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OSA > OSA > Flashcards

OSA Flashcards

1
Q

Definition of SDB

A

General term for breathing difficulties during sleep

- ranges from snoring to OSA

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1
Q

Definition of SDB

A

General term for breathing difficulties during sleep

- ranges from snoring to OSA

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2
Q

Types of sleep apnea

A
  • Central
  • Obstructive
  • Complex
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3
Q

Definition of OSA

A

Interrupted airflow despite persistent respiratory effort.

Apenea: <20% airflow from baseline for 10 sec (adults)
50% 6 sec (children)

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4
Q

What is RERA

A

Respiratory Efffort Related Arousal:
breathing and ozygenation maintained at the expense of great increase in resp. effort due to increased upper ariway resistance

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5
Q

Prevalence

- Gender

A

M x2> F (reduce with age, same by 50y.o)

Sg (Tan et al., 2016):
30% mod-severe
90% undiagnosed/ untx
Chinese more likely to develop and more severe than Europeans

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6
Q

Risk factors + Evidence

A

(Yow & Lye, 2014)

  • Obesity: morbidly obsese increase incidence by 12-30x
  • Age
  • Gender
  • Post stroke
  • Craniofacial anomalies/ morph
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7
Q

What are the craniofacial anomalies

A 
Retro Mn
Dolicofacial
Narrow deep palate
Increase Mn plane angle
Lower hyoid position
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8
Q

Evidence re craniofacial anomalies and OSA

A

Behrents et al, 2019
NOT well est

Kim et al., 2015
Mouth breathing + certain malocclusions rs DEBATABLE

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9
Q

Famous monkey experiment

A

Harvold, 1973
Rhesus monkey
- show rs between mod. facial growth and mouth breathing
- suggest vert. growth pattern with mouth breathing and obstruction of pharyngeal airway

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10
Q

Ortho role

A

1) History taking
2) Clinical exam
3) Radiographic
4) PSG - REFER to sleep clinic for baseline

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11
Q

Things to do in history taking

A

1) MHx
2) Sign and symptoms of OSA
3) STOPBANG
4) Epworth sleepiness scale

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12
Q

STOP BANG

A

Snoring
Tiredness
Observed choking/ breathing difficulties
Pressure: high BP

BMI >10% of normal
Age >50
Neck size >43 M >37 F
Gender

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13
Q

STOP BANG risk levels

A

Low: 2
Intermediate: 3-4
High: 5-8 or M/Fat/Neck + 2 STOP

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14
Q

Things to lookout for in LC +

EVIDENCE

A

Kim, 2015

1) Posterior airway space <11mm
2) Hyoid to Mn distance >15.4
- compensatory to alleviate increase airway resistance
3) Airway smallest cross-sectional area <63.3mm2
4) >51% of nasophargyngeal area occupied by adenoid mass
5) Increased total and LAFH

  • reduced cranial base length
  • long thick soft palate
  • increased tongue area
  • retro mx/mn
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15
Q

Adult consequences of OSA

A
  • increase morbidity and mortality
  • traffic accidents
  • poor work performance
  • cardiovascular diseases
16
Q

Paeds consequences of OSA

A
  • Poor sch performance/ learning skills
  • AHDH
  • Hyperactivity
  • Depression
  • Beharviourial prob
17
Q

First line of tx for paeds OSA + EVIDENCE

A

Adenotonsillectomy (Kim et al., 2020)

- 60% achieve AHI <1 (Friedman, 2009)

18
Q

Dx of residual paeds OSA

A

Sk vs ST abnormality

SK -> GM:

  • VME: High pull HG
  • Constricted Mx: RME
  • Retro Mn: Functional app
  • Retro Mx: PFM

ST:

  • Neuromotor dysfunction: CPAP
  • Chronic inflammation of UA: Meds
  • Obesity: Weight loss
19
Q

Outcome of RME for OSA

A
  • enlarge nasal cavity
  • increase P vault
  • increase nasal airflow
  • reduce resistance and phayrgngeal collapsibility

CONVERT to nasal breathing

20
Q

Outcome of FM in OSA

A

Naso-velo-pharyngeal enlargement

sig. increase in nasopharyngeal airway dimensions (Ming et al., 2018)

21
Q

Whats required for TB

A
  • good growth potential/ pattern

- compliance

22
Q

Outcome of TB in OSA + evidence

A

Mn adv-> open oropharyngeal airwar-> increase O2 sat and reduce suppression of growth hormone -> increase growth potential to treat OSA and face

Yanyan,2018:
Mean diff of 1.75 event/hr in AHI
at least 6mth more eff. than short term

23
Q

Adult OSA mx

A

1) Weight loss
2) CPAP
3) MAD
4) MARPE/SARPE
5) MMA

24
Q

CPAP compliance evidence

A

POOR
29-83%
Behrents et al., 2019

25
Q

MAD v CPAP

A

Ramar, 2015

CPAP sig greater odds of achieving AHI<10

26
Q

Effectivness of MAD

A

Ramar et al. 2015
Mild- No diff with CPAP
Mod-severe: CPAP

27
Q

Side effects of MAD

A
  • Reduced OJ/OB
  • Ui retro/ Li pro
  • TMD
  • Long term wear
28
Q

Why MAD side effect

A

Musculature attempt to restore Mn normal position

- transmit reciprocal force to hard tissues and dentition

29
Q

Amt of MMA + evidence

A

Hassing et al., 2021
>10mm to remain stable
Increase in oropharyngeal vol.

30
Q

Premolar exo + incisor retraction on UAR

EVIDENCE + findings

A

Ng et al., 2019

  • systematic review
  • > 16
  • 4 premolar exo

Findings:
- AP ariway narrowing at oro-, sometimes hypo-
but small and comparable to measurement errors
- high variable
- 2/3 east asian studies show reduced airway dimensions
- single functional breathing study showed increased simulated flow R after incisor retraction

31
Q

Latest evidence on airway and exo

A

Orabi et al., 2021

  • NO sig diff in total, naso-,glossal-,oro- vol. or min. sectional area
  • questionable clinical sig.
  • NO strong evidence exo in crowded/bimax pt reduce pharyngeal airway vol. of MCA

OSA multi factorial, not just anatomical -need for OSA phenotyping

32
Q

Evidence re OSA and Mn setback

A

Kim et al., 2021

  • retrospective
  • evaluate sequential change in pharyngeal airway dimension after Mn setback
  • Short term (11.8m)
  • Long term (43m)

Findings:
Imm. post op: reduced airway dimension
Short term fu; recovered
Long term fu: maintained

Long term changes: unknown
Role of Mn setback DEBATABLE

33
Q

Evidence on setback and breathing

A

Yavari et al., 2020
- STOPBANG preop, 1mth, 6mth postop

<5mm setback: no increased risk in healthy young non smoker, Cl.III

> 5mm: sig risk increase

measured from incisal edge

34
Q

Conclusion for OSA + Ortho

Evidence

A 
AAO White paper
Behrents, 2019
- NO convincing data to show detrimental changes
- Not cause rs doesnt exisit
- No quality evidence

To incorporate screening

  • Refer
  • Indisciplinary mx
35
Q

What is exo claims on OSA

A

exo premolars -> reduce arch length/ over retract incisors-> risk positioning tongue posteriorly and inferiorly -> obstructing existing narrow oro-phayngeal airway

OSA (1 decks)

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