Snoring & Sleep Apnea
Dr. Zemplenyi firmly believes that severe snoring, whether or not associated with sleep apnea, is a significant medical problem. Sadly however, medical insurance plans exclude surgery for severe snoring from covered services, unless the snoring is associated with documented obstructive sleep apnea.
Thus, Dr. Zemplenyi approaches the evaluation of a patient with snoring with two important questions in mind: 1. Does the patient suffer “only” from snoring or is he/she likely to also have significant sleep apnea? 2. Are the likely anatomical sites of obstruction at the level of the soft palate (retro-palatal), base of the tongue (retro-lingual) or combination of both?
Dr. Zemplenyi uses his extensive training and expertise to assess the severity of sleep disordered breathing, and to assess the airway for possible sites of obstruction. A comprehensive history as well as an examination of height, weight, (body mass index), nose, dental occlusion, jaw size, tongue size, throat configuration, larynx and neck size are obtained. Nasal fiberoptic examination in a sitting and a reclining position is performed.
Further assessment of the problem usually involves an overnight sleep study (a polysomnogram) obtained in a certified sleep center and interpreted by a sleep medicine colleague. A sleep study measures several important physiologic parameters such as brain waves, heart rate & oxygen saturation, and it results in quantification of the number, duration and severity of obstructive episodes that occur during sleep. A rate of six or more episodes of partial or complete physiological obstruction (respiratory distress index ‘RDI’ or apnea/hypopnea index ‘AHI’ greater than 6) is by definition considered medically significant.
This type of work-up results in two separate groups with different initial treatments: