Obstructive Sleep Apnoea Flashcards
OBSTRUCTIVE SLEEP APNOEA (OSA)
• Affects 1-2% of population; Most often in Overweight, Middle-aged Males; Can occur in
children especially if tonsils enlarged
• Presents as Loud snoring, Daytime sleepiness, Unrefreshed/Restless sleep, Morning
Headache, Nocturnal Choking, Reduced Libido
• Apnoea occurs when airway at back of throat is sucked closed when breathing in during
sleep; Hypotonia of opening muscles of upper airway (Genioglossal and Palatal); Partial
narrowing results in snoring
o Apnoea leads to hypoxia and strenuous respiratory effort to overcome resistance
• Combination of Central Hypoxic Stimulation and respiratory effort wakes patient; Awakenings
are brief, and patient might not be aware; Reduction in sleep especially REM sleep
• Obesity, Narrow Pharyngeal opening, Co-existent COPD, Enlarged Tonsils, Deformities and
Obstruction, Respiratory Depressants (Alcohol, Sedatives, Strong Analgesia)
Diagnosis and Management of OSA
• Relatives can provide good history of snore-silence-snore cycle; Epworth Sleepiness Scale can
help discriminated OSA from simple snoring
• Diagnosis supported by overnight SpO2; Falls in cyclical manner = Sawtooth appearance
• Inpatient Assessment with oximetry and video recording if home SpO2 not useful
• Diagnosis requires >10-15 episodes of apnoea/hypopnoeas in 1 hour of sleep
• Correction of Treatable factors, Nasal CPAP therapy (Raises Pharyngeal pressure by 1kPa to
stunt walls open) although up to 50% cannot tolerate CPAP; Modafinil (CNS stimulant) as a
short-term alternative
Childhood Vs Adult Obstructive Sleep Apnoea
• OSA – Intermittent upper airway collapse during sleep
• In childhood, most commonly due to enlarged Pharyngeal or Palatine Tonsils (Tonsillar
Hypertrophy) whereas in adults mostly due to obesity
• Children – ENT review more likely; CPAP also an option; In adults, weight management plays a
more prominent role in management of OSA
