sleep disorders Flashcards
sleep occupies how much of a human’s life?
1/3
obstructive sleep apnea
if a patient’s breathing is interrupted or if they stop breathing completely during sleep
- respiratory obstruction
- decrease in oxygen, heart rate and pulse will increase; if no proper treatment, can lead to CV disease of higher dosage of medications
central sleep apnea
no obstruction of the airway, brain does not send signal to respiratory muscles
obstructive sleep apnea diagnoses
- hospital based test
- poly somno graphy (PSG)
normal
0-5 respiratory events /hr of sleep
mild
5-15 respiratory events/ hr of sleep
moderate
15-30 respiratory events/ hr of sleep
severe
> 30 respiratory events/ hr of sleep
what causes snoring
obesity pregnancy allergies smoking alcohol- muscle relaxant
hallmark symptom of sleep apnea
snoring, narrowing of upper airway
where does the snoring sound come from?
vibration of the uvula
percentage of snorers
25% men and 15% women are habitual snorers
percentage of snorers between 41 - 65 yrs
60% men and 40% of women between 41-65 yrs
what percent of sleep apnea patients snore?
95%
snoring is related to
cardiovascular disease
heavy smoking
myocardial infarction
atherosclerosis
nocturnal symptoms of obstructive sleep apnea
chocking or gasping
insomnia
diaphoresis (sweating)
impotence (weakness)
diurnal symptoms of obstructive sleep apnea
excessive daytime sleepiness
what percentage of people report daytime sleepiness
30% to 50% of general population
epworth sleeping scale
rating how much you doze during sitting, reading, watching TV, sitting inactive, passenger in a car for an hr, lying down to rest, sitting and talking to someone, sitting quietly after lunch with no alcohol, in a car while stopped in traffic
most common physical characteristic of obstructive sleep apnea
craniofacial anatomy-narrowing of the oropharyngeal airway
physical characteristics of obstructive sleep apnea
craniofacial anatomy retrognathia narrow maxillomandibular arches tonsillar hypertrophy macroglossia inferior displacement of hyoid bone
retrognathia
malocclusion, abnormal posterior positioning of maxillar or mandible
narrow maxillomandibular arches
patient will have difficulty breathing through nose an become a mouth breather
macroglossia
narrow maxilla + large tongue
inferior displacement of hyoid bone
retrusive position of hyoid bone indicates restriction of airway
look for shape and size of maxillar, position of mandible, amount of missing teeth; amount of missing teeth will decrease
vertical dimension
clinical predictors of obstructive sleep apnea
scalloped tongue, size of tongue, position of tongue relative to occlusal plane
bruxism and sleep apnea?
retrusive movement during bruxism may obstruct the airway
friedman classification for tongue
A Tongue is normal B tongue covers half of space in throat C tongue covers 2/3 of space in throat D tongue covers space in throat E tongue covers space in throat and more
sleep apnea patients Friedman classification
usually between C +D
Friedman test for obstructive sleep apnea
patient opens mouth
mallampati score to test for Obstructive sleep apnea
patient protrudes tongue
mallampati score
I= normal
II= tongue covers half of throat
III= tongue covers more than half of throat
IV tongue covers throat
Is Friedman or mallampati score more accurate for testing for obstructive sleep apnea?
friedman
clinical predictor of obstrutive sleep apnea
wear facets
OSA prevalence
male, 40-70 yrs, overweight, obese, central body fat distribution, large neck girth, craniofacial and upper airway abnormalities
suspected risk factors for OSA
genetics smoking meopause alcohol before sleep nighttime nasal congestion
OSA symptoms
habitual, loud snoring
nocturnal breathing pauses, choking, gasping
excessive daytime sleepiness
problems with daytime functioning
daytime sleepiness motor vehicle crashes psychosocial problems decreased cognitive function reduced quality of life
CV and cerebrovascular disease
hypertension coronary artery disease myocardial infarction CHF stroke diabetes and metabolic syndrome
oral appliance therapy
selection fabrication fitting adjustment long term follow up care -muscle relaxation during sleep allows open airway to widen
oral appliance therapy aims to
- modify position of upper airway structures
- increase the airway size
- prevent the collapse of the tongue and soft tissues
what the oral appliance does
- hyoid bone will move forawrd and up, providing more clearance
- prevents uvula from producing snoring sound; snoring sounds are at the level of the uvula
oral appliance is
adjustable
pre-fabricated oral appliances
not recommneded, potential side effects, dentist should evaluate
monoblock non-adjustable oral appliance
first appliance used
-mech: increase vertical dimension and maintain jaw in forward position, which is similar to previous appliance
clinical protocol for oral appliance
examination bite reg/ impressions oral appliance selection fitting/adjustments follow ups (6 mos, yearly)
why are symptoms worse while patient is sleeping on his back?
gravity causing lower jaw to move back, muscles to relax, and decrease in size of the airway
during REM
increase in muscle relaxation; severity increases, oxygen decreases by 78%
how do these devices work?
when the lower jaw is protruded, there is more airflow and the snoring sound is not as intense
Home sleep monitor measures
oxygen levels and obstruction during sleep
5 screening questions for obstructive sleep apnea
1 what prevents you from getting a good night sleep?
2are you excessively sleepy during the day?
3 how many hours do you normally sleep
4 have you been told that you snore or stop breathing
5 what medications and other substances do you take (muscle relaxants? )
if you have a patient that falls asleep on the chair
send him for a consult on the 6th floor and follow up
