Obstructive Sleep Apneoa

Question 1

Definition

Answer 1

Recurrent pharyngeal collapse with cessation of breathing for >10s during sleep, followed by arousal (which may or may not be recollected)

Question 2

Aetiology

Answer 2

Obstruction of the upper airway due to pharyngeal collapse occurs during sleep due to decreased tone in pharyngeal dilator muscles. This can be due to:

• Excessive weight gain, smoking, alcohol use
• Adenopathy or tonsillitis in children
• Marfan’s, macroglossia or craniofacial abnormalities

Question 3

Epidemiology

Answer 3

5-20% males and 5% females >35.

Incidence increases with age.

Question 4

Presenting symptoms

Answer 4

Daytime sleepiness
Waking up at night gasping for air
Unrefreshing sleep or restless
Dry mouth, headaches, mood changes, difficult to concentrate
Partner will report snoring or lack of breathing

Question 5

Signs on physical examination

Answer 5

Neck circumference >42M and >40F

Lymphadenopathy , large tongue, large uvula, pulled back jaws

Obesity and HTN often coexist.

Question 6

Investigations

Answer 6

Video recording of sleep

Sleep study: in sleep centre, taking HR BP etc.

Blood: TFT and ABG.

Question 7

Management plan

Answer 7

Advice on sleeping position, smoking alcohol and diet

Moderate: mandibular advancement splints

Severe: CPAP positive pressure to maintain airway during the night

Surgery: used in severe cases with ntomical abnormality with varying success

Public health: advise DVLA

Question 8

Possible complications

Answer 8

Risk of accidnets due to tiredness. 
Worsening CHF. 
High risk 
of other lifestyle
associated diseases. Ie. CAD.

Question 9

Prognosis

Answer 9

Good if good compliance with treatment, but many patients do not comply.