7- OSA

• Obstructive sleep apnea

  Cessation of breathing for more than 10sec for multiple times during sleep, because of upper airway obstruction since muscles are hypotonic
• Obstructive sleep apnea

  • Nasal effort reduced but respiratory effort maintained (have thoracoabdominal movement)
  • Obstruction happens in REM sleep
• Usual causes of obstructive sleep apnea

  • Obesity
  • Large tongue
  • Hypothyroidism
  • Acromegaly
  • Goiter
• Nocturnal symptoms of obstructive sleep apnea

  • Loud snoring
  • Witnessed apnea
  • Nocturia
  • Insomnia
  • Restless sleep
  • Gasping & choking sensations that wake patient from sleep
• Daytime symptoms of obstructive sleep apnea

  • Non-restorative sleep (tired)
  • Morning headache
  • Excessive daytime sleepiness and fatigue (impaired work/driving)
  • Memory impairment
  • Concentration, personality, & mood changes
  • Sexual dysfunction
  • GERD
• Risk factors for obstructive sleep apnea

  • BMI > 30
  • Neck circumference >40cm
  • Metabolic syndrome
  • Male gender
  • Postmenopausal women
  • Family history
  • Age >40
  • Down syndrome
• Diagnosis of obstructive sleep apnea

  1. Screening test: overnight oximetry (cyclic drop in saturation)

  2. Sleep study: 10-15 apneas in 1hr of sleep is diagnostic

  3. Epworth sleepiness scale: total score more than 10 indicates sleep disorder
• Treatments for obstructive sleep apnea

  • Weight loss if overweight
  • Sleep in lateral position
  • Surgery if there is distinct obstruction (tonsils, nasal polyps, facial deformity)
  • CPAP mask during sleep (keeps pharyngeal walls open)