14. Adult and Pediatric Obstructive Sleep Apnea. Diagnosis, Physical Examination and Treatment.

Question 1

What is Obstructive Sleep Apnoea?

Answer 1

• Type of Sleep-Related Breathing Disorder
• Similar to Snoring

Question 2

What is the ETIOLOGY / PATHOGENESIS of OSA?

Answer 2

1) COLLAPSE of Velum / Oropharynx / Hypopharynx, during sleep

2) NARROWING airflow pathway, causing periods of apnoea lasting upto 2 mins

3) Leading to frequent arousals from sleep / gasping for air, preventing normal sleeping pattern

• Long Term Effect = REDUCED Blood 02 Levels, potentially damaging Cardiopulmonary System

Question 3

What are the SYMPTOMS of OSA?

Answer 3

• Morning Lethargy
• Daytime Fatigue = Tendency to fall asleep during the day
• Obesity is an accompanying Condition

Question 4

What is the DIAGNOSIS / PHYSICAL EXAMINATION for OSA?

Answer 4

1) HEAD MIRROR EXAMINATION
- Elongated Uvula
- Narrowed Velopharyngeal Passage
- Bulky Soft Palate
- Small Oropharyngeal Lumen
- Hyperplastic Tongue Base
- Hyperplasia of Palatine Tonsils

2) NASAL AIRWAY
- Septal Deviation
- Turbinate Hyperplasia

3) FLEXIBLE TRANSNASAL ENDOSCOPY = Assesses degree of Oropharyngeal Obstruction at level of Soft Palate

• Px sits upright in 45D reclined position
• Doctor compresses Px Nostrils and tells Px to inhale the residual intraoral air with mouth closed

4) SCREENING TEST = Polysomnography (Gold Standard!); Measuring Thoracic / Abdominal respiratory excursions

Question 5

What is the TREATMENT for OSA?

Answer 5

1) CONSERVATIVE Tx
- Weight REDUCTION
- Stop Alcohol / Nicotine
- Establish REGULAR Sleep-Wake cycle
- AVOID Sedatives

2) ESMARCH SPLINT
- Occlusive splint that advances the Lower Jaw
- Moves Tongue Base / Pharynx forward
- Widens airways in unstable portion of Oropharynx

3) SURGICAL Tx
- Uvulopalatopharyngoplasty (UPPP)

• Tonsillectomy = REDUNDANT Mucosa is resected from Posterior Pillars and remaining ones are sutured to Anterior Pillars