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Wake up dad !

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Wake up dad !

Anatomy of the upper respiratory tract
Sleep apnea
- What it it?
  - Disorder in which breathing repeatedly stops and starts.
- Signs and symptoms:
  - Snoring
    - Mechanism
      - 1 - Airway is partially obstructed by the uvula, nasal congestion, adenoids.
      - 2 - Lung will work harder to get the same amount of air (TV) to satisfy the bodies demand of O2
      - 3 - This causes vibration of the soft palate and uvula which produces the snoring sound
    - Life risk factors of snoring
  - Morning headache
  - Difficulty staying asleep
    - Sleep cycle
      - Changes in the sleep cycle with age
      - Stages
        NREM – Non-Rapid eye movements
        N1 – very light sleep - 5%
        N2 – slightly deeper - 25%
        N3 – deep sleep - 45%
        REM – Rapid eye movements
        Dreams and brain development - 25%
  - Excessive daytime sleepiness
  - Attention problems
  - Irritability
  - Awakening with a dry mouth or sore throat
  - Episodes of breathing cessation
  - Abrupt awakenings accompanied by shortness of breath
- Types and causes of each type
  - Obstructive sleep apnea
    - More common form that occurs when throat muscles relax.
  - Central sleep apnea
    - Occurs when your brain doesn't send proper signals to the muscles that control breathing
  - Complex sleep apnea syndrome
    - Occurs when someone has both obstructive sleep apnea and central sleep apnea
- Risk factor
  - Being older.
  - Heart disorders.
  - Using narcotic pain medications.
  - Stroke.
- Complication
  - Daytime fatigue.
  - High blood pressure or heart problems.
  - Obstructive sleep apnea may increase the risk of recurrent heart attack, and abnormal heartbeats, such as atrial fibrillation.
  - You may also feel quick tempered, moody or depressed.
  - You may have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving.
  - Type 2 diabetes.
  - Complications with medications and surgery.
  - Metabolic syndrome.
  - Liver problems.
  - Sleep-deprived partners.
- History taking
  - Questions regarding sleep apnea
  - Background information
    - Medical History
      - Childhood sleeping patterns
      - Surgery
      - Long standing illnesses --> HTN and Diabetes
      - Medication
    - Family History
      - Long standing illnesses
      - Genetic sleep apnea - Genes leads to sleep apnea indirectly
    - Social history
      - Stress
  - Differential diagnosis
    - Asthma
    - Central Sleep Apnea Syndromes
    - COPD
    - Depression
    - Gastroesophageal Reflux Disease
    - Hypothyroidism
    - Narcolepsy
    - Obstructive Sleep Apnea
    - Periodic Limb Movement Disorder
- Physical examination
  - Breathing pattern
    - Rate
    - Depth and mode
    - Chest expansion
    - Breathing sounds
- Investigations
  - Polysomnogram
    - What is it?
      - Records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.
    - How do you prepare ?
      - The doctor may advise you to stop drinks that contains caffeine such as alcohol and coffee.
    - Normal Polysomnograph
- Treatment
  - Surgical - Tonsillectomy
    - What is it?
      - surgical procedure to remove the palatine tonsils
    - Complications
      - Fever
      - Nasal congestion or drainage
      - Snoring and mouth breathing may worsen for 10-14 days after surgery
      - Bad breath
      - Voice changes
    - Health problems that can be treated by tonsillectomy
      - Tonsillitis
      - Breathing problems related to swollen tonsils
      - Frequent and loud snoring
      - Bleeding of the tonsils
      - Cancer of the tonsils
  - Non-Surgical - CPAP
    - Applied to the airways of a spontaneously breathing patient throughout the respiratory cycle.
    - How does it wokr?
      - Maintains constant level of airway pressure
      - Keeps alveoli open (asthma, COPD)
      - Moves extracellular fluid into vasculature (pulmonary edema)
      - Improves gas exchange
      - Buys time for medications to work