ENT: Sleep-disordered Breathing

Question 1

Sleep-disordered breathing

Answer 1

1. Sleep apnea syndrome
   - Obstructive
   - Central
2. Snoring

Question 2

Symptoms of OSAS

Answer 2

1. Excessive daytime sleepiness
2. Loud snoring
3. Observed episodes of stopped breathing during sleep
4. Abrupt awakenings accompanied by gasping or choking
5. Awakening with a dry mouth or sore throat
6. Morning headache
7. Difficulty concentrating during the day
8. Experiencing mood changes, such as depression or irritability
9. High blood pressure
10. Nighttime sweating
11. Decreased libido

Question 3

Investigations

Answer 3

1. Physical examination
   - Large tonsils
   - Body build
   - Neck girth
   - BMI Asian upper limit 23
2. Epworth Sleepiness Scale (ESS) Questionnaire
3. Upper airway examination
   - Pharynx
   - Nasopharynx
   - Oral cavity: Tongue, Tonsils
4. Upper neck mass
   - Thyroid
5. Polysomnography
   - SaO2
   - Apnea-Hyponea index (>30 severe)
   - Thoracic movement (Central: no movement; Obstructive: have movement)
   - EEG
   - Airflow by temperature monitor
   - REM stage: Most relaxed stage, more obstruction

Question 4

Treatment of OSAS

Answer 4

• Lifestyle modification
• CPAP (Gold standard)
• Airway surgery e.g. UPV surgery, Tongue base resection, Bimaxillary enlargement
• Mandibular Advancement device: protrude lower jaw to open up airway
• Avoid hypnotics (antihistamine), alcohol
• Sleeping posture
• Refrain from driving