Week 2 Sleep Apnea Risk factors

Question 1

Sleep Apnea Risk factors include:

Answer 1

Obesity
increasing age
male
Anatomic abnormalities of upper airway
Family history
Alcohol or sedative use 
smoking
Associated conditions

Question 2

True or False?

Neck size is a better predictor than overall BMI

Answer 2

True

Question 3

Former smokers have ____ chance to have sleep apnea than non-smokers

Current smokers have ____ chance to have sleep apnea than smokers

Answer 3

2X

2X

Question 4

In older people, OSA is not as closely associated with ______

Answer 4

obesity

Question 5

Major risk factors of OSA in children?

Answer 5

Adenoidal

Tonsillar hypertrophy

Question 6

Neck size of _____ in males and _____ females increases likelihood of OSA

Answer 6

≥17

≥16

Question 7

Why is neck size better predictor of OSAS than body weight?

Answer 7

Because it is where it happens!

Question 8

Other diseases that are risk factors for OSA

Answer 8

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…)

Question 9

AHI of _____ is OSA in children.

Answer 9

> 1

Question 10

Clinical features of OSA

Answer 10

habitual loud snoring
witnessed apneas, snoring/gasping
nocturnal awakenings
nocturia
EDS
fatigue
Decreased libido (sex drive) 
Depression

Question 11

In the US, the most common cause of EDS is ___________

Answer 11

chronic insufficient sleep

Question 12

True or False?

Not all patients with OSA will complain of hypersomnolence (EDS)

Answer 12

True

Question 13

True or False?

All habitual snorers will have OSA

Answer 13

False!!

Not all habitual snorers will have OSA

Question 14

Stop-Bang model questionnair

Answer 14

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

Question 15

High risk of OSA saying, Yes to ____ or more items

Low risk of OSA answering Yes to _____ items

on stop-bang questionnaire

Answer 15

3

less than 3

Question 16

OSA diagnosis is done by using _____

Answer 16

Polysomnogram

Question 17

Sleep apnea treatment revolutionized by ________

Answer 17

Continuous Positive Airway Pressure (CPAP)

Question 18

Earlier alternative of CPAP:

Answer 18

tracheotomy
weight loss
medication
jaw surgery (not to children)

Question 19

To reduce sleep apnea.. encourage patients to:

Answer 19

lose weight
avoid alcohol and sedatives 
avoid sleep deprivation 
avoid supine sleep position
stop smoking
behavioral cognitive therapy

Question 20

Treatment of OSA: 3 specific measures

Answer 20

1. Positive airway pressure therapy (CPAP, Bi-level, auto-CPAP)
2. Dental devices
3. upper airway surgery

Question 21

Nasal CPAP is….

Answer 21

primary treatment modality for OSA

most common therapy

acts as a pneumatic splint (provides enough air)

Question 22

Problems with CPAP??????

Answer 22

Patient acceptability!!!

Nobody likes wearing a CPAP….

Question 23

If the patient does not want to use CPAP.. what’s a sleep doc to do?

Answer 23

Refer for oral device

Question 24

Oral Appliances indications (MSA)

Answer 24

Snoring and Apnea (not severe)

Question 25

Side effects of Oral appliances (MSA)

Answer 25

TMJ discomfort
Changes in occlusion
Salivation
Loss of restorations

Question 26

Mandibular Advancement devices won’t be effective with _______

Answer 26

SEVERE (AHI >30) OSA

Question 27

Further surgery options for OSA

Answer 27

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)

Question 28

UPPP (Uvulopalatopharyngoplasty)

Answer 28

surgery used to remove tissue and/or remodel tissue in the throat.

Limited success rate

Question 29

Localization of obstruction in OSA

Answer 29

Nasopharynx 4(20%)
Oropharynx 14 (70%) 
Hypopharynx 2(10%)

Question 30

Oral appliances aim to ….

Answer 30

relieve upper airway obstruction and snoring by modifying the position of mandible, tongue, and other oropharyngeal structures

Question 31

Types of oral appliances to treat OSA

Answer 31

Tongue-retaining appliances: no or few teeth

Mandibular repositioning appliances (mostly used)

Question 32

What is RDI

Answer 32

same as AHI

Question 33

How do MRAs compared to nCPAP

Answer 33

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

Question 34

MRAs compared to upper airway surgery?

Answer 34

some data suggest that MRAs are SUPERIOR to UPPP

Question 35

True or False?

Oral appliances have better patient compliance than CPAP

Answer 35

True

Question 36

Contraindications of oral applaicnes

Answer 36

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

Question 37

treatment end-point you need at least…

Answer 37

7mm or 75% protrusion

If above criteria is met, continue advancing till snoring and apnea has subjectively resolved.

Question 38

MRAs are usually adjusted how often….

Answer 38

6-8 weeks!