Snoring and OSA Flashcards
What is Upper airways resistance syndrome (UARS)?
Presence of snoring symptoms without evidence of obstructive apnoeas or de-saturations. It is characterised by increased respiratory effort identified by oesophageal pressure analysis. Further progression of airway obstruction leads to near total or total obstruction of airflow
What is Obstructive sleep apnoea hypopnoea syndrome (OSAHS)?
Categorised by the co-existence of excess daytime sleepiness with interrupted and repeated collapse of the upper airway during sleep, usually with associated de-saturations. This collapse can be complete with total cessation of airflow (apnoea) or partial with significant hypo-ventilation (hypopnoea).
How is OSAHS categorised?
OSAHS is categorised as mild (5-14 events per hour), moderate (15-30 events per hours) or severe if they are greater than 30 events per hour3. Although AHI is often used to assess the severity of OSAHS, clinically significant OSAHS is only likely to be present when the AHI is greater than 15 events per hour, in association with unexplained day time sleepiness or a minimum of 2 of the other features of the condition
What are the symptoms associated with OSAHS?
Excessive daytime sleepiness Witnessed apnoeas Impaired concentration Snoring Unrefreshed sleep Choking episodes Restless sleep Irritability/personality change Nocturia Decreased libido
Which factors increase the risk of sleep related breathing disorders (SRBD)?
Age: increase up to 6th and 7th decade
Sex: more in men and menopausal women
Obesity
Obstructive upper airway anatomy: craniofacial abnormalities, adenotonsillar hypertrophy, nasal polyps
Smoking and drinking
Family history, hypothyroidism, acromegaly, hypnotics/opioids
What are the consequences of SRBD?
Neurocognitive: increase in accident rates and impaired cognitive performance
Cardiovascular: hypertension
Impotence and reflux
What is the Epworth sleepiness scale?
Method of identifying excessive daytime sleepiness
A formal assessment of nasal airway and pharyngeal anatomy needs to be undertaken preferably with an endoscope (flexible or rigid).
What are sleep studies?
indicated in all patients presenting with snoring or suspected sleep apnoea
Patients with COPD and snoring should have an urgent sleep study as the combination is potentially dangerous
What is Polysomnography (PSG)?
Considered the gold standard for diagnosis of OSAHS. The assessment entails an in-patient study involving overnight assessment of variable number of parameters including- EEG, electromyogram, electro-oculogram, respiratory airflow, thoraco-abdominal movement, ECG, oximetry, body position, snoring sound and video.
What is the management for OSAHS?
Behavioural changes Weight loss Lifestyle changes CPAP Intra-oral appliance Drugs: Protrytyline, acetozolaminde and progesterone, are respiratory stimulants and also known to suppress rapid eye movement sleep, modafenil for daytime sleepiness Upper airway surgery
What are the surgical options for OSAHS?
Tracheostomy (rarely used)
Nasal surgery (polyps, deviated septum, turbinate hypertrophy)
Uvulopalatopharyngoplasty (UPPP) (widening the oropharyngeal pathway, involves tonsillectomy, uvulectomy and excision of a variable segment of the soft palate)
Laser-Assisted Uvulopalatoplasty (LAUP)
Radiofrequency (RF)- volume reduction and scarring
Maxillofacial and Multilevel Surgery
What are the differences in OSA in children?
Peak 2-5 M:F same usually undernourished Uncommon daytime somnolence Hyperactive and developmental delay ADHD AHI greater than 1 is considered abnormal