Sleep Apnea

Question 1

OSA

Answer 1

Obstructive sleep apnea (OSA) is defined by repeated episodes of upper airway closure during sleep that result in recurrent oxyhemoglobin desaturation and sleep fragmentation

Question 2

Health Consequences of Untreated OSA

Answer 2

• daytime sleepiness –> MVAs, occupational accidents, reduced quality of life
• oxyhemoglobin desaturations and physiologic stresses from repetitive upper airway obstruction –> increased BP and cardiovascular disease

Question 3

Apnea

Answer 3

Breathing cessation for ≥ 10 seconds

Question 4

Hypopnea

Answer 4

Breathing flow reduction for ≥ 10 seconds accompanied by either a ≥3% or ≥4% oxyhemoglobin desaturation or by arousal from sleep

Question 5

Risk Factors for OSA

Answer 5

• Obesity, especially with body mass index > 35 kg/m2
• Family history of obstructive sleep apnea •Retrognathia
• Treatment-resistant hypertension
• Congestive heart failure
• Atrial fibrillation
• Stroke
• Type 2 diabetes

Question 6

Symptoms of OSA

Answer 6

• Witnessed episodes of apnea
• Loud, frequent, bothersome snoring
• Choking/gasping during sleep
• Excessive daytime sleepiness
• Drowsy driving (recent sleepinessassociated motor vehicle accident or near-miss)
• Unrefreshing sleep
• Sleep fragmentation
• Insomnia
• Nocturia
• Morning headaches
• Decreased concentration
• Memory loss
• Decreased libido

Question 7

Answer 7

Question 8

Central Sleep Apnea Syndrome

Answer 8

Central sleep apnea is a disorder in which your breathing repeatedly stops and starts during sleep. Central sleep apnea occurs because your brain doesn’t send proper signals to the muscles that control your breathing.

Question 9

OSA and Children

Answer 9

(1) All children/adolescents should be screened for snoring.
(2) Polysomnography should be performed in children/adolescents with snoring and symptoms/signs of OSAS; if polysomnography is not available, then alternative diagnostic tests or referral to a specialist for more extensive evaluation may be considered.
(3) Adenotonsillectomy is recommended as the first-line treatment of patients with adenotonsillar hypertrophy.
(4) High-risk patients should be monitored as inpatients postoperatively.
(5) Patients should be reevaluated postoperatively to determine whether further treatment is required. Objective testing should be performed in patients who are high risk or have persistent symptoms/signs of OSAS after therapy.
(6) Continuous positive airway pressure is recommended as treatment if adenotonsillectomy is not performed or if OSAS persists postoperatively.
(7) Weight loss is recommended in addition to other therapy in patients who are overweight or obese.
(8) Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated or for mild postoperative OSAS.

Question 10

Treatment for OSA in Adults

Answer 10

• weight loss
• CPAP
• manibular advancemnt devices
• change in sleep position