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Introduction

Obstructive sleep apnea (OSA) is a disorder that is characterized by obstructive apneas, hypopneas, and/or respiratory effort-related arousals caused by repetitive collapse of the upper airway during sleep.  It is normal to experience some variation in breathing at night.  A diagnosis of sleep apnea is based on the presence of more than 5 disruptions in breathing per hour of sleep. 

It is estimated that 15-30% of men and 10-15% of women in North America suffer from sleep apnea.  Risk factors for sleep apnea include age, male gender, post-menopausal status in women, obesity, facial anatomy, smoking, nasal allergies, opioid pain medications, and use of certain sleep medications.

Sleep is accompanied by multiple physiologic changes in breathing.  The muscles that maintain the patency of the upper airway are less active during sleep.  This is of little clinical consequence in healthy individuals but can lead to repetitive airway collapse and closure in susceptible individuals.

Symptoms

Individuals with sleep apnea may experience problems with snoring, daytime sleepiness, gasping for air at night, morning headaches, difficulty initiating/maintaining sleep, increased irritability, reduced concentration/attention span, and problems with memory.  The prevalence of sleep apnea is also increased in patients with certain medical conditions including congestive heart failure, end stage kidney disease, chronic lung disease, stroke, acromegaly, hypothyroidism, polycystic ovarian syndrome, and Parkinson disease.  Sleep apnea may also develop in women during pregnancy.

Untreated sleep apnea is associated with an increase in risk for heart disease, high blood pressure, memory loss/dementia, atrial fibrillation, stroke, and motor vehicle accidents.

Diagnosis

A complete medical history, including a comprehensive review of medications, can help determine the risk of having sleep apnea.   Because sleep apnea is not a clinical diagnosis, objective confirmatory diagnostic testing must be performed.  A polysomnogram (PSG) is often the first step in establishing a diagnosis of sleep apnea.  This test evaluates how an individual’s breathing is affected while sleeping and how their breathing might affect their sleep quality. 

Treatment

The goals of obstructive sleep apnea therapy are to resolve signs and symptoms of the disorder, improve sleep quality, and normalize the disruptions in breathing at night.  Sleep apnea should be approached as a chronic disease that requires long-term, multidisciplinary management. The potential benefits of successfully treating OSA include clinical improvement (less daytime sleepiness), reduced and possibly, decreased cardiovascular risk and cognitive risk.  The following are options for treatment:

  1. Weight loss and exercise – All patients with sleep apnea who are overweight or obese are advised to lose weight.  While this does not often lead to complete resolution of sleep apnea, weight loss has been shown to improve overall health and decrease the severity of sleep apnea.
  2. PAP (positive airway pressure therapy) – PAP therapy is the mainstay of therapy for individuals with obstructive sleep apnea.  Simple and effective, PAP therapy treats sleep apnea by splinting the airway open and stabilizing it using pressurized airflow.  There is high quality evidence from randomized trials and meta-analyses that in most adults, including the elderly, PAP therapy reduces the frequency of respiratory events during sleep, decreases daytime sleepiness, improves blood pressure, lowers the risk of crashes, improves erectile dysfunction, and improves quality of life across a range of disease severities.  To precisely establish therapeutic settings, individuals seeking treatment may be required to complete a polysomnogram with CPAP titration (PSG w/ CPAP) prior to starting treatment at home.
  3. Oral Appliances – An oral appliance may be a reasonable alternative for select patients with mild to moderate sleep apnea who are not candidates for, or are intolerant of, PAP therapy.  The efficacy of oral appliance therapy in patients with severe sleep apnea is highly variable and therefore it is generally not recommended in these cases.  Oral appliances protrude the mandible (jaw) forward to maintain the patency of the upper airway which improves airflow.  These appliances are fabricated and adjusted by experienced dentists with a special interest and qualification in treating patients with sleep apnea.
  4. Hypoglossal nerve stimulator therapy (Inspire) - Hypoglossal nerve stimulation with an implantable neurostimulator device is a treatment strategy that may have a role in selected patients with moderate to severe OSA, who have failed PAP therapy with a body mass index <32 kg/m2, (BMI <35 kg/m2 is used in some centers) and no unfavorable collapse on drug-induced sleep endoscopy (determined by an ENT specialist).

Patient Testimonials









"Just wanted to thank you and your staff for creating such a safe environment at your K Street office. I was reassured to see everyone wearing their masks properly yesterday! When a patient's mask started to slip in the reception area, someone IMMEDIATELY came out to ask him to pull it up. It was so reassuring!”

