12/12 Sleep Apnea - Scharf

Question 1

OSA pathophysiology

3 effects

Answer 1

intermittent collapse of upper airway during sleep causing disruption of airflow

respiratory pauses cause:

1. oxygen destaurations
2. sleep fragmentation
3. poor quality sleep

Question 2

OSA risk factors

Answer 2

obesity

neck size

age

male sex

race

anatomic factors

• retrognathia (chin extra-recessed)
• oropharyngeal crowding
• craniofacial abnormalities

Question 3

OSA clinical presentation

OSA physical exam findings

Answer 3

clinical presentation

• loud snoring
• witnessed apneas
• dry mouth in morning (likely bc they mouth-breathe)
• morning headache (high CO2)
• excessive daytime somnolence

physical exam

• crowded upper airway (big tongue, narrow lateral airway, high arched palate, retrognathia, tonsillar hypertrophy)
• obesity
• incr neck size
• sleepy

Question 4

OSA diagnosis

Answer 4

• gold standard: polysomnogram (“sleep study”)
  
  • EEG, ECG, EOG (ocular movements), oronasal airflow, muscle tone sensors, movement/position sensors
• home sleep test
• validated questionnnaires

Question 5

how is OSA diagnosed on polysomnogram?

obstructive vs central SA

apnea vs hypopnea

apnea-hypopnea index

Answer 5

obstructive apnea: PRESENCE of respiratory effort

central apnea: ABSENCE of respiratory effort

apnea: cessation of flow for 10+ s

hypopnea: decr in flow by 30+% for 10+ s assoc with oxygen desat or electrophysiologic arousal

• apnea-hypopnea index is the number of apneas and hypopneas per hour. > 5 = sleep apnea
  
  • 5-15: mild
  • 15-30: moderate
  • > 30: severe

Question 6

OSA tx

Answer 6

• weight loss (bariatric surgery)
• adenotonsillectomy in kids
• positional therapy
• mandibular advancement device (keeps airway open by pulling jaw forward)
• oral pressure therapy (mouthpiece that uses negative pressure to pull tongue forward)
• hypoglossal nerve stimulator (stimulates tongue extension)
• CPAP: continuous positive airway pressure (positive pressure to keep airway from collapsing)
  
  • pneumatic splint
  • nearly 100% effective BUT patient compliance is an issue

Question 7

consequences of untreated OSA

Answer 7

symptomatic sleepiness

adverse health effects

• DM, HTN, heart disease, stroke, afib
• incr mortality

impaired attention, psychomotor vigilance

associated with HTN

• RCT showed that CPAP lowers HTN in SA pts

associated with DM

• lower risk in those using CPAP