Obstructive Sleep Apnea

Question 1

What is Obstructive Sleep Apnea?

Answer 1

• Syndrome that results from a repetitive pharyngeal narrowing and collapse during sleep

Question 2

What are some OSA Systemic Effects?

Answer 2

• Hypertension
• Myocardial Ischemia/Infaraction
• Congestive Heart Failure
• Arrhythmias
• Cerebrovascular Accidents
• Death

Question 3

Define Apnea…

Answer 3

Observed cessation of inspiratory effort for greater than 10 seconds during sleep…leads to oxygen desaturation

Question 4

Define Hypopnea…

Answer 4

> 30% reduction in airflow for > or equal to 10 from baseline with > 4% 02 desaturation

Question 5

What is the cause of Snoring (noisy breathing - rhoncus)?

Answer 5

Vibration of the uvula and osft palate against the posterior wall of the oropharynx

Question 6

How does one arrive to the AHI value?

Apnea + Hypopnea Index…

Answer 6

Apnea + Hypopnea Index which is calculated by adding the number of apneas to the hypopneas divided by the number of hours of sleep

Question 7

What value is synonmymous with AHI?

Answer 7

RDI

Respiratory Disturbance Index

Question 8

What does RERA stand for?

Answer 8

Respiratory Effort Related Arousals

Question 9

What are some OSA Risk Factors?

Answer 9

• Obesity present in 60-90% of OSA patients
• Gender: male:female ratio 2-3:1
• Nasal Obstruction
• Craniofacial abnormalities
• Mandibular retrognathia
• Micrognathia
• Macroglossia
• Narrowed, tapered, and short max arch
• Overbite
• Long soft palate
• Mallampati grade III or IV
• Tonsillar hypertrophy
• Neck circumference
• Increase Snoring

Question 10

What are some OSA symptoms?

Answer 10

• Loud snoring
• EDS (daytime sleepiness)
• Sleep fragmentation
• Mental deterioration
• Depression
• Reduced sleep latency

Question 11

What are some different tests for Obstructive Sleep Apnea?

Answer 11

• Epworth Sleepiness Scale
• Multiple Sleep Latency Test
• Home/Ambulatory
• Polysomnography (PSG)

Question 12

What AHI value must you have to be diagnosed with OSA?

Answer 12

> 5/hr

• Daytime sleepiness
• Witnessed noctural apneas
• Awakening with choking
• Breath holding
• Gasping

Question 13

What are the values for a normal AHI, Mild OSA, Moderate OSA, and Severe OSA?

Answer 13

• Classified by number of apneic/hypopneic episodes per hour
• AHI < 5 Normal
• AHI > or equal to 5 < 15 = Mild OSA
• AHI > or equal to 15 < or equal to 30 = Moderate OSA
• AHI > 30 = Severe OSA

Question 14

What are some Non-Surgical OSA Treatments?

Answer 14

• Weight loss/behavior modification
• Drug therapy
• Continuous Positive Airway Pressure (Gold Standard)
• Dental appliance

Question 15

What OSA classifications are Dental Appliances Indicated?

Answer 15

Dental devices are indicated in snoring and mild-moderate OSA patients after medical evalution and referral

Question 16

What are some Surgical treatment for OSA?

Answer 16

• Tosilloadenoidectomy
• UPPP (uvulopalatopharyngoplasty)
• LAUP (laser assited uvulopalatoplasty)
• Anterior mandibular osteotomy
• Bimaxillary advancement