Obstructive Sleep Apnea

Question 1

OSA

What is the definition of apnea and hypoapnea?

Answer 1

apnea: not breathing for >10 seconds
hypopnoea: reduced breathing

Question 2

OSA

What causes the apnea?

Answer 2

a repetitive complete or partial collapse of the upper airway during sleep

Question 3

OSA

What anatomical parts of the body can cause obstruction of the upper airway?

3

Answer 3

• base of the tongue
• soft palate with uvula
• epiglottis

Question 4

OSA

How long can apneaic episodes last for and how many times per night?

Answer 4

• 20 seconds to 3 minutes
• 100-160 episodes per night

Question 5

OSA

What are the nighttime and daytime symptoms?

Answer 5

night:
snoring
snorting
choking
awakening in the night

day:
morning headache
sleepiness

Question 6

OSA

What scoring system do we use to assess sleepiness?

How is it scored?

What can it help us distinguish sleepiness from?

Answer 6

The Epworth Sleepiness Scale (ESS) (score of 10 or more) can be used to distinguish sleepiness from fatigue.

Question 7

OSA

In the long run, patients with untreated OSA are at increased risk of ____, ____, ____ and ____.

Answer 7

hypertension
CAD
CVA
arrythmias

Question 8

OSA

Chronic hypoxaemia can have long term effects on the body. Name 3.

Answer 8

pulmonary hypertension, right ventricular dysfunction and cor pulmonale

cor pulmonale: abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

Question 9

OSA

Name some risk factors.

7

Answer 9

• obesity
• older age
• male sex
• Craniofacial and upper airway abnormalities
• mechanical obstruction (neuromuscular diseases)
• family history
• smoking

Question 10

OSA

Diagnosis is based on clinical symptoms and the frequency of respiratory events during sleep, as measured by ____.

Answer 10

nocturnal polysomnography

Question 11

OSA

In asymptomatic pts how many apneic events need to occur per hour to get a diagnosis? What about in symptomatic pts?

Answer 11

asymptomatic: 15+
symptomatic: 5+

Question 12

OSA

What questionnaire can we use for a preoperative evaluation of patients with undiagnosed OSA?

Answer 12

STOP-Bang

Question 13

OSA

What is the STOP-Bang questionnaire?

How is it scored?

Answer 13

The STOP-Bang questionnaire is an eight-item survey that incorporates information on:

Snoring
Tiredness
Observed apneas
Blood pressure
Body mass index (BMI)
Age
Neck circumference
Gender

A score of 3 or higher suggests the diagnosis of OSA.

Question 14

OSA

Differential diagnoses for OSA are based on the presenting complaint. These can range from reasons such as ________

Distinctions are made via clinical history and polysomnography.

name a few

Answer 14

insufficient sleep, sleep disorders, neurologic disorders, psychiatric disorders to medications.

Question 15

OSA

How do we confirm diagnosis?

Answer 15

Nocturnal polysomnography (PSG)

Question 16

OSA

What is Nocturnal polysomnography (PSG)?

Answer 16

a sleep study that observes brain waves, skeletal muscle activity, blood oxygen levels, heart rate, breathing rate and eye movement to help identify sleep disorders

Question 17

OSA

If we observe macroglossia, what might we test for?

Answer 17

TSH (hypothyroidism)

Question 18

OSA

To determine associated conditions and complications from OSA, what might we investigate for?

Answer 18

Blood pressure measurement
Fasting blood sugar

Question 19

OSA

What conservative management options are there?

9

Answer 19

• pt education (driving risk!)
• weight loss
• smoking cessation
• avoidance of alcohol + sedatives
• avoidance of sleeping supine
• treating nasal problems
• CPAP
• BiPAP (for more severe, but more expensive)
• dental appliances

Question 20

OSA

What kind of surgery can be done?

4

Answer 20

• Somnoplasty
• Uvulopalatopharyngoplasty (UPPP)
• Tonsillectomy
• Adenoidectomy – in children