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Obstructive sleep apnea :sleepy: (Apnea :popcorn: (Types (ObstructiveâĶ
Obstructive sleep apnea
:sleepy:
Def
Airway obstruction āļĄāļēāļ until apnea āđāļāđāļāļāđāļ§āļāđāļāļāļ°sleep
Two types of Snoring
Primary snoring (normal)
Dangerous snoring (got
apnea
)
Sleep PSO
Sleep
stage
Check fr
EEG
EOG â electro ocular
EMG
:zzz:
Non-Rapid eye movement (NREM)
N1 āļŦāļĨāļąāļāļāļ·āđāļ
N2 āļŦāļĨāļąāļāļāļ·āđāļ
N3 āļŦāļĨāļąāļāļĨāļķāļ
:zzz:
Rapid eyemovement (REM)
āļŦāļĨāļąāļāļāļąāļ
Snoring
Causes :champagne:
Incompetent tone of palatal, pharyngeal, and glossary muscles
Space-occupying masses
Elongated soft palate & uvula
Nasal obstruction
:gear:
PathoPSO
Apnea
:popcorn:
Drop on
peak thermal sensor excursion
by
âĨ 90%
of baseline
Duration
Adult:
> 10 sec
or 2 cycles of breathing
Children:
No specific duration
need âĨ2 missed breaths
(compared to baseline RR)
At 90% of eventâs duration meets amplitude criteria above
:!: no need for desaturation to be scored
Types
Obstructive apnea
Central apnea
Mixed apnea (1+2)
Hypopnea (adult)
Nasal signs excursions
drop
by
> 30% of baseline
Duration:
âĨ 10 sec
Desaturation
> 4%
fr pre-event baseline
Signal amplitude criteria
maintain âĨ 90% of event
Apnea-Hypopnea Index (AHI)
āļāļģāļāļ§āļāļāļĢāļąāđāļ to Apnea or Hypopnea
within 1 hr
Upper airway resistance syndrome (UARS)
AHI < 5
Arousal index > 5
Excessive daytime sleepiness (EDS)
OSAS
AHI
> 5
OxyHb desaturation
< 90%
Neurobehavioral symptoms
Excessive daytime sleepiness (EDS)
Adult vs Children
differ at Mx
Dx
:mostly_sunny:
Hx
(+ Hx of children)
Physical/ENT exam
Inx
Blood tests: CBC, TFT, ABG
X-rays: CXR, cephalometric study, plain film skull, CT, MRI, fluoroscopy
Sleep tape recording
Flexible nasophrayngolaryngoscopy
Polysomnography (PSG)
:star:
GOLD STANDARD!
Full PSG Parameters
(standard âĨ 7 channels)
EEG derivations
EOG derivations
Chin EMG (Leg EMG derivations)
EKG
Airflow monitoring
Respiratory effort
Oxygen saturation
Body position
Additional (PSG)
VDO monitoring
End-Tidal CO2
Esophageal manometry
GOLD STANDARD
for āļāļđ Respiratory effort :star:
16 channels EEG for seizure monitoring
I/C
:check:
S&S that probably fr Sleep apnea and need to confirm Dx
(eg. Loud snoring, Apnea pattern, Excessive day time sleepiness)
Got
Risk factors
of causing OSA
Neck circumference â Big
:male_sign: >17 in/āļāļīāđāļ§
:female_sign: >16 in
BMI > 35
Complication of OSA
(eg. RHF, HT, pul.HT, Cardiac arrhythmias)
If got just Loud snoring or Fat but no other S&S so
no I/C for PSG
Suspected OSA but
Hx & PE not correlated
To Dx suspected pt of abnormal breathing while sleep
To find Appropriate pressure of āđāļāļĢāļ·āđāļāļāđāļāđāļēāļĨāļĄ to treat OSA by using CPAP, titration
or Look For result of each treatment options
Only did in I/C to do as itâs
pricey
each exam take time & cost
Treatment
Non-Sx
Mx
Wt reduction
Avoid CNS suppressed substances
(alcohol, āļĒāļēāļāļāļāļŦāļĨāļąāļ, anti-histamines)
Positional therapy
Pharmacologic Respiratory stimulants
eg. Amitrpthline, Theophylline, Progesterone
not popular!
Airway devices
Intraoral appliances
Continuous positive airway pressures (CPAP)
GOLD STANDARD!
:star:
Sx
Mx
I/C
:Check:
Anatomical abnormalities
Symptoms affect daily activities
Failure of non-surgical Rx