Chapter 5 - Snoring, OSA Flashcards
Elevated RF OSA
65, BMI >30, Post-menopause, AA/Asian, Male, Neck >16/17in, relative with OSA
Craniofacial abnormalities and OSA
Often must correct skeleton prior to Soft Tissue
Cause of snoring
Lax tissue vibration, due to variations in airflow
Uvula, SP, tonsillar pillars, pharyngeal walls > BOT
UARS vs OSA
UARS is the mild form of SDB (snoring plus sx) where AHI doesn’t meet OSA threshold
OSA, how obesity impacts
Most severe form of SDB
AHI or RDI > 5
Heavier ST, more parapharyngeal fat (narrows pharynx), redundant SP, full BOT
Prevalence of snoring and OSA
Snore: 40% men, 28% women (84/73 by 60s)
OSA: 3-7% men, 2-5% women
OSA Sx
Snore, restless sleep, choke/gasp for air when sleep, daytime somnolence, morning HA, nocturia, changes in mood (dep/irrit/anxiety/aggression), poor concentration, memory loss, night sweat, bruxism
Comorbidities of OSA
Hypothyroid- independent of weight (mucoprotein/hyalouronic acid)
GERD (changing thoracic pressure worsens GERD, inflammation worsens OSA)
PCOS (hormones)
Acromegaly
Complications of OSA
HTN, MI, stroke, CHF, Cor Pulm, atherosclerosis, A Fib, Arrhythmia, Pulm HTN, Glaucoma, Seizure (DEC threshold), libido
Kids: ADHD, growth delay, enuresis
Muller Maneuver
Scope in nose, close mouth, pinch nose, attempt to breathe in
+ (collapse) means obstruction likely below level of palate
Defining AHI, RDI
Apnea- no flow 10s
Hypopnea- reduce ventilation 30%, 10s, O2 sat down 3%/arousal
RDI- includes arousals that don’t meet hypopnea criteria
5-15 mild, over 30 severe
Causes of SDB in kids
Adenoids/Tonsils
Nasopharyngeal cyst, encephalocele, Chapman atresia, deviated septum, malformation
Tonsil Grades
0- surgically absent 1- within pillars (0-25%) 2- 25-50% 3- 50-75% 4- > 75%
Percentage of airway measured by line between anterior tonsillar pillars
Sleep of OSA
Quick onset
More I, II
Less III, IV, REM (most obstructions occur in these stages)
Good OSA treatments lead to INC REM, INC dreaming
Conservative OSA Tx
No alcohol or sedatives
Treat GERD, T4, HRT
WL
CPAP/BiPAP (Bi lowers pressure in exploratory phase, more comfort)
Dental appliance (mandible adv, tongue position)
Sleep position change
