Obstructive Sleep Apnea 2

8/7/2019 Obstructive Sleep Apnea 2

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Obstructive Sleep Apnea

Dr Awofisoye O.I


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Outline

Historical background

Definition

Pathophysiology

Risk Factors Clinical Features

Evaluation

Investigations

Management

Complications


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Historical Background

Charles Dickens: Pickwick papers

William Osler : Pickwickian syndrome

Guilleminault: OSAS,1973 Sullivan: CPAP, 1981


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Definitions

Apnea

Hypopnea

OSA/OSAHS


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Apnea: Spontaneaous Transient Ceasation of

Breathing for 10secs or more, usually up to

30secs.

Hypopnea Transient Shallow respiration with

reduction in airflow up to 50% lasting at least

10 seconds or up to 30% with reduction in O2

saturation(4%)

OSA:


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Pathophysiology

Sleep

Sleep and Respiration

OSAHS Sleep fragmentation & hypoxaemia


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Structural anomalies


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Apnea cycle


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Risk Factors

Obesity Large Neck

Anatomical deformities: small lower jaw(retrognathia),PRS,congeintal malf, tonsillar hypertrophy,pharyngeal masses

Male Sex

Older age(40-65) Alcohol

Sedatives

Smoking

Snoring

Acromegaly Hypothyroidism

Mucopolysaccharidosis

Family history


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Clinical Features

Snoring

Restless sleep

Spouse report of apnea in sleep

Non-restorative sleep Daytime sleepiness

Impaired Cognitive skills

Poor performance at work

Depression Sexual dysfunction

Nocturia


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Clinical features

Tired appearance

Features: signs & symptoms of risk factors


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Systemic effects

Hypertension

Insulin Resistance/Diabetes Mellitus

LVH

Sympathetic activation Arrythmias

Increased risk of Cardiovascular events esp Stroke

Liver disease

Sexual Dysfunction

Anasthetic problems


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Other Evaluation

Daytime Sleepiness: Epworths sleepiness

scale, multiple sleep latency tests

Cephalometry BMI (>30)

Neck circumference(>40cm)


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Differential Diagnosis

Insufficient Sleep

Nacrolepsy

Shift work related sleep disorder

Drugs

Idiopathis Hypersomnlonence

Simple Snoring Sleep Related Breathing Disorder


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Investigations

Polysmonogrpahy :

Limited sleep studies/Portable Home

Monitors:(recording respiratory and oxygenation patterns overnight withoutneurophysiologic recording.)

Investigate underlying causes/associated

problems


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Polysmnography


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Polysmnogrraphy

EEG

EOG

EMG; Submental,Limbs

Airflow monitor(nasal, oral)

Pulse oximetry

Respiratory effort(Intercostal EMG)

Body position

ECG

Snoring Monitor


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Treatment

Patient education and support

Conservative Rx: Positioning, Weight loss,

avoiding aggravators NCPAP

Oral devices

Surgery:Tonsillectomy,Uvulopalatopharyngoplasty,

Jaw/Tounge advancement, Tracheostomy

Adjunct pharmacotheraphy


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Continous Positive Airway Pressure


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CPAP

Best proven treatment

Optimal pressure is titrated then maintained,

usually 5-20cmH20. Rapid resolution of symptoms

Poor compliance


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Oral devices


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Oral Devices


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Surgery

Adenotonsillectomy: in children

Uvulopalatopharyngoplasty: excess tisuue

excised from margins of soft palate Nasal surgery

Tracheostomy

Laser glossectomy Mandibular advancement


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Complications

Of Excessive daytime sleepiness

Of OSA/HS

Of treatments


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Conclusion

OSA/HS is a common underrecognised disease

with far reaching consequences in the

untreated patient. There should be increased

awareness of this condition at all cadres of

heathcare with prompt referral for diagnosis

and treatment.


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Thank You!!!

Documents

Obstructive Sleep Apnea 2