Pat McBride teaches us to read diagnostic sleep tests

1. The Dental Sleep Medicine Paradigm
Diagnostic Sleep Interpretation
“Changing Lives, One Breath at a Time”
Pat Mc Bride, BA,RDA,CPSGT, CCSH, Sleep Clinician
Board of Directors American Academy of
Physiological Medicine and Dentistry
Sleep Scoring and Reporting 2016

2. Disclosures
AAPMD, ATS
Consultant for:
CA Centers for Sleep Disorders
Respiratory Medical Group
John Muir Physicians and Surgeons
Contra Costa Sleep Centers
Faculty Member for Metz Sleep Continuum
Hang Orthotropic Post Doctorate Residency
Staff Writer for “Talk About Sleep”
Dental Sleep Practice Journal
Private Clinical Practice
Practice Management & Consulting for Sleep

3. How Do we Score Sleep?
⦿ Scoring a sleep study is divided into 4 parts:
⦿ 1) Scoring sleep stages
⦿ 2) Scoring respiratory events
⦿ 3) Scoring arousals
⦿ 4) Scoring periodic limb movements

4. Scoring and Staging Basics
⦿ Read between the lines
⦿ EEG takes precedence over EOG & EMG
⦿ Pattern Recognition
⦿ Sleep architecture
⦿ Score sleep stages in 30 second sequential epochs (from
Lights Out to Lights On)
⦿ Assign a stage to each epoch
⦿ •If 2 or more stages exist in a single epoch, assign the
stage comprising the greatest portion of the epoch
(majority rules).

5. Wake

6. N1

7. N1

8. N2

9. N3

10. REM

11. EOG changes in REM Sleep

12. TRANSITIONING IN AND OUT

13. Obstructive Apnea

14. Central Apnea

15. Mixed Apnea

16. Hypopnea

17. RERA
respiratory effort related arousal

18. UARS

19. No Desat = Nothing Wrong
Failed philosophy and myopic thinking

20. Orphan Syndrome

23. IFL Noted on PES Study

25. Cheynes-Stokes
Chemoreflexive Breathing

26. Arousals

27. Arousal in REM

28. PLM’s / Periodic Limb Movement

29. PLM

30. PSG vs HST Understanding what you DO
and DON’T Get

33. Treatment Tolerance

36. Testing and Reporting Issues
⦿ Slow turn around time for results
⦿ Interpreters failing to review raw data
⦿ PSG analysis by automated scoring algorithms
⦿ Tweaking analysis to under score data
⦿ Tweaking analysis to meet reimbursement
criteria
⦿ Failure to report/count RERAS
⦿ Poor/incomplete reporting to Physicians and
Dentists

37. System Fails the Patient
⦿ Under testing children
⦿ Inappropriate set up for children’s testing
⦿ Lack of sufficient knowledge to refer
⦿ Access to PES
⦿ Access to care– is HST the answer?
⦿ Thin Fit Females
⦿ The insomnia Patient
⦿ The daily Headache Patient

38. Partnership Fosters Understanding