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Obstructive Sleep Apnea (conditions that promote snoring and apnea…
Obstructive Sleep Apnea
- Apnea: cessation of airflow for longer than 10 seconds; complete airway closure
- Hypopnea: 50% decrease in airflow or >4% reduction on oxygen saturation due to partial airway closure
- Male:female = 2:1
- snorers have 60% incidence of OSA
- Obese patients most commonly affected
- Associated conditions: hypothyroidism, acromegaly, Down syndrom, Treacher Collins syndrom, Alcohol, sedatives, hypnotics
Pathogenesis
- tendency for the velum (soft palate), oropharynx and/or hypopharynx to collapse during sleep, narrowing the pathway for airflow and causing periods of apnea or hypopnea that can last up to 2 minutes
- long-term effects due to a reduction in blood oxygen level (e.g. damage to the cardiopulmonary system, even cardiac sudden death)
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Diagnosis
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clinical examination
- transnasal endoscopy to perform a functional test (Muller maneuver)
Clinical manifestations
Loud snoring, apneas
Gasping/choking while asleep
Noctural awakening, daytime somnolence
personality change, depression, decreased mental acuity
automobile or work-related accidents
decreased libido
cardiovascular morbidity
Polysomnography
- Gold standard for the diagnosis of OSAS
- EEG.
- EOG (electrooculogram)
- EMG (submental electromyogram)
- Respiratory tests
- Oxygen saturation
- ECG
Treatment
Weight reduction
abstinence from alkohol and nicotine
avoid big meals at night
regular sleep-wake cycle
avoid the use of sedatives
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- Surgical:
Uvulopalatopharyngoplasty (UPPP) sometimes with tonsillectomy
Laser-assisted uvulopalatoplasty(LAUP)
intranasal surgery (septoplasty, septorhinoplasty, turbinate reduction)
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