W6 - Sleep Opnoea - Abdalla Flashcards
Describe the sleep cycle
Stage 1 - light sleep “twitches, jerking”
REM - first occurs after 90 min, then every 90 min thereafter
Stage 2 - brainwaves slow, assoc w/ memory consolidation
Stage 3+4 final and deepest stages of sleep
REM gets longer through the night
Deep sleep reduces through the night
Sleep disorders (6)
Insomnia
Parasomnia (sleep walking, talk, etc)
Sleep-related breathing disorders (OSA, snoring)
Sleep-related mvmt disorders - nocturnal bruxism
Narcolepsy
Circadian rhythm sleep disorders (jet lag)
What other chronic conditions can be worsened by OSA (4)
Increased risk of developing:
Heart failure
Heart attack
Schizophrenia
Anxiety/depression
What causes snoring in adults
Vibration of loose soft tissues in the airway as air passes over them
What causes snoring in children
Enlarged tonsils or adenoids
Snoring = sleep apnoea?
No
How does sleep apnoea get subclassified
Central sleep apnoea (CSA)
Obstructive sleep apnoea (OSA)
Complex (combination)
Features of central sleep apnoea
Airflow ceases due to a temporary lack of inspiration
CNS issue
- Polymyelitis
- Spinal cord injury
- Encephalitis
Apnoea vs hypopnea
Hypopnea - reduced airlow for at least 10s, accompanied by arousal or drop in o2 sat
Apnoea - Total cessation of airflow for at least 10s
Central sleep apnoea vs obstructive sleep apnoea
CSA = CNS issue
OSA = physical obstruction of airway
Describe severity of apnoea for children and adult ranges
Describe the pathophysiology cycle of OSA
How does apnoea affect the sleep cycle and lead to symptoms?
Patients are unable to complete the sleep cycle - keep getting woken up
- 27 min in
Symptoms of sleep apnoea (8)
Poor concentration
Low mood
Restless sleep
Heartburn
Waking up in the morning with dry mouth
Night sweats
Weight gain
Daytime fatigue
Modifiable risk factors of OSA adult
Obesity
Smoking
alcohol
Upper airway collapsibility
How can lifestyle be modified to reduce OSA (4)
Weight management
no drinking/smoking
sleeping position alteration (not supine)
CPAP
Describe the comorbidities of OSA (4)
Hypertension
CVD
Stroke
Metabolic syndromes
Dental risk factors of OSA (7)
High narrow palate
Narrow dental arches
Increased anterior face height
Increased overjet
Retrognathia
Large tongue
Tonsillar hypertrophy
Why doesnt CPAP work very effectively in adults?
Poor pt compliance
Differences btw adult and children OSA
Concern with CPAP machine use in children
Hypomaxillary development
Class 3 / midface def
Management of OSA children (4)
Adenotonsillectomy
Pharmacological agents to reduce lymphoid tissue
Weight loss if obese
CPAP (caution - maxillary retrusion)
Why is assessing OSA important for dentists? (4)
- Under diagnosed and reported - GP’s dont screen for it
- Dentists see their pts regularly
- Dentist can manage pts with provision of mandibular advancement devices
- Should always be done under guidance of specialist sleep physician
How to screen adults (mallampati score) for OSA
How to screen adults for OSA using STOP BANG questions
What anatomical feature to screen for OSA
Scalloped tongue
- 70% diagnostic for OSA
- Also sign of nocturnal bruxism
- Tongue presses up against teeth during sleep
3 ways of screening adults of OSA
- Check for scalloped tongue
- STOP-BANG questionnarie
- Mallampati Score
How to screen children for OSA (5)
Epworth Sleepiness Scale
Paediatric sleep questionnaire
History of snoring, daytime sleepiness, ADHD
Brodsky scale for enlarged tonsils
Skeletal risk factors (narrow mx, mandibular retrognathia)
What is the only way to truly diagnose OSA
Dentists can’t do it - we can only screen
Polysomnogram / Polysomnography test
TG advice on how to manage OSA (4)
Diagnosis of facial skeletal retrusion (retrognathia)
Refer for medical examination and sleep lab investigation
Construction of md advancement splints BUT must be done in association with a multidisciplinary team led by resp specialist physician
Be mindful of GA - OSA pts are at increased risk of respiratory arrest with GA and sedation - do it in hospital if required
Consideration of sedation and GA for dental treatment in OSA pts
increased risk of respiratory arrest
- treat in hosp if required
What is the role of the dentist/ortho in tx of OSA (3)
- Skeletal problems causing malocclusion should be corrected (RME, functional appliance, etc) in adults
- Mandibular advancement splints to be used in adults with mild-mod OSA who cannot tolerate CPAP
- Bimax protrusion orthognathic surgery if all else fails
Should ortho appliances and mandibular advancement splints be used to treat OSA in children?
No - insufficient evidence
Features of mandibular advancement splints for OSA (4)
- Better tolerated than CPAP
- Less effective in severe cases
- Can cause changes to occlusion over time
- Adults need to be dentate for most appliances
Risk factors for smaller upper airway in children (2)
Narrow maxilla
Mandibular retrognathia
Class 2
What is the Brodsky scale for enlarged tonsils in kids
