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