#26 Jasani - Sleep Apnea

Question 1

What is not a predisposing factor for OSA?
Nasal Obstruction
Anemia
Obesity
Tonsilar hypertrophy

Answer 1

Anemia (wasn’t on list)

Question 2

What is OSA? What are other sleep apneas?

Answer 2

Obstructive Sleep Apnea (Sleep apnea, obstructive sleep apnea syndrome, sleep disordered breathing)

Other sleep apneas: C^3
Central Sleep apnea
Cheyne Stoke respiration
Complex Sleep Apnea

Question 3

What are the consequences of untreated OSA?

Answer 3

Increased insulin resistance
High blood pressure
Depression
Cardiac problems (afib, heart attack, heart failure)
Snoring (your spouse may want to put a pillow over your head)
Memory problems
Stroke
Hormone disruption
Increased accidents
Death

Question 4

How would you diagnose OSA?

Answer 4

AHI (Apnea Hypopnea Event) >= 15 OR

AHI >=5 with another event (daytime somnolence, witnessed apneic evetn, impaired cognition, HTN, CAD, CVA, CHF)

Question 5

Who is eligible to do an at-home sleep study?

Answer 5

Candidate must be without chronic lung or heart disease.

Question 6

How would you treat OSA?

Answer 6

CPAP 
Weight loss
Positional therapy
Alter the upper airway
Bypass the upper airway (tracheostomy)

Question 7

A surgeon tells you he will be doing a level I surgical treatment of OSA. What will he be working on?

Answer 7

Nasal:
FESS (Functional Endoscopic Sinus Surgery)
Septal Surgery
Turbinate surgery

Question 8

A surgeon tells you he will be doing a level II surgical treatment of OSA. What will he be working on?

Answer 8

Oropharynx:
Adenoids

UPP (Uvulopalatopharyngoplasty)[overall success less than 42%]

Palatine tonsillectomy
LIngual tonsillectomy

Question 9

A surgeon tells you he will be doing a level III surgical treatment of OSA. What will he be working on?

Answer 9

Base of tongue & laryngopharynx:
MMA (maxillomandibular advancement)
Genioglossus advancement
Hyoid Suspension

Question 10

How would you screen for OSA?

Answer 10

Neck > than 17"
Sleep history: snoring
Overweight males
Witness apneic events
Multiple nocturnal awakenings
Nocturia (>= 2/night)
Non-restorative sleep

Question 11

What is able to be monitored in a home sleep test?

Answer 11

Nasal airflow
Pulse oximetery
Heart rate
Body position

Question 12

What is able to be monitored at an in lab sleep study?

Answer 12

EEG - sleep stages
EOG - eye movement
EMG - muscle tone/leg movement
EKG
Thoracic and abdominal respiratory effort
Oral and nasal airflow
Pulse oximetery
HR
Body position

Question 13

What defines compliance?

Answer 13

CPAP use greater than 4 hours, 80% of nights

Question 14

What interventions have an effect on compliance?

Answer 14

MASK FIT - critical 
Heated humidification
CPAP/Mask Desensitization programs
OSA/CPAP education
DEDICATED CPAP clinics
Follow up with sleep specialist
***Compliance is not related to severity of apnea or pressure required for treatment.***

Question 15

What are possible positive airway pressure problems?

Answer 15

Mask discomfort
Air leak
Claustrophobia
Aerophagia (swallowing air)
Chest discomfort

Question 16

When could you use a dental appliance?

Answer 16

Primary snoring without sleep apnea
Mild OSA (AHI less than 15)

Question 17

When would you choose surgical treatment of OSA?

Answer 17

Young
Anatomic airway obstruction
Enlarged tonsils and adenoids
Skeletal abnormalities involving face & jaw
Nasal obstruction
Significant CPAP intolerance