1.26 Obstructive Sleep Apnoea

Question 1

Predisposing factors

Answer 1

1. Obesity
2. Male Gender
3. Age
4. FH
5. Alcohol
6. Smoking
7. Anatomical
   - Nasal
   - Pharyngeal (adenotonsillar hypertrophy)
   - Laryngeal obstruction
8. Craniofacial abnorm
   - Pierre robin
   Acromegaly
   T21
   Mucopolysaccharide disorder

9. Other
CVA
IHD
HTN 
CRF
CP
Cushings

Question 2

Preop invx

Answer 2

1. FBC
   polycythaemia
2. ABG
   Chronic hypoxaemia
   hypercapnia (incl. compensated metabolic state)
3. ECG
   RV strain
   (RAD, P waves II and V1
   Large R wave V1 Deep S wave V6)

AF

4. CXR
   Cardiomeg
   RVH
   RAD

5. Echo:
red EF
RVH / dilate
TR
PAP

6. Sleep studies
   Periods hypoxaemia hypercapnia
   classify type and severity of sleep disorder
   EEG EMG Resp measure

Question 3

Perioperative Mx

Answer 3

1. Refer to sleep clinic OSA Severity assessment
   - ?nocturnal CPAP
2. Evidence underlying CVS disease
   r/f cardio for optimisation
3. Avoid sedative premed
4. Regurg / aspiration risk
   premed
   ETT
   ?RSI
5. Intubation may be more challenging
   prepare difficulty
   consider AFOI
6. Avoid long acting Opioids where possible
7. RA adjunct
8. Consider post op destination
   HDU/ ICU