SLeep Apnoea Syndrome

Answer 1

Obstructive sleep apnea (OSA) is a common chronic sleep-related breathing disorder characterized by repetitive upper airway collapse during sleep, which causes sleep fragmentation, oxygen desaturation, and excessive daytime sleepiness.
This disorder is also associated with increased all-cause mortality

Question 2

How is osa diagnosed?

Answer 2

Polysomnography where there is obstructed sleep with atleast 5 episodes of apnea or hypopnea per hour and each episodes associated with reductionnin saturation >4%

Question 3

Define hypoapoapnea.

Answer 3

It is defined as partial airflow obstruction that causes reduction of >50% in airflow for 10 seconds or longer associated with reduction in oxygen saturation >3% or an EEG evidence of arousal.

Question 4

What are the risk factors for developing OSA?

Answer 4

Obesity
Age >40
Male
Excessive alcohol intake
Smoking
Pregnancy ( overweight/obese, 50% have sleep disorder breathing link with PIH, some association with IUGR)
Sedentary lifestyle
Low socioeconomic status
Neck circumference >40cm
Tonsilitis/adenoid hypertrophy
Craniofacial abnormalities
Neuromuscular disorders

Question 5

Define apnea

Answer 5

Reduced airflow >90% for x2 breaths or more

Question 6

What are the questionnaires for OSA assessment?

Answer 6

1. The Berlin
2. ASA checklist
3. STOP BANG

Question 7

Components of STOP BANG questionnaire

Answer 7

S- snoring: loud
T- tired: day time somnolence
O- observed apnea
P- Pressure: hypertension
B- BMI: >35
A- age : >40
N- neck circumference >40cm
G- gender : male

Question 8

How is osa risk stratified with STOP BANG?

Answer 8

Yes to >4 questions

Question 9

The Berlin

Question 10

ASA checklist

Question 11

Define hypersomnolance

Answer 11

Occurs secondary to poor sleep quality especially during 3&4th stages of sleep with frequent arousal due to hypoxia and hypercarbia.

Question 12

McGill oximetry scoring for osa

Answer 12

Question 13

How is the severity of OSA graded

Answer 13

Apnea-hpoapnea index AHI

Question 14

AHI severity of OSA

Answer 14

Mild<5
Moderate 5-
Severe >30 AHI/hr

Question 15

What is measured by polysomnogram

Answer 15

Nadir od pso2
RDI: # of apnea/hypopnea/hr
Apnoea-hypopnea index: #of apnea/hypopnea 2° to obstructive event /hr

Question 16

Neurological

Answer 16

Increased ccs associated with poor outcomes
Psychosocial problem 2° to daytime somnolence
Reduced cognitive function, depression loelw IQand poor memory
Irreversible reduction in Grey matter

Question 17

Endocrine

Answer 17

Impaired glucose tolerance
Dyslipidemia
Altered HPA axis with high adrenocorticotrophic and cortisol
Testicular and ovarian dysfunction (PCOS+hypothyroid)

Question 18

Cvs

Answer 18

Hypertension
Brady & tachyarrythmias
Biventricular dysfunction
Pulmonary hypertension
Corpulmonale
Ccf 2° endothelial dysfunction, dyslipidem7a, platelets dysfunction, high pro-inflammatory mediators and low antioxidants

Question 19

What are treatment goals

Answer 19

resolve signs and symptoms of OSA,
○ improve sleep quality, and normalize the apnea-hypopnea index
And oxyhemoglobin saturation levels.

Answer 20

EDUCATION AND BEHAVIOR

Patient education
Behavior modification
Weight loss and exercise
Sleep position
Alcohol avoidance
Concomitant medications

POSITIVE AIRWAY PRESSURE THERAPY

Question 21

Anesthetic concerns

Answer 21

Difficult intubation
Sensitive to resp depressant
Minimize long acting opioids
Extubate awake whenever possible
Use theor own chapters masking ward or pacu

Question 22

CPAP adjustments

Answer 22

Pressure 5-20cmH20 in non obese

Question 23

Intraoperative concerns