a 3D printed nylon mouth guard (MAS). The patient understood the reasons and was very happy with the outcome.

Patient 2: BMI of 40. Very sleepy. The sleep study showed severe sleep apnea. Endoscopy showed severe collapse of the soft palate, sidewall of the airway, and broad base of tongue collapse, along with reflux-related changes. The primary treatment modality will be an APAP trial (automated pressure CPAP) for four weeks. If it fails, surgery could be a second-line option with combination therapy (combined with weight loss, a side position device, or a mouth guard). The reflux that we diagnosed will be managed with diet and medications. Weight loss surgery was also considered appropriate. We plan to review in 4 weeks after the APAP trial.

Patient 3: Young with a high-intensity job. Very tired and very sleepy. Sleep study showed sleep apnea in all sleep positions. The endoscopic assessment showed tonsil collapse, severe soft palate, and midline base of tongue collapse. The patient was considered moderately suitable for surgery. The plan was a CPAP trial for four weeks, and if not tolerant, to offer surgery.

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Patient 4: Young, high-intensity job and extremely sleepy (sleepiness score - 18/24). Severe sleep apnea. Found to be a good candidate for surgery from endoscopic findings. However, recommended to trial CPAP first. When symptoms are worse than expected, as in this case, CPAP can also help determine if all the symptoms are related to sleep apnea or if there is another cause (such as narcolepsy). If this level of sleepiness was only related to sleep apnea, the patient should feel much better during the CPAP trial. Plan to review in four weeks, and if intolerant of CPAP, modern sleep surgery to be offered.

Patient 5: young and fit but overweight (BMI 29). Severe supine position sleep apnea, small jaw, underbite, and severe tongue collapse. Tried CPAP in the past and it was unsuccessful. Disappointed by that, has not tried any other treatment.

The endoscopic assessment showed a predominant base of tongue collapse with no sidewall collapse and some soft palate collapse. Found to have ideal anatomy for treatment with a 3D-printed mouthguard followed by a repeat split sleep study (1/2 the night's sleep assessed with the mouthguard on). The patient was happy with the plan.

Patient 6: Saw a sleep doctor/sleep psychologist and failed to use CPAP due to anxiety and insomnia. Referred for surgery but had some medical co-morbidities. We noted in the sleep study that restless legs syndrome was causing insomnia, which was then causing intolerance to CPAP. We also noted that the patient was vegan with possibly low iron levels, which can cause restless legs. Planned for iron studies and medication for restless legs and insomnia and re-trial of CPAP. If still failed, plan for modern sleep surgery after optimizing general health, as the patient had suitable anatomy. Review in 4-6 weeks.

Patient 7: Tried CPAP and it was unsuccessful. The patient has a very small jaw and difficult surgical anatomy but preferred surgery over a device and completed surgery five weeks ago. Recovering well with no complications. Symptoms are already 30% better and likely will be 50% or more when fully recovered. Will be seen in a sleep clinic in two months with a follow-up sleep study. Will obtain a side positioning device due to residual tongue collapse when lying flat.

Patients 8/9 are two weeks after modern sleep surgery. No complications. No deviation from the expected pathway for an excellent outcome.

Patient 10: Had severe sleep apnea and was intolerant of CPAP due to nasal obstruction. Diagnosed with severe nasal polyps. Had surgery and recovered with excellent nasal function. Sleep symptoms have improved significantly. The patient wished not to repeat the sleep study or use CPAP due to improved symptoms. GP was notified and will be managed by GP hereon with advice to repeat the sleep study when the patient is ready and retry CPAP.

This once again is a typical sleep clinic day. This holistic approach to treating sleep apnea stems from the two doctors' desire to combine their knowledge and skill to bring the best possible care for the patient. This level of care, assessment, education, and tailored treatment has resulted in high patient satisfaction and very high overall success.

Disclaimer: The material and information contained in this blog are relevant to the time it was written, for general purposes and in addition to what was provided for patients during their consultation. You should not rely upon the material on this website as a basis for decision-making..

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