Sleep Apnea
Is definted
Episodes of apnea and hypopnea associated with symptoms such as excessive daytime and cardiovascular morbidity and mortality
Etiology
Male gender
Craniofacial abnormalities
Obesity
Increased age
Smoking
Family history of OSA (obstructive sleep apnea)
Pathophysiology
1.- During sleep, there is decreased tonic activity of the laryngeal, supraglottic, oropharyngeal, nasopharyngeal, and lingual musculature, which results in dynamic collapse with respiration.
2.- This decreased upper airway tonic activity results in a dynamic decrease in the caliber of the upper airway and therefore increased resistance to airflow.
3.- The effects of this dynamic collapse can range from mild collapse without significant changes to respiration and no effect on oxygenation or arousal to complete airway obstruction, decreased oxygenation, and frequent arousals throughout sleep
Treatment
Healthy lifestyle changes
Breathing devices
Oral devices
Therapy for your mouth and facial muscles
Surgical procedures
Maxillary or jaw advancement surgery
Surgery to remove some soft tissue from your mouth and throat
Surgery to place an implant
Adenotonsillectomy
Tongue retaining devices
Mandibular repositioning mouthpieces
Triad
Observation of Witnessed Apnea
Excessive Daytime Sleepiness
Snoring
A hoarse sound that occurs when air flows past relaxed tissues in the throat , causing the tissues to vibrate during breathing
A patient repeatedly stop breathing during sleep
The tendency to fall asleep involuntarily in inappropriate situations during the day warrants clinical attention
Incidence
In North America found prevalence rates for an AHI of more than five episodes per hour of 24 percent in men and 9 percent in women, and for OSAHS with an index greater than five episodes per hour plus excessive sleepiness of 4 percent in men and 2 percent in women.
There are international differences
Which obesity is considered to be an important determinant. Ethnic differences in prevalence have also been found after adjustment for other risk factors. Little is known about the incidence in resource-poor countries.
Management
General education on the impact
Alcohol avoidance
Risk factor modification
Sleep position
Medication effects should be provided
Weight loss
Education and Behavior
Positive Airway Pressure Therapy
Signs and symptoms
Daytime sleepiness
Snoring, choking, gasping during sleep
Morning headaches
Sleep maintenance insomnia
Nocturia
Diagnosis
In-laboratory polysomnography
Is the gold standard diagnostic test
Home sleep apnea testing
Full-night study
Split-night study