15 - Sleep Respiratory Disorders

obstructive sleep apnea (OSA)

sleep apnea caused by obstruction of the mouth and upper respiratory tract

obstructive sleep apnea (OSA)

• CV associations

• nocturnal angina

• MI

• a-fib

• HTN

• CHF

obstructive sleep apnea (OSA)

• risks

• obesity

• neck circumference > 17 in.

• HTN

• chronic nasal congestion

• male

• 65+ years old

• menopause

• family history

• alcohol

• sedatives

obstructive sleep apnea (OSA)

• neurological complications

• morning headache

• stroke

• seizures

• depression

• short-term memory loss

central sleep apnea (CSA)

sleep apnea caused by no nervous stimulation of the diaphragm

• due to disorders of CV, metabolism, CNS

central sleep apnea (CSA)

• diagnosis

central AHI > 5 events/hour, > 50% total

mixed sleep apnea

both types of sleep apnea

• CSA → OSA

complex sleep apnea

both types of sleep apnea

• OSA → CSA with PAP

• requires special mode (ASV)

screening tools for sleep apