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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Got sleep study test done. Does it indicate obstructive sleep apnea?

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Dr. Shashi Dangwal

Pulmonologist

Practicing since :1979

Answered : 1126 Questions

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Posted on Fri, 18 Jan 2013 in Lung and Chest disorders
Question: Dear Doctor,
Please guide for following-
1.from my sleep study reports -does this is Obstructive sleep apnea or central Sleep apnea or compex one.
2.Does in my case CPAP is suitable and first degree recommendations or BPAP is first prefernce.
3.What can be evaluated from lung function test enclosed? does this carry any serious in lungs.
4.Even on usage of CPAP for 7-8 hours getting sleepy,tired, dizzy during day time, what can be done.?
5.As evaluated by Sleep specialist MALLAMPATI score is 4,HEENT,significant edema and erythema of Uvula and soft palate, what can be done for this high score of Malampati and narrow high arched palate with modified M score of 4,Like no space in breath air way does this can be treated with CPAP or I should go for some other available treatment ,so you can please guide for this, worried.\
He has put me on Venlafaxin daily one, does this is a long term medicine or I should ask him to stop .
What do you suggest under all conditions,
What is your opinion of MODAFINIL medicine?
6.under parotid ultra scan you will see that there is a changes, does these are a matter of concern?report is attached.does these changes related to sleep apnea or of some other medical concern.
7.Now while sleeping in day time getting some trouble like getting breath.

Please
doctor
Answered by Dr. Shashi Dangwal 2 days later
Hi XXXXXXX

I`ve gone through your query and various reports attached by you. I`ll try and answer your query one by one:-

1. From your sleep study reports, it is clear that you are suffering from OSA ie Obstructive Sleep Apnoea.

2. CPAP is the first choice of non invasive ventilation for management of OSA.

3. There is nothing grossly abnormal with your lung function test. There may be minimal restrictive disorder which may be because of chest wall as it seems you are overweight.

4. From your sleep studies, i could gather that you have been put on CPAP with 10 cm of water pressure. If symptoms are persisting, the pressure may be graduslly increased or BiPAP may be tried. Consult your sleep specialist.

5. Weight reduction and CPAP are the first line of treatment for OSA. If this does`nt help, some devicse like mandibular advancement devices or some surgery to remove or tighten the loose soft tissue can be tried. However, there success may be equivocal. Consult your sleep therapist.
Venaflaxine is an antidepressant. It may also help in some weight loss. It is also used for sleep related narcolepsy. Your treating physician will guide you regarding the duration of treatment.
Modafinil is used for excessive day time sleepiness and you should continue it.

6. The parotid and submandibular glands show inflammatory changes which may be due to some viral/bacterial infection you may have had in the recent past. Consult an ENT specialist for it.

7. If your symptoms are occuring during day time , you may try using CPAP during day also.

I hope i`ve been able to answer your queries.

Bye.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shashi Dangwal 6 hours later
Dear Dr XXXXXXX
Happy New Year .
Thanks a lot for your informative reply,You are great.
Please guide for the surgery option of Obs,Sleep Apnea, in India Trevendrum Dr.Paulse is doing this, does these surgeries carry any side effects and percentage of success of these. Actually my belly weight is main concern and bothering me a lot.
You did not mention your contact tel number under profile.My DHEAS was low, may be due to this pain allover body is a matter of daily life.What can be done for this.
See if you can guide for test reports and ECHO too.
Regards.
XXXXXXX
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Follow up: Dr. Shashi Dangwal 24 hours later
Dear Dr XXXXXXX
Waiting for help in answering my health concern with following additional guidance please.
please guide how to proceed to check effectiveness for usage of Venlafexin -co Venlafexin xr 37.5 mg, means that what tests should be done to check the levels of Serotonin and Norepinephrine chemicals,these chemical are released by this medicine in brain etc.
Definitely excess presence of these chemicals must have side effects.There can be some dependable test which can be done for these chemicals.
Sleep specialist are in just in routine mood that to continue this medicine which is having some doubts keeping in view the present advancements of lab testings.
doctor
Answered by Dr. Shashi Dangwal 17 hours later
Hi XXXXXXX

Regarding your fresh queries- as mentioned by me earlier, the treatment of OSA remains weight reduction and CPAP. Surgical options are opted for only as a last measure and the results may not be very encouraging. I`ll not be able to throw much light on who and where this kind of work is being done in India as this is a surgical speciality and not my field. However, you may try out reconstructive or oral surgeon in Apollo group of hospitals.

For low DHEAS, you will have to consult an endocrinologist or a sexologist.

I may not be the right person to comment on your ECHO and other reports but they appear to be more or less normal except that there may be some overload on heart as indicated by dilatation of aortic root which could be due to hypertension. You should consult a cardiologist.

Regarding your query on Venlaflaxin, checking for levels of various chemicals is really not indicated as effectiveness can be monitored clinically. Your sleep therapist will advise you about it.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shashi Dangwal 5 hours later
Dear Dr XXXXXXX
Thanks.
please guide for these clarifications-
Please guide-
Can we say that CPAP is a first level of Ventilator therapy? means that CPAP falls under first degree of treatment of ventilator therapy- CPAP falls under same group of ventilation -breathing from out side.
doctor
Answered by Dr. Shashi Dangwal 18 hours later
Hi XXXXXXX

Your question is not very clear.

CPAP is a type of noninvasive ventilation which is being used in many conditions where artificial ventilation is required. Yes it is breathing frome outside with the help of a machine.It is the treatment of choice in conditions like OSA where simple strategies like weight reduction fail. In many other conditions, in advanced stages, where artificial ventilation becomes mandatory, non invasive ventilation like CPAP is tried instead of invasive ventilation as first choice since it is much safer.

Bye.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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