“I am happy to let everyone know how great the Neurology Center/Chevy Chase is. My primary care doctor referred me there because of neuropathy symptoms. He advised that every doctor there is first class, and any will serve me well. I was assigned to Dr. Nabil Altememi, and how fortunate for me. He is brilliant, thorough, experienced, confident and a great communicator. After two appointments now, I am confident in my experience and my judgment. I commend the Neurology Center to you, and I specifically commend Dr. Altememi. Good luck.” –TM
 
“I like the fact that there is very little waiting to see the doctor. Dr. Stephanie Block takes time to hear questions and answer them. I don't feel rushed. And there's plenty of parking.” –NF
 
“Dr. Ezra Cohen takes the time to go through my health issue and concerns on my first visit. He is really great and I just recommended him to one of my friends who is looking for good neurologist. Other staff members are pleasant and the waiting time is reasonable. Overall experience was great.” –MMM
 
“The Neurology Center is awesome and particularly Dr. Eric Jeffries. He’d been tracking an issue with my health for a few years. He sent me to a surgeon this past fall because he didn’t like what he saw. I had surgery in December and the issue has been resolved. Not only is Dr. Jeffries top notch, but the staff is always friendly and helpful. I’d recommend them to anyone.” – LK
 
“The staff at each office over many years have been AWESOME!! My heart goes to Dr. Taryn Fortune. She is so thorough and has been diligent in helping me with my discomfort. I recommend that anyone who is wants a kind, caring, and thorough Neurologist Don't walk to Dr Fortune, Run!! She is the best!!!” – SM
 
“Thank you Dr. Stephanie Chen Block for your professional manner, your personal concern and your thorough description of my medical situation. Your advice and counsel were invaluable and I would highly recommend you to friends and family.” – DS
 
“Everyone at the Leisure World Office was very professional and courteous. We were taken on time.” – TJA
 
“The Providence staff and Dr. Moore were very pleasant. Dr. Moore was very detailed and he took his time explaining each step of the EMG so I was aware what to expect. The technician was pleasant and made me feel comfortable.” – CL
 
“Dr. Cohen was patient and thorough. I felt like he really cared. I would recommend this practice very highly.” – MB
 
“The White Oak staff is polite and made me feel welcome. My procedure was explained to lessen feelings of anxiety.” – MC

“I’ve been going here for years, and compare to the other doctor’s offices, this practice is great! Dr. Hari Hall is wonderful, very knowledgeable and cares about her patients. I highly recommend the practice!” -RJ

“The kindness and responsiveness of the staff are admired and appreciated!” -GG

“Dr. Rhanni Herzfeld is a hero. She was so great to me that my mom is actually going to move down from Michigan, partly to have access to such great resources like Neurology Center.” -ET

“Dr. Stephanie Block is a wonderful practitioner who listens carefully and always has good suggestions to offer. I would highly recommend her.” –RO

“Met with Dr. Neal Kurzrok for my diagnosis and Dr. Moore for my testing for peripheral neuropathy. I found Dr. Kurzrok to be a no nonsense but heavily qualified physician. He is straight to the point and I like that. I wanted to know just what my issues were and my options. Dr. David Moore knows how to do the professional testing phase and has an easy going bedside manner. He is qualified and very likeable. The Providence office space is very clean and the check in staff efficient.” –AG

“I truly loved the center. The staff was welcoming and attentive. I enjoyed visiting with Dr. Melissa Carswell who was very friendly, patient and professional. Thank you.” – MG

“Honestly, my experience with this practice has been nothing short of stellar. The doctors are thorough and caring. They listen and are eager to help. Dr. Taryn Fortune is amazing at what she does, and is generally a very cool person.”- DS

“The staff and doctors at the Neurology Center have been fantastic....very informative and supportive. I have full trust in their recommendations.” -BT

“The physicians and staff are great. Everything runs smoothly and stress free. Their objectives are scientific.” -JS

“I’ve never written a review before, but I feel compelled to after my excellent experience here. Dr. Philip Pulaski was fantastic - he explained everything very clearly and was very caring. Additionally, the staff are wonderful (Tammy in particular). They’ve gone above and beyond to ensure a very smooth client experience. All around this is a fantastic practice and I would recommend them to anyone in need of a neurologist.” -ST

“Good experience. Dr. David Taragin showed empathy and concern towards my husband who was not feeling well.” -CM

“Dr. Debbie Lin is amazing, very knowledgeable and caring, also very honest and direct. I first spoke with her PA, Ashley Holt today on a telemedicine appointment. She was also extremely helpful, knowledgeable and very clear. She was happy to answer any and all questions. This is a wonderful practice.” – HL

“I love everything about this practice. Easy location. Ample parking. Ease in making appointments. Immaculate office. Professional and kind administrative staff. The doctors and assistants I’ve seen have been top notch (and I come from a family of doctors!) I’ve raved about them to anyone who’ll listen- so glad I found this neurology group. I trust them implicitly.” – HG

“The Neurology Center is a highly professional and very caring practice. The doctors and staff are all friendly and helpful, and they opt for conservative rather than aggressive treatments while being fully pragmatic. Highly recommended.” - BB

“Highly recommend Dr. Hari-Hall. Have been a patient for a few years, and always receive excellent service. Toye and other technical staff are also always thorough and efficient.” -MM

“Great office atmosphere, the doctor was very informative and seemed genuinely concerned. The K Street office staff worked well together.” –AC

“The Leisure World office staff was helpful and friendly. The doctor we saw was caring and through.” –KBB

“The Providence staff was very professional and the doctor was on time and very thorough and listened to my concerns. I am glad The Neurology Center was recommended to me.” -GW

“Ashley Holt and Dr. Stephanie Block have helped me so much with my migraines. Ashley is a pro at giving Botox injections- always on time and efficient. This office has been a lifesaver for me!” – DB

“They are all very professional, courteous and handle appointments in a timely manner. I have never had to wait after my appointment time to be seen . Dr. Eric Jeffries is the best. He's honest and keeps it real with you. I recommend The Neurology Center in White Oak who is looking for neurological services.” – JC

“Everyone was extremely helpful and warm. Dr. Aman Savani was highly knowledgeable, gladly listened to me, answered my questions, welcomed my adult daughter who came with me and had support staff to provide the additional diagnosing necessities.” -CH

“Dr. Rhanni Herzfeld is everything you want a doctor to be: highly knowledgeable, attentive, inquisitive, sincere — and prompt! In short, she cares.” –CA

“Administrative Staff are competent and courteous and Clinical Staff are highly qualified and conduct themselves so that it is clear they have the patient’s best interests in mind.” – BS

“Physically, the Sleep Center resembles that which you would expect if staying at a very nice motel/hotel, a comfortable double bed, closet space, and a clean bathroom with towels, soap, and shampoo, plus TV. The staff were also very professional from the time of check-in, to showing you around your assigned room, and explaining the process for attaching the requisite electrodes on your body. If you awaken during the night in need of the bathroom, just say your assigned staff member’s name out loud and she will quickly appear to unhook your electrodes from the monitoring station. You are awoken early, around 5am, released from your electrodes and told you may now shower, get dressed, and go home. If, in my case, the testing resolves my sleep disorder, I will upgrade the facility’s rating to the highest level.” -PL

“A very professional yet friendly atmosphere that welcomes you at once, and a staff of very confident and competent caregivers. What more can I ask for? Dr. David Taragin is an extraordinary neurologist, and I know I am lucky to have him for my doctor.” -JK

“Very friendly and helpful staff. My doctor is very caring and has a lot of experience. I would recommend her to family and friends, as my daughter was very happy with the Neurology Center in Rockville.” – BG

“My daughter needed a sleep study to be done. I was contacted before hand, all questions were answered, staff could not have been more friendly, knowledgeable. They explained what was going on and when and what would happen. If I or someone in my family needs a study done, we will be coming here. First class all the way.” -ES

“The Neurology Center has a friendly front office staff always providing outstanding professional customer service with a smile. Dr. Philip Pulaski is the “BEST.” He is kind, compassionate, knowledgeable and really knows his stuff. He has always provided guidance and excellent medical advice throughout the years. Dr. Pulaski is my favorite “Doctor/Friend.” -Ms. M

“Great front desk presence (I don’t get to say that elsewhere). Professional and positive. That sets the tone for the appointment and the importance of this is frequently overlooked. Well done staff! Dr. Nadia Yusuf was warm and genuine and (most importantly) knowledgeable and communicative. Great visit. Keep up the great experience and work!” - MD

“Dr. Nabil Altememi listened to our concerns and took into a count all of my Mom’s issues before recommending the next step. He also let us choose how fast and how far to take the work up, because her issue did not require immediate neurological action. It was very reassuring.” -AB

“The K Street office staff was super kind and helpful, my neurologist was also incredibly kind and personable. One of the best private medical experiences I’ve ever had.” -AM

“Very clean and positive environment. Everyone was very professional. I was impressed with Dr. Nadia Yusuf.” - PL