Obstructive Sleep Apnea

Obstructive Sleep Apnea

1. Causes

   • Weight
     • Adults
     • Tonsils
       • Children
       • Jaw anatomy

2. occurs due to

   • Obstruction in any of the upper respiratory structures.
     • Anatomy of the upper respiratory system
       • Nose
         • External features
           • Dorsum of the nose
             • Extends from the root to the apex
           • Nostrils
             • The nares or anterior nasal apertures
             • Are bound laterally
               • by
                 • the alae of the nose
         • skeleton
           • Movable
             • cartilagenous
               • made up of
                 • hyaline cartilages
           • Immovable
             • (bridge of the nose) is bony
       • Larynx
         • features
           • The skeleton consists of
             • cartilages
               • membranes
           • principal cartilages are
             • two arytenoid cartilages
               • thyroid
                 • epiglottis
                   • cricoid
                     • is the only complete cartilaginous ring in the respiratory system
       • Pharynx
         • features
           • Is about 12-14 cm long
             • Direct air into the larynx, while solid and liquid food are directed to the esophagus.
               • wide superiorly but becomes narrow at the junction with the esophagus
           • Extends from
             • the base of the skull to the inferior border of the cricoid cartilage (C6)
           • Provides a common route for air and food.

3. clinical presentation

   • Unrefreshing nocturnal sleep
     • Difficulty concentrating
       • Daytime sleepiness
         • Nocturnal choking
           • Disturbed sleep
             • Hypertension
               • Depression
                 • Nocturia

4. Obesity causes OSA or vice versa?

   • If a person is overweight and suffering from sleep-disordered breathing, he/she may not be as motivated to exercise or to diet. When apnea leads to daytime sleepiness, it may be that much harder to begin or sustain an exercise program, which has been shown to help people begin or maintain weight loss

5. was later diagnosed with

   • WAKEUP DAD !
     • presents with
       • Snoring
         • is
           • The vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping
         • Treatment
           • Lifestyle changes
             • Surgery
               • Medication
                 • CPAP

6. Has 3 Types

   • Central Sleep apnea
     • The reduction in the drive to breathe from the brain. Usually occurs with heart failure,
   • Sleep apnea
   • Mixed sleep apnea
     • combination of obstructive and central

7. Diagnosis

   • Physical Exam
   • Medical and Family Historiies
   • Sleep Studies
     • such as
       • Home-Based Portable Monitor
         • This system consists
           • Of a small recording device, sensors, belts and related cables.
         • A portable monitor will record
           • The amount of oxygen in the blood
             • How much air is moving in and out
               • Heart rate
                 • Chest movements
       • Polysomnogram
         • Usually
           • Assessment of sleep stages requires 3 studies
             • Electroencephalography : monitor sleep stage
               • Electrooculography: monitor both horizontal and vertical eye movements.
                 • Electromyography: record atonia during REM sleep or lack of atonia in patients with REM- related parasomnias.
         • Other Parameters measured
           • Sound recordings to measure snoring
             • End tidal or transcutaneous CO2
               • Continuous video monitoring
                 • Respiratory effort
                   • Electrocardiography
                     • Pulse oximetry
                       • Thermistor

8. complication

   • Low blood oxygen levels
     • during
       • sleep
         • lead to
           • hypertension & pulmonary hypertension
     • Heart failure
       • Polycythemia
         • Death

9. Management

   • Modification of behavioral factors
     • Weight loss (including exercise regime)
     • Avoidance of alcohol and sedatives before sleep
     • Avoidance of supine sleep position
   • Oral/dental devices
     • May be useful in mild-to-moderate cases
     • Not uniformly effective
   • Nasal CPAP
     • Noninvasive
     • Very effective
   • Surgical procedures
     • UPPP
       • Nasal surgery
     • Tonsillectomy
       • LAUP
     • Tracheostomy
       • Maxillofacial surgery

10. Definition

    • Airflow is blocked and air cannot enter lungs.

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