Obstructive Sleep Apnea -Goya Flashcards
What is obstructive sleep apnea? What does this cause?
repetitive partial or complete obstruction of the airway during sleep causing:
- sleep disruption
- oxygen desaturation
- high catecholamine states
OSA is defined as having an AHI (apnea hypopnea index) or RDI (respiratory disturbance index) > 5
What is considered apnea? hypopnea? RERA?
apnea=complete (>90%) cessation of airflow for >10 seconds
hypopnea=partial (>30%) cessation of airflow for >10 seconds with oxygen desaturation (>3%) or cortical arousal
RERA=respiratory effort related arousal = inc reap effort and/or blunted nasal airflow > 10 sec with cortical arousal
What is AHI? RFI? What is OSA?
AHI=(apneas + hypopneas)/ hours of sleep
RDI= (apneas + hypopneas + RERAs) / hours of sleep
In patient with Acromegaly, which of the following is the mechanism for the development of obstructive sleep apnea?
A. Upper airway narrowing with tissue infiltration
B. Contraction of upper airway dilating muscle
C. Positive pressure during inspiration
D. Dystrophy of upper airway dilating muscle
E. Pressure from the neck muscles during inspiration
A. Upper airway narrowing with tissue infiltration
Who are some risk factors for OSA?
Obesity (BMI and neck circumference > 16”)
Mallampati Class (I –> IV ) (IV =more occluded airway due to soft tissue
tonsillar hypertrophy
retrognathia/micrognathia (small chin compared to the mandible)
macroglossia (tongue scalloping)
narrow high arched palate
epworth sleepiness scale > 10 (excessively sleepy)
resistant HTN (> 3 drugs)
unexplained A fib
CHF
What is the testing for OSA?
attended polysomnogram (sleep study)
Embletta =portable testing
What are the indications for CPAP in OSA?
AHI > 15 events / hour or AHI 5-14 events/hour with clinical sequelae
Consider in pts with AHI of 5 with symptoms or who perform critical work
What are the adverse effects of CPAP?
dry mouth, rhinitis, congestion
How does a mandibular repositioning splint work? What OSA pts is this effective in?
Protrudes the mandible forward and holds the tongue anterior, away from the posterior pharyngeal wall
treat mild OSA
What kinds of behavioral modifications are recommended for OSA?
diet and exercise
no alcohol
no drugs
sleep positions
When is OSA surgery indicated? What are the different surgical options?
if CPAP is ineffective
Uvulopalapharyngoplasty (UPPP)-resection of uvula & soft palate
Craniofacial Reconstruction- tongue advancement or maxillo-mandibular osteotomy
Tracheostomy-tube into the airway bypasses obstruction and to be used for severe OSA
