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Obstructive Sleep Apnea
Dr Awofisoye O.I
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Outline
Historical background
Definition
Pathophysiology
Risk Factors Clinical Features
Evaluation
Investigations
Management
Complications
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Historical Background
Charles Dickens: Pickwick papers
William Osler : Pickwickian syndrome
Guilleminault: OSAS,1973 Sullivan: CPAP, 1981
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Definitions
Apnea
Hypopnea
OSA/OSAHS
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Apnea: Spontaneaous Transient Ceasation of
Breathing for 10secs or more, usually up to
30secs.
Hypopnea Transient Shallow respiration with
reduction in airflow up to 50% lasting at least
10 seconds or up to 30% with reduction in O2
saturation(4%)
OSA:
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Pathophysiology
Sleep
Sleep and Respiration
OSAHS Sleep fragmentation & hypoxaemia
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Structural anomalies
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Apnea cycle
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Risk Factors
Obesity Large Neck
Anatomical deformities: small lower jaw(retrognathia),PRS,congeintal malf, tonsillar hypertrophy,pharyngeal masses
Male Sex
Older age(40-65) Alcohol
Sedatives
Smoking
Snoring
Acromegaly Hypothyroidism
Mucopolysaccharidosis
Family history
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Clinical Features
Snoring
Restless sleep
Spouse report of apnea in sleep
Non-restorative sleep Daytime sleepiness
Impaired Cognitive skills
Poor performance at work
Depression Sexual dysfunction
Nocturia
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Clinical features
Tired appearance
Features: signs & symptoms of risk factors
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Systemic effects
Hypertension
Insulin Resistance/Diabetes Mellitus
LVH
Sympathetic activation Arrythmias
Increased risk of Cardiovascular events esp Stroke
Liver disease
Sexual Dysfunction
Anasthetic problems
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Other Evaluation
Daytime Sleepiness: Epworths sleepiness
scale, multiple sleep latency tests
Cephalometry BMI (>30)
Neck circumference(>40cm)
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Differential Diagnosis
Insufficient Sleep
Nacrolepsy
Shift work related sleep disorder
Drugs
Idiopathis Hypersomnlonence
Simple Snoring Sleep Related Breathing Disorder
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Investigations
Polysmonogrpahy :
Limited sleep studies/Portable Home
Monitors:(recording respiratory and oxygenation patterns overnight withoutneurophysiologic recording.)
Investigate underlying causes/associated
problems
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Polysmnography
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Polysmnogrraphy
EEG
EOG
EMG; Submental,Limbs
Airflow monitor(nasal, oral)
Pulse oximetry
Respiratory effort(Intercostal EMG)
Body position
ECG
Snoring Monitor
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Treatment
Patient education and support
Conservative Rx: Positioning, Weight loss,
avoiding aggravators NCPAP
Oral devices
Surgery:Tonsillectomy,Uvulopalatopharyngoplasty,
Jaw/Tounge advancement, Tracheostomy
Adjunct pharmacotheraphy
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Continous Positive Airway Pressure
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CPAP
Best proven treatment
Optimal pressure is titrated then maintained,
usually 5-20cmH20. Rapid resolution of symptoms
Poor compliance
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Oral devices
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Oral Devices
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Surgery
Adenotonsillectomy: in children
Uvulopalatopharyngoplasty: excess tisuue
excised from margins of soft palate Nasal surgery
Tracheostomy
Laser glossectomy Mandibular advancement
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Complications
Of Excessive daytime sleepiness
Of OSA/HS
Of treatments
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Conclusion
OSA/HS is a common underrecognised disease
with far reaching consequences in the
untreated patient. There should be increased
awareness of this condition at all cadres of
heathcare with prompt referral for diagnosis
and treatment.
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Thank You!!!
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