Clin Med: OSA Flashcards
OSA is
characterized by episodes of complete airway collapse or partial collapse with associated decrease in O2 saturation or arousal from sleep
OSA: these disturbances results in
fragmented, non-restorative sleep
OSA sx
loud, disruptive snoring, witnessed apneas during sleep, excessive daytime sleepiness
OSA m/c in children:
adults:
children: enlarged tonsils and/or adenoids
adults: obesity, male sex, advancing age
Episode of Apnea is caused by at least 90% of
anterior to posterior collapse of the airway > 10 seconds
Typical Adult PE for OSA
larger than average neck circumference
crowded oropharynx
larger tongue
retrognathism may be present
_____ pts should be screened for OSA regardless of symptoms
refractory Afib
resistant HTN
hx of stroke
Epworth sleepiness scale score
> 10 suggests sleep disorder rather than generalized fatigue
Gold standard dx testing
Polysomnography
Workup OSA
Home sleep test (might miss mild, detects moderate-severe)
Polysomnography
AHI (apnea hypopnea index): average number of obstructive event per hour
Adult scores:
> or equal to 15 events per hour - dx of OSA
15- 29.9 = moderate
30+ = severe
AHI (apnea hypopnea index): average number of obstructive event per hour
children scores:
mild 1-4.9
moderate 5-9.9
severe 10+
either adults or children criteria can be used for 13-17 yo
Adults - treatment of OSA
CPAP - most effective
custom fitted oral appliances (brings lower jaw forward and relives airway obstruction)
BiPAP - severe OSA, better tolerated if requires higher pressure settings
surgery
inspire (implantable hypoglossal nerve stimulator)
Children - treatment of OSA
tonsillectomy and adenoidectomy
if mild - montelukast, nasal steroids
consider steroids
Surgical treatments for OSA
uvulopalatopharyngoplasty (UPPP) : removal of uvula and soft palate tissue to create space in oropharynx
maxillomandibular advancement (MMA) : upper and lower jaws detached, advanced anteriorly increases oropharynx area
