Week 2 Sleep Apnea Risk factors Flashcards
Sleep Apnea Risk factors include:
Obesity increasing age male Anatomic abnormalities of upper airway Family history Alcohol or sedative use smoking Associated conditions
True or False?
Neck size is a better predictor than overall BMI
True
Former smokers have ____ chance to have sleep apnea than non-smokers
Current smokers have ____ chance to have sleep apnea than smokers
2X
2X
In older people, OSA is not as closely associated with ______
obesity
Major risk factors of OSA in children?
Adenoidal
Tonsillar hypertrophy
Neck size of _____ in males and _____ females increases likelihood of OSA
≥17
≥16
Why is neck size better predictor of OSAS than body weight?
Because it is where it happens!
Other diseases that are risk factors for OSA
Cranio-facial disorders (eg. Pierre-Robin)
Retroposed Mandible/maxilla
Endocrine abnormalities
Genetic diseases (down syndrome: associated with a large tongue and retrognathic maxilla)
Post-menopause
Polycystic ovary syndrome (increases the chance of OSA for some reason…)
AHI of _____ is OSA in children.
> 1
Clinical features of OSA
habitual loud snoring witnessed apneas, snoring/gasping nocturnal awakenings nocturia EDS fatigue Decreased libido (sex drive) Depression
In the US, the most common cause of EDS is ___________
chronic insufficient sleep
True or False?
Not all patients with OSA will complain of hypersomnolence (EDS)
True
True or False?
All habitual snorers will have OSA
False!!
Not all habitual snorers will have OSA
Stop-Bang model questionnair
S - snoring T - tired O - observed P - blood Pressure B - BMI (more than 35kg/m) A - Age (Over 50) N - Neck size (over 16 inches) G - Gender
High risk of OSA saying, Yes to ____ or more items
Low risk of OSA answering Yes to _____ items
on stop-bang questionnaire
3
less than 3
OSA diagnosis is done by using _____
Polysomnogram
Sleep apnea treatment revolutionized by ________
Continuous Positive Airway Pressure (CPAP)
Earlier alternative of CPAP:
tracheotomy
weight loss
medication
jaw surgery (not to children)
To reduce sleep apnea.. encourage patients to:
lose weight avoid alcohol and sedatives avoid sleep deprivation avoid supine sleep position stop smoking behavioral cognitive therapy
Treatment of OSA: 3 specific measures
- Positive airway pressure therapy (CPAP, Bi-level, auto-CPAP)
- Dental devices
- upper airway surgery
Nasal CPAP is….
primary treatment modality for OSA
most common therapy
acts as a pneumatic splint (provides enough air)
Problems with CPAP??????
Patient acceptability!!!
Nobody likes wearing a CPAP….
If the patient does not want to use CPAP.. what’s a sleep doc to do?
Refer for oral device
Oral Appliances indications (MSA)
Snoring and Apnea (not severe)
Side effects of Oral appliances (MSA)
TMJ discomfort
Changes in occlusion
Salivation
Loss of restorations
Mandibular Advancement devices won’t be effective with _______
SEVERE (AHI >30) OSA
Further surgery options for OSA
Nasal surgery
Removal of tonsils and adenoids (children)
Uvulopalatopharyngoplasty (UPPP)
Genioglossus advancemen/hyomyotomy (GAHM): keep the tongue from going down
Maxillomandibular advancement
Tracheotomy (last resort)
UPPP (Uvulopalatopharyngoplasty)
surgery used to remove tissue and/or remodel tissue in the throat.
Limited success rate
Localization of obstruction in OSA
Nasopharynx 4(20%) Oropharynx 14 (70%) Hypopharynx 2(10%)
Oral appliances aim to ….
relieve upper airway obstruction and snoring by modifying the position of mandible, tongue, and other oropharyngeal structures
Types of oral appliances to treat OSA
Tongue-retaining appliances: no or few teeth
Mandibular repositioning appliances (mostly used)
What is RDI
same as AHI
How do MRAs compared to nCPAP
less effective in reducing AHI in those with SEVERE disease
Can be an option as primary treatment in those with MILD-MODERATE disease; (but improved health outcomes have only been shown with CPAP)
Used in those who refuse to try CPAP
MRAs compared to upper airway surgery?
some data suggest that MRAs are SUPERIOR to UPPP
True or False?
Oral appliances have better patient compliance than CPAP
True
Contraindications of oral applaicnes
less than 5 teeth per quadrant (excluding 3rd molars, with exception of fixed bridges)
Visual evidence of periodontal disease or dental caries
Evidence of TMJ disorder
treatment end-point you need at least…
7mm or 75% protrusion
If above criteria is met, continue advancing till snoring and apnea has subjectively resolved.
MRAs are usually adjusted how often….
6-8 weeks!
