Case 15: OSA and Uvulopalatopharyngoplasty

Question 1

What is the difference between

• Obstructive sleep apnea
• Obstructive sleep hypopnea syndrome,
• Obesity hypoventilation syndrome
• Pickwickian Syndrome

Answer 1

• Obstructive sleep apnea (OSA)
  
  • defined as complete cessation of airflow for >10 seconds, occuring 5 or more times per hour of sleep despite continued respiratory effort and associated w/ >4% decrease in SpO2
• Obstructive sleep hypopnea syndrome (OSH)
  
  • Milder form of OSA, when a sleep study demonstrates 50% reduction in airflow for >10 seconds occuring 15 or more times per hour of sleep and associated w/ >4% decrease in SpO2
• Obesity hypoventilation syndrome (OHS)
  
  • Develops secondary to obesity and/or as a longer term consequence of OSA. Defined by a constellation of obesity (BMI >30), daytime arterial hypercapnia (PaCO2 >45), nocturnal hypoxia and polycythemia in absence of known causes of hypoventilation.
  • Pickwickian Syndrome
    
    • Severe form of OHS in which chronic hypoventilation leads to pulmonary HTN and Right ventricular failure

Question 2

Factors to consider when determining whether outpatient care appropriate for patient with OSA

Answer 2

1. Severity of sleep apnea
2. Anatomical and physiological abnormalities
3. Coexisting diseases
4. Nature of the surgery
5. Type of anesthesia being performed
6. Need for post operative opioids
7. Adequacy of post discharge observation
8. Capabilities of outpatient center