OSA Flashcards
What is OSA
Characterized by episodes of complete airway collapse of partial collapse associated with decrease in O2 or arousal from sleep
What is the most common cause of OSA in children
enlarged tonsils / adenoids
What is the most common association of OSA in adults
obesity
Males (17+ inch neck)
advancing age
What is the pathophys of OSA
Episode of apnea is caused by at least 90% anterior to posterior collapse of the airway >10sec
What is a typical presentation of OSA
Excessive daytime sleepiness
loud nightly snoring
overweight
night sweating
night time reflux
What may be see on physical exam with OSA
Large neck
large tongue
crowded oropharynx
retrognathism
What is class 1 mallampati score
complete visualization of soft palate
What is class 2 mallampati score
complete visualization of uvula
What is class 3 mallampati score
visualization of only the base of the uvula
What is class 4 mallampati score
soft palate is not visible at all
What is the presentation of OSA in children
hyperactive rather than sleepy
loud nightly snoring
academic difficulties
What may be seen in PE of kids of OSA
Adenoid facies
tonsils hypertrophy
hypo-nasal speech
high arched palate
Which patients should be screened for OSA regardless of symptoms
any patients with hypotonia (downs syndrome)
What is the Hepworth sleepiness scale
indicator of inadequate restorative nighttime sleep
*score >10 suggest sleep disorder rather than general fatigue
What is the use of the Berlin questionnaire
predicts high or low likelihood OSA
What is the STOP-BANG score
most specific criteria for OSA
*3+ positive answers is considered high risk of OSA and should be referred for further eval
How can you workup sleep apnea
Nighttime in lab polysomnography (PSG) - gold standard
What is the criteria for hypopnea
Reduction in airflow >30% for more than 10sec with >4% O2 desaturation
Reduction in airflow >30% for more than 10sec with >3% O2 desaturation or an arousal from sleep on EEG
What is the home sleep test
Higher accessibility and lower cost than PSG
What is the downfall of home sleep tests
can miss mild OSA
What is Apnea-hypopnea index (AHI)
average number of obstructive events per hour
What AHI gives you the dx of OSA
> 15 events/hour
What is moderate OSA AHI score
15-30 events/houe
If someone has 30+ obstructive events per hour, what is their OSA dx
severe
If a patient has <5 obstructive events at night… what is their DX
mild OSA IF there is excessive daytime drowsiness, sleep maintenance insomnia, or cognitive dysfunction is reported
What is the AHI criteria for children with OSA
Mild = 1-4.9 events/hour & clinical sequela
Moderate = 5-10
Severe = 10+
What is the most effective tx for sleep apnea
CPAP
If someone is adherent to CPAP, what will the outcome be
near resolution of symptoms
who is BiPAP used for
severe OSA
When is surgery used with OSA
Severe
Unable to tolerate treatment modalities
Is weight loss curative with OSA
no but it is recommended when obese
What is the primary treatment of OSA in children
tonsillectomy and adenoidectomy
If a child has mild OSA, what may their treatment be
trial of montelukast and nasal steroids may reduce AHI goal
What are the surgical options for OSA
Uvulopalatopharyngoplasty (UPPP)
Drug-induced sleep endoscopy (DISE)
maxillomandibular advancement (MMA)
Implantable hypoglossal nerve stimulator (inspire)
Who is inspire useful for
if CPAP cannot be used
moderate to severe OSA
At least 18 y/o
not significantly overweight
What is the STAR clinical trial
stimulation therapy for apnea reduction
What is treatment for extreme cases of OSA
tracheostomy
