Week 6 Abdalla- OSA Flashcards
Describe sleep cycle
REM: 25% of sleep in a night (every 90 minutes and gets progressively longer)
Stage 1: light sleep
Stage 2: deep sleep
Stage 3-4: deepest sleep
Approx how many patients have OSA?
5%
What is insomnia?
Difficulty falling and / or staying asleep
What is parasomnia?
Sleep walking, talking, abnormal movements, night terrors
What are sleep related breathing disorders?
Snoring, CSA, OSA
What are sleep related movement disorders?
Restless leg syndrome, nocturnal bruxism
What is narcolepsy?
Overwhelming daytime drowsiness leading to daytime sleeping
What are circadian rhythm sleep disorders?
Jet lag, shift work
What conditions are greater risk in patients with sleep disorders?
Greater risk of heart failure, heart attack, diabetes, depression/anxiety, schizophrenia
What is central sleep apneoa?
Airflow ceases due to a temporary lack of inspiration (CNS issue). Can be associated with:
- polymyelitis
- spinal cord injury
- encephalitis
What is obstructive sleep apneoa?
Airflow stops due to physical obstruction
What are the 3 types of sleep apneoa?
Central
Obstructive
Complex (combination)
What is apneoa vs hypopnea?
- Apnoea: Total cessation of airflow for at least 10 seconds
- Hypopnea: Reduced airflow for at least 10 secs accompanied by arousal or drop in O2 saturation
What is the sleep cycle for OSA?
- Inc breathing effort (dec O2, inc CO2)
- Arousal
- Hyperventilation
- Return to sleep
- Hyperventilation
- Upper airway narrowing/collapse
What are symptoms of sleep apneoa?
- Poor concentration
- Low mood
- Restless sleep
- Heart burn
- Waking up with dry mouth
- Night sweats
- Insomnia
- Waking up dizzy
- Weight gain
- Fatigue, lack of energy
- Forgetfulness
- Irritability
- Frequent night time urination
What are risk factors for OSA?
- Obesity*
- Smoking
- Alcohol use
- Upper airway collapsibility
- Male
- Older age
- Genetics
What are dental risk factors for OSA?
- High narrow palate
- Narrow dental arches
- Increased anterior face height
- Increased overjet
- Retrognathia
- Large tongue
- Tonsillar hypertrophy
What is most common risk factor for OSA in children?
Enlarged tonsils and/or adenoids
How to manage adults with OSA?
- Weight management
- Smoking cessation
- Alcohol cessation (evenings)
- Sleeping position (not supine)
- CPAP
How to manage children with OSA?
- Referral to sleep specialist
- Adenotonsillectomy
- Pharmacological agents to reduce lymphoid tissue- not that effective
- Wight loss if obese
- (avoid CPAP as can cause mx retrusion)
What are implications of OSA for dentist?
- Often underdiagnosed and under reported
- Dentists can have role in management of pts through provision of MAS- this would always be done under guidance of specialist sleep physician
How to screen adults for OSA?
- Mallampati (friedman) score
- May have scalloped tongue (sign of sleep bruxism)
What questions to ask adults at risk of OSA (STOP-BANG)?
- Snoring: Do you snore? Is it as loud as or louder than talking
- Tiredness: Do you wake up tired, or do you become tired during the day
- Observed Apnoeas: Have you felt or has anyone else told you that you stop breathing in your sleep?
- Hypertension: Do you have high blood pressure, or are you on medication for high blood pressure?
- BMI >35kg/m2
- Age: >50 years
- Neck circumference: >40cm
- Gender: male
How to screen children at risk of OSA?
- History snoring, daytime sleepiness, difficulty concentrating, ADHD
- Paediatric sleep questionnaire
- Epworth Sleepiness Scale for Children and Adolescents
- Enlarged tonsils (Brodsky scale)
- Skeletal risk factors (mandibular retrognathia, narrow maxilla)
How to diagnose OSA?
Polysomnography
What should you do if you suspect OSA?
Refer pt for medical assessment. Use of oral appliances to treat snoring without medical exam/investigation is innapropriate
Why is it important to know if patient has OSA?
Increased risk of respiratory arrest from sedation and GA- procedures should be undertaken in hospital and anaesthetist present
Who can MAS be used in?
Adults with mild to moderate OSA who do not tolerate CPAP
What are MAS?
- Better tolerated than CPAP
- Less effective in more severe cases
- Can cause changes to the occlusion over time
- Adults need to be dentate for most appliances
How can OSA be treated?
- CPAP
- MAS
- Orthognathic surgery
What are risk factors for smaller airways in children?
- Narrow mx
- Retrogthnathic md
Are appliances useful for increasing airway in children?
RME doesn’t have much of an effect on increasing airway
Difficult to research as there is huge variation in children and airway increases as they grow
