Airway and Sleep Health
Apnea Risk Evaluation System (ARES)
The Apnea Risk Evaluation System (ARES™) integrates physiological data acquired in-home with clinical history and anthropomorphic data to determine the presence and severity of Obstructive Sleep Apnea (OSA). ARES™ has been cleared for use by the United States Food and Drug Administration (FDA), and is ISO 13485 certified for Europe and Canada.
ARES™ Home Sleep test Device integrates:
ARES™: A sleep-wearable, wireless physiological recorder worn on the forehead that acquires and stores up to 3 nights of nocturnal data. ARES™ measures blood oxygen saturation (SpO2) and pulse rate (reflectance pulse oximetry), airflow (by nasal cannula connected to a pressure transducer), snoring levels (calibrated acoustic microphone), head movement and head position (accelerometers). When worn in the home, the ARES™ provides a better profile of the patient’s breathing during sleep in his/her normal environment. Audio and visual indicators notify the user when the ARES™ requires adjustment, thus increasing reliability of the device in the home. The small size of ARES™ allows it to be comfortably worn in all sleep positions.
ARES™ Screener: A validated predictor of OSA risk (those in need of a sleep study based on a predicted apnea/hypopnea index > 5 events/hour) and OSA severity (i.e., minimal, mild, moderate or severe) using responses to questions about body type, symptoms of daytime drowsiness, snoring, and other sleep-related characteristics or health conditions associated with OSA. The results can be used to rapidly screen large populations to determine a prior probability of obstructive sleep apnea (OSA). The results are also used to supplement the physiological data obtained in the ARES Sleep Apnea Study.
ARES Sleep Study Signals and Measurements:
ARES captures blood oxygen saturation and pulse rate using reflectance pulse oximetry. The ARES oximeter was designed specifically for the diagnosis of OSA, which involves the detections and quantification of brief desaturations and resaturations. It measures oxyhemoglobin saturation in 0.1% increments rather than the typical 1%, which allows identification of small but important changes in saturation.
Airflow (nasal pressure) – Changes in air pressure are measured with a pressure transducer connected to the nasal opening via a nasal cannula. Decreases and increases in flow of 50% or more are automatically identified and marked as hypopneas and cessations of airflow for at least 10 seconds are marked as apneas.
Pulse Rate – ARES uses reflectance pulse oximetry to measure pulse rate. Limited smoothing of pulse rate signal increases capability of ARES Insight software to recognize brief changes in pulse rate (e.g., Brady-tachycardias). These changes in pulse rate are recognized markers of arousal.
Snoring – Snoring is recorded with a calibrated acoustic microphone so that the level of loudness can be precisely quantified. Changes in snoring patterns and crescendo snoring are automatically recognized and used as markers of a respiratory-related arousals.
Head Position/Movement – Head position indicates the position of the pharynx and is used to determine the positionality of obstructive events. Understanding the influence of position on the severity of the OSA is useful in making treatment decisions. Head movement is measured using accelerometers similar to those used for actigraphy. Head movement is a unique signal identified by ARES as a marker of respiratory related arousal.
Sleep/Wake – ARES measures sleep behaviorally by combining the detection of subtle movements through actigraphy, with variability of the airflow signal and recognition of snoring.
REM/NREM – ARES distinguishes REM from NREM using EEG, EOG and EMG signals derived from two electrodes placed at FP1 and FP2 on the forehead.
Apnea/Hypopnea Index (AHI) – ARES determines AHI by adding the number of apneas and hypopneas per hour, where there is a 4% oxygen desaturation.
Respiratory Disturbance Index (RDI) – ARES measures RDI by adding the number of apneas and hypopneas per hour, where the hypopneas require a 1% oxygen desaturation/resaturation and at least one behavioral arousal indicator.
Free Airway and Sleep Health Screening
At Wilton Dental Associates we work directly with a Sleep MD and can offer our patients a Home Sleep Study which is accepted by all insurance companies. For home sleep studies we use the Watermark Ares system which is extremely accurate, easy to use, and comfortable. If the free screening we offer indicates an unstable or inadequate airway we prescribe a home sleep study which goes to a sleep MD. If the study indicates that the airway is a health concern, treatment is covered by medial insurance. If a oral sleep appliance is indicated Wilton Dental Associates accepts all Medical Insurance plans and Medicare as payment.
The equipment we use is the newest in diagnosing airway stability and efficiency. We use this equipment as part of our Free Airway and Sleep Health Screening procedure. The medical profession estimates that 80% of people with Sleep Apnea are undiagnosed.We also use this equipment in determining the best design of an oral appliance to treat snoring and especially mild and moderate sleep apnea.
We use oral appliance therapy for severe sleep apnea in cases where the person can not tolerate a CPAP machine. A very large number of people can not tolerate CPAPs. It has been reported that has high as 70% of people are CPAP intolerant. Dr.Strait has been involved with sleep and Airway health for over 25 years. The newest sleep technology and sleep appliances are extremely effective and successful.
Obstructive Sleep Apnea (OSA) at a glance
Obstructive Sleep Apnea (OSA) is reported to occur as many as 83% of women and 92% of men.1 This phenomenon occurs nightly when the tongue falls back and blocks the airway. This means that every hour of every night there are multiple periods of no O2 to every cell in the body. These periods occur five to 100+ times an hour, for 10 to 90 seconds an episode. With insufficient oxygen, cellular regeneration is unable to transpire nightly during sleep. Poor cellular regeneration results in an individual being more susceptible to numerous pathologies anywhere in the body. This nightly cellular breakdown has a destructive effect on the health of mankind. The co-morbidities for sleep apnea are numerous.2,3,4,5 OSA is the disease that dentistry now leads the world in for accepted treatment of the afflicted.
The most successful treatment for OSA is CPAP. It is the No. 1 treatment prescribed by the medical community. CPAP is highly successful when it can be used. But the big problem with the CPAP are the numerous difficulties patients have using it. The CPAP is not tolerated by up to 60%,6,7 and some estimate up to 83%, of users.8 With an inability to tolerate the CPAP, these patients find themselves at great risk in regard to their health and longevity. It is a major problem for mankind when medicine’s most effective treatment tool is rejected by 60% to 83% of the users.
With the high rejection rate of the CPAP, the American Academy of Sleep Medicine designated dental sleep oral appliances as the No. 1 nonsurgical alternative for the CPAP intolerant.9 Numerous sleep appliances are available to the public and distributed through dentists. These are double-arched appliances that gain success by opening the vertical dimension and advancing the mandible. Vertical opening can range from 2 mm to15 mm. The advancement can be as much as full forward prognathic extension, with forward movement up to three-quarters of an inch. The problem presented by these appliances is that they can cause pain or malocclusion.