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Oral Surgery > sleep apnea > Flashcards

sleep apnea Flashcards

1
Q

snoring definition

A

partial airway obstruction that reduces airflow but does not cause arousal from sleep

like hypnoapnea

you can snore and not have sleep apnea

25 % of men and 15% of woman are habitual snorers

30-50% of asymptomatic snorers have sleep apnea

snoring is risk factor for
- HTN, CVA, MI

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2
Q

upper airway resistance syndrome

A

exaggerated breathing effort and snoring created by high resistance to airflow in the upper airway

this causes fragmented sleep and significant daytime drowsiness (no evidnece of apnea on testing)

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3
Q

general effect of upper airway resistance syndrome

A

this causes fragmented sleep and significant daytime drowsiness (no evidnece of apnea on testing)

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4
Q

evidence of apnea with upper airway resistance syndrome

A

no

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5
Q

evidence of apnea with upper airway resistance syndrome

A

no

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6
Q

snoring and sleep apnea relationship

A

30% of snoreers have sleep apnea

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7
Q

obstructive sleep apnea syndrom definition

A

stoppage of breathing for 10 seconds or more for at least 5 x a hour

oxyen saturation in the blood decreases more than 4%

apnea events end with an arousal from sleep

arousals lead to chronic daytime sleepiness and other symptoms

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8
Q

apnea events ends when

A

with an arousal from sleep

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9
Q

arousals lead to

A

chronic daytime sleepiness and other symptom

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10
Q

hyponea definition

A

decrease in airflow with oxygen deaturations greater than 4% and an arousal from sleep

snoring usually associated

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11
Q

risks of OSA

A

increased rate of motor vehicle accidents

increased risk of unemploment

unisuraility

marital discord

cardiovascular consequences

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12
Q

apnea hyponea index (AHI)

A

the average number of apneas plus hypopneas per hour of sleep

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13
Q

predisposing factors for OSA

A

increaseed age

increased weight / obesity

male gender

disproportionate upper airway anatomy

alcohol

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14
Q

OSA syndtom

A

loud snoring

irregular breathing

restless sleeep

excessive daytime sleepiness

witnessed apnea by partner in bed

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15
Q

major risk factor for OSA

A

obesity

  • losing weight can signficanttly improve sleep apnea

need to lose over 10 kg weight

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16
Q

severity of apnea defined by

A

length of time of apnea event and percentage of oxygen desaturation

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17
Q

mild OSA

apnea- hypnea index

A

5-15 events / hour

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18
Q

moderate OSA

apnea- hypnea index

A

10-40 events / hour

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19
Q

severe OSA

apnea- hypnea index

A

over 40 events/ hour

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20
Q

anatomic predisposition

A

reduced posterior airway space

posterior rotation of mandible

tongue posterior and inferior

hyoid inferior placed

decreased A-P diameter of cranial base

decreased
A-P diameter of maxilla/ manidble

decreased posterior facial height (VME)

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21
Q

polysomnogram aka?

looks at?

A

sleep study

EEG - brain waves
EMG - muscles
ECG - heart

respiratory airflow and effort

blood oxygen ssaturation

pulse rate

body position

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22
Q

what your dentist might if you snore or have obstructive sleep apnea

A

elongated uvula and soft palate that can contact the tongue

enlarged tonsils which partially obscure the airway

the tongue is large and usually rests above the biting surface of the teeth

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23
Q

what your dentist might if you snore or have obstructive sleep apnea

A

elongated uvula and soft palate that can contact the tongue

enlarged tonsils which partially obscure the airway

long uvula

the tongue is large and usually rests above the biting surface of the teeth

a normal class I tongue is at or below the level of occlusal plane

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24
Q

effects of oral appliances

A

bring mandible and base of tongue forward palate and mandibular rotation

prevention of mandibular opening during sleep

downward mandibular rotation

support soft palate and uvula

increased genioglossus activity

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25
Q

goals of oral repositioning devices

A

50-75% of maximum protrusion

start movement slowly

vertical dimension increased by 5 mm

26
Q

indications for use of oral appliances

A

primary snoring

mild to moderate OSA

poor tolerance of nasal CPAP

failure of UPPP
- surgical technique to remove uvula and soft palate

use of appliance during travel

use in combination with other treatmetns

27
Q

benefits of CPAP

A

always eliminates snoring if properly titrated

elimniates or reduces dangerous OSA, hypopnea and oxygen desaturation of blood

28
Q

protocol for for oral appliances

A

trial evaluation for 2-3 months

subjective symptom assessment

ceph with appliance in place

repear overnight sleep study

repeat evaluation / recall

29
Q

protocol for for oral appliances

A

medical assessment and polysomnography by sleep specialist FIRST

  • oro-facial / dental evaluation
  • design, fabricate, fitting, training, adjustment

trial evaluation for 2-3 months

subjective symptom assessment

ceph with appliance in place

repear overnight sleep study

repeat evaluation / recall

30
Q

contraindications for oral appliances

A

severe sleep apnea

obesity

TMJ problems

poor dentition
- like perio and could extract the teeth with appliance use

steep mandibular plane angle

31
Q

sleep deprivation statistics

A

32 % of americans sleep 6 hour or less per night

23% of adults fell asleep at the wheel during the past year

sleep time has decreased 20% over last century

32
Q

statistics of snoring

A

approx 40% of adults over 40 snore

33
Q

stastics of signs of OSA on testing

A

9% of men
4% of woman
HAVE SIGNS ON TESTING

34
Q

statistics of signs and SYMPTOMS of OSA

A

4% of men and 2% of woman

35
Q

general prevelance of OSA

A

as prevalent as diabetes or asthma!!!

36
Q

tx for snoring

A 
avoid alcohol
weight loss
CPAP - prob overkill
- position therapy 
oral appliances *
37
Q

T/F pulse oximetry is a poor screening tool

A

true

we need sleep study

38
Q

severity of apnea defined by?

A

length of time of apnea event

percentage of time apnea event

percent of oxygen desaturation

39
Q

apnea - hypoapnea ndex is

A

mild - 5-15 (5-20 on other slide) events/hour

moderate 15-40 (20-40 on other slide) events/ hours

severe over 40 events/ hour

40
Q

risks of OSA

A

increased rate of motor vehicle accidents

increased risk of unemployment

uninsurability

martial discord

cardiovascular consequences

41
Q

sleep breathing disorder continuim

A

snoring –> UARS–> Hypopnea –> apnea –> hypoventilation

42
Q

signs and symptoms of OSA

A
  1. snoring and intermittent pauses
  2. excessive daytime sleepiness
  3. awakness due to gasping and choking
  4. fragmented, non-refreshing sleep
  5. poor memory and clouded intellect
  6. personality changes
  7. decreased sex drive
  8. morning headaches
43
Q

predisposing factors for OSA

A
  1. increased age
  2. increased weight / obesity
  3. male gender
  4. disproportionate upper airway anatomy
  5. alcohol and sedative hyptonics
  6. hypothyroidism
44
Q

collar size and neck size

A

men over 17 and woman over 15

increased risk

45
Q

upper airway configuration in apneics

A

apneic airway has an A-P configuration

NARROWED LATERALLY due to the lateral soft tissue structures – pharyngeal wall and fat pads

VOLUME of lateral pharyngeal walls, soft palate and fat pads are SIGNIFICANTLY LARGER in apneic patients

46
Q

primary screening tool

A

epworth questions

over 10 = OSA

47
Q

epworth norms

- breakdown

A

normal is 5.9 (so 6 or less)

OSA = 11.7

Narcolepsy = 17.5

48
Q

behavior treatment and avoidance with OSA

A

weight loss

body positioning

avoidance of CNS depressants

avoidance of upper airway irritants

49
Q

only one that really raises oxygen saturation

A

CPAP

continuous positive airway pressure

50
Q

side effects of oral appliances

A

excessive salivation

transient discomfort of teeth, TMJ

dry mouth - xerostomia

soft tissue irritation

occlusal changes

51
Q

effectiveness of oral appliances

A

85-90 % effective in snoring

60-70% effective in mild - moderate OSA

10% complication rate

success is highly variable and DOES NOT IMPROVE lowest sa02 levels

52
Q

george gauge

A

intra-oral device used to register correct jaw position for mandibular repositioning appliances

measures prottrusion and retrusion of mandible

start at HALF OF MAXIMUM

53
Q

CLASSIFICATION of oral appliances

A

mandibular repositioning devices

tongue retaining devices

54
Q

tongue retaining devices for?

A

edentulous

55
Q

CPAP success?

A

80-90%

but 40-60% non- compliance issues

20% complication rate

increases lowerst Sa 02

56
Q

general over arching treatment of snoring

A
  1. behavioral tx and avoidance of risk factors
  2. contious positive airway irritants
  3. oral appliance therapy
  4. surgery
57
Q

downfall of Uvulopalatopharynggoplasty

A

painful
removes the uvula palate and tonisls

ONLY 40% SUCCESS WHEN PERFORMED ALONE

ONLY

58
Q

phase I sureries

A

UPPP/ tonsilectomy

mandibular anterior segmental osteotomy with genioglossus muscle advancement

possibly include hyoid bone
stabilization

success increases when do them together

like UPPP alone = 40-50

all three together = 60-70%

59
Q

phase II surgeries
success?
implicatino

A

maxillomandibular advancement (MMA)

maxilla and mandible advanced forward 10 mm - usually combined with advancement of genial tubercles / genioglossus muscle (total of 20 mm for genioglossus)

success rate of approx 97% – bt invasive and a lot of surgery

60
Q

airway is increased at multiple levels

A

tongue base

palate

nasal valve

61
Q

maxillomandibular advancement success rate

A

90-98%

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