Workflow in sleep laboratory

  • We are the only one in the country who performs the entire diagnosis of sleep disorders, focusing on obstructive sleep apnea (OSA) at the ambulatory level.
  • Full diagnostics in performed in our center in Slovenj Gradec.
  • We perform sleep polygraphy, which has been recognized equally as polysomnography in the diagnostics of OSA.
  • Complex identification of patients:  we perform full internistic evaluation, nasoscopy, X-ray of the nose and para-nasal sinuses, allergy testing, metacholine testing (for asthma), exercise testing (CEM or treadmill) and laboratory services, including the determination of gases in arterial blood (PAAK).
  • At the beginning you complete questionnaires on the like hood of sleep disorders (ESS and Berlin questionnaire); score higher than 10/24 speaks likely to have a sleep disorder and score higher than 18/24 very likely to have a sleep disorder (see ESS questionnaire).
  • Device, the size of mobile phone, SomnoLab2 (Weimann) and all relevant sensors are mounted on patient`s chest in our ambulance right after the clinical examination, The device automatically switches on and off after certain time. Overnight it detects position of patient during sleep, snoring frequency and duration of apnea during sleep (Apnea Hypopnea Index, AHI), the level and frequency of oxygen drop in the blood (Oxygen Desaturation Index, ODI), heart rate and rhythm disorders.
  • During investigation patient sleeps in the comfort of his home bed. For patients who are distant from our laboratory and are unwilling to return home for one night, we can arrange spending the night in a local hotel or rural tourism.
  • Patients who have changes in the upper respiratory airway are redirected to ENT specialists, patients who have high weight problems are redirected to bariatric surgeon, and those who have jaw and teeth problems to the orthodontist. The most severe patients with OSA, who are very sleepy during the day and have AHI>25 events per hour, are introduced to therapy with appliances that produce overpressure in the airway (CPAP, APAP…)
  • Entire diagnostics can be either covered by health insurance (residents) or self-paid.
  • The waiting time for clinical examination and screening is up to 7 days and for sleep polygraphy only 1-2 weeks.
  • Waiting times for patients who have services covered by health insurance and those who self-pay are the same.
 
DIAGNOSTICS PROCEDURE:
  • Preliminary examination by specialist (general medicine specialist, pulmonologist, allergologist, diabetologist, neurologist, ORL specialist or cardiologist) who suspected OSA is desirable.
  • Patient is required to bring all previously obtained medical reports and  X-rays of the lungs.
  • ESS questionnaire is completed, which must be positive.
  • Sleep polygraphy and assessment of the nature and degree of sleep disorders are performed in outpatient manner.
  • Polygraph is adjusted at our clinic, patient then goes home to sleep in his own bed. For patients who are very distant from us, we can arrange accommodation in the city youth hotel or at nearby rural tourism in the quiet surroundings of the Pohorje foothills (22 EUR for B&B)
  • All patients are subjected to in-depth and targeted medical history and are entirely clinically examined. If appropriate we perform X-ray of the nose and par nasal sinuses, nasoscopy and inspection of the trachea with optical instruments, allergy testing, lung and heart X-rays, evaluation of lung function, pharmacodynamics tests, ECG and stress testing (CEM).
 
COURSE OF TREATMENT:
We advise therapeutic approach to diseases of the upper and lower respiratory tracts, cardiovascular and related diseases. Hygienic – dietary regime and lifestyle are suggested as well.
Patients with OSA can be divided into three stages:
·         Mild OSA: AHI from 5-15 events per hour,
·         Moderate OSA: AHI between 15-30 events per hour,
·         Heavy OSA: AHI of more than 30 events per hour.
 
Patients with mild to moderate OSA (AHI < 30/hour), who have altered anatomy of the nose, soft palate, tonsil, pharynx or larynx are directed to our ENT specialists with a proposal for preferential treatment. We collaborate with three ENT specialists from Celje, Ljubljana and Maribor, who are deeply involved in the treatment of snorers, who also have OSA.
Patients with changed anatomy of the lower jaw or teeth are diverted to consular dentist or orthodontist, who cure mild OSA (AHI < 15/hour) with jaw prosthesis, which move lower jaw forward and relay the airway (mandibular advancement device) during sleep. We work  with the dentist from Slovenj Gradec and orthodontist from Maribor.
Patients who are overweight  (BMI over 40) are redirected to the bariatric surgeon in Slovenj Gradec hospital. He is an experienced professional who helps to reduce weight utilizing surgical methods.

 

In case of severe OSA (AHI>25) with a significant decline in oxygen saturation in the peripheral blood, titration (testing) is continued at patient`s home. Titration means determining the height of the overpressure which stabilizes the upper airways. It is produced by the testing device which expands the collapsed nose, mouth and throat. Hence, patient stops snoring and apneas disappear.

  • The procedure is very simple and painless.
  • Patient is given a device which produces overpressure to overcome resistance in the patient`s pharynx or throat so he can sleep peacefully and effectively, with no snoring and apnea. The device is named APAP (automatic positive airway pressure), which is automatically and depending on patient response adjusting overpressure in the respiratory tract, most commonly in the range 4-12 cm H2O.  Device  can detect remaining number of apnea (RDI), concentration of oxygen in the blood, heart rate and time use of the device.
  • Patients who live near our laboratory are thought to handle the device at our clinic, for those who are distant from us (more than 75 km) optional visit can be arranged at their home. We acquaint patients with the testing, select the appropriate respiratory mask and teach them how to adjust mask to the face. Patients are then followed for one hour under the control of our experts to ensure adequate sealing or any discomfort or tightness of the mask.
  • After one or two days of testing (titration), which is carried out by the patient at home, the computer record of the patient`s response to APAP (RDI, ODI, heart rate, required overpressure in the respiratory system, mask sealing…) is verified in the clinic. If the response is appropriate, CPAP or APAP machine is prescribed.
  • Our laboratory is authorized to act on behalf of our main insurance company to prescribe CPAP device.
 
 
SELF-PAID DIAGNOSTICS
Self-paid diagnostics is the same as the one paid by health insurance.
Price of sleep polygraphy is 100 EUR and the price of titration is also 100 EUR (for two nights).
Other necessary tests are carried out in agreement with patients at the official price list, which is available at our website (http://www.pulmolog.com/cenik-samoplacniske-storitve.html)