Dog Sniffing, Sleep Apnea, & Facial Profiling

February 2, 2011

Someone just emailed me a link to an article showing that dogs can be trained to detect colon cancer in breath and stool samples, even in its’ early stages. He asked if this could be applied to sleep apnea. I though long and hard about this. There are so many metabolites in urine, stools, sweat, saliva, and even cerumen from untreated sleep apnea that could possibly be detected by dogs, but not any one of these substances would be specific, like cancer cells.

However, there’s an even easier way: Look at the person’s facial features. Look for narrow and/or recessed jaws, flat cheekbones, narrow nasal width, mouth breathing, or forward head lean. Inside the mouth, the classic findings would be multiple missing teeth, dental crowding, a high arched high palate, narrow and crowded dental arches, tongue scalloping, and a relatively large tongue that prevents you from seeing the uvula. Tongue scalloping alone has been found to predict apneas in 89%, oxygen desaturation in 89%, and abnormal AHI is 67%.

If you combine these exam findings which can take just a few minutes to observe, along with simple screening questionnaires such as the Epworth Sleepiness Scale or the STOP-BANG, you could probably screen for and pick out from 1/2 to 2/3 of all sleep apnea patients. Currently, it’s estimated that only about 10% of sleep apnea is diagnosed. Notice I didn’t mention being overweight, being male, or even the fact that you have to snore.

These days, I play an informal game with myself whenever I see patients. Just by looking at the medical history and external facial appearances, I try to guess who has sleep apnea versus who doesn’t. It’s scary, but I’m close to being about 95 to 98% accurate.

I know this may sound dangerously like facial profiling, but since I’m able to help many of these people breathe better and sleep better, I’ll continue to engage in this practice. Try it on yourself and then on your family members, and then on your friends. With some practice, you can be just a good as me.

Written by Steven Park · Filed Under Blog | 6 Comments

Tongue Scalloping: A Simple Marker for Sleep Apnea?

January 21, 2010

Besides the typical descriptions of physical features for someone at risk for obstructive sleep apnea (such as male, overweight, obnoxious snoring, and a big neck), one physical finding that's rarely mentioned is tongue scalloping (click here for picture). This is when you have impressions or ridges on the sides of your tongue where it sits against your molars. One past study showed that having tongue scalloping can positively predict the presence of apneas or hypopneas and oxygen desaturation in 89% of cases. Overall, having scalloping is about 70 sensitive in picking up obstructive sleep apnea.

The traditional explanation is that the tongue is too big, but for sleep apnea patients, the jaw is too small for the normal sized tongue. If you add additional inflammation due to chronic reflux from the stomach with each obstruction, the swelling of the tongue will only aggravate the dental impressions on the tongue. Along with the small jaws and scalloping, you'll also have a high-arched hard palate, and the tongue sits very high in the mouth, preventing you from seeing the back of the throat more fully.

This condition is also described in hypothyroid patients, but as I've stated before sleep apnea can cause hypothyroidism.

Take a look at your tongue in the mirror right now. Do you have scalloping? Do any of your family members or friends have it? Please enter your responses below in the comments box.

Written by Steven Park · Filed Under Blog | 10 Comments

Sleep Apnea and Tongue Scalloping: A Simple Screening Test?

November 8, 2009

One of the most common exam findings that I see in people with sleep apnea is what’s called tongue scalloping. This is where you see ridges, or a scalloping pattern along with sides of the tongue, created by the tongue pressing against the side teeth. One study showed that having tongue scalloping was 70% predictive of the presence of obstructive sleep apnea.

Why does tongue scalloping occur? Multiple obstructions cause repeated vacuum pressures in the throat which suctions up your normal stomach juices, which includes acid, bile, enzymes and bacteria. These materials cause inflammation and swelling of the mucous membranes, narrowing the throat even further, causing even more obstruction. The tongue also swells slightly and because sleep apnea patients have small jaws by definition, the teeth press into the sides of the tongue, leaving indentation marks.

If you combine this finding with a small mouth and dental crowding, along with a tongue that sits very high (which prevents you from seeing the back of the throat), you’ll have a very high likelihood of having sleep apnea.

Take a look in the mirror right now. Do you have tongue scalloping? Please post your answers in the comment box below.

Written by Steven Park · Filed Under Blog, obstructive sleep apnea | 3 Comments