General oto OSA Flashcards
Describe the Müller maneuver.
Endoscopic evaluation during maximal inspiration, against a closed nose and mouth, at various levels in an attempt to identify anatomical regions of obstruction
What is the Epworth sleepiness scale?
A commonly used, statistically validated questionnaire for
daytime sleepiness.
A score of 0 to 5 is supernormal, 5 to 10 is normal, 10 to 15
is sleepy, 15 to 20 is very sleepy, > 20 is dangerously sleepy.
What is upper airway resistance syndrome (UARS)?
UARS is characterized by excessive daytime somnolence but normal sleep studies. Esophageal pressure monitoring
shows abnormally increased negative intrathoracic pres-
sures leading to increased work of breathing and sleep
arousals. UARS is associated with crescendo snoring. In
contrast to OSA, UARS is seen as frequently in women as in men, occurs in nonobese patients, and is more common in young adults than in elderly adults.
What cephalometric findings are associated with
OSA?
The skull base appears to be shorter. The sagittal dimension of both jaws is smaller and in a more retrognathic position.
The height of the lower face is increased, as the mandible
tends to be rotated posteriorly. The chin and tongue are
retruded, the soft palate is elongated, and the upper airway space is narrowed.
What is the definition of OSA?
OSA is a sleep disorder characterized by periodic complete
or partial upper airway obstruction during sleep, causing
intermittent apneas, hypopnea, or both despite ongoing respiratory effort. There is no universally accepted definition, but it is usually defined as a respiratory disturbance index (RDI) of 5 or greater. Measurements of the severity of OSA are based on the RDI, the severity of oxygen
desaturation, and the level of daytime sleepiness.
What medical therapies exist for treatment of
OSA?
● Weight control, CPAP (continuous positive airway pres-
sure), and oral appliances
● Medical conditions such as acromegaly and hypothy-
roidism should be ruled out.
● Medications or substances such as alcohol, sedative
hypnotics, narcotics, anesthetics, and sedating antihist-
amines should be avoided.
What are potential complications or sequelae of Uvulopalatopharyngoplasty (UPPP)?
Persistent snoring or OSA, bleeding, nasopharyngeal
regurgitation of liquids, oropharyngeal dryness, oropharyngeal dysphagia, and pharyngeal stenosis
What does the Friedman staging system assess?
This staging system is used as a clinical predictor of which
patients may have successful improvement of their OSA after UPPP surgery.
What is the most common surgical treatment of
children with OSA?
Adenotonsillectomy. Less commonly, lingual tonsillectomy
may be performed.
What craniofacial syndromes are closely associated
with snoring and sleep apnea?
Achondroplasia, Pierre Robin syndrome, Treacher-Collins
syndrome, Crouzon disease, Down syndrome, Prader-Willi
syndrome, and Apert syndrome
What is the mechanism of radiofrequency tissue volume reduction used for the treatment of
snoring?
Inserting electrodes and applying thermal energy will create a definable “thermal lesion” that over time will be replaced by stiff fibrotic tissue with reduced vibratory capacity.
Describe tongue base and hyoid bone suspension
procedures for treatment of OSA.
A screw, with two sutures attached, is drilled into the
lingual cortex of the mandibular symphysis. The two
sutures are then submucosally secured to the tongue base or wrapped around the hyoid and tied under tension.
What EEG findings are associated with each stage of sleep?
N1 (stage 1) - Theta waves
N2 (stage 2) - K complexes and spindles
N3 (stage 3-4) - Delta waves
Define apnea
A period of 10+ seconds during which air flow is absent
Define hypopnea
Decreases airflow to 10-70% for more than 10 secs associated with a 3% desaturation and arousal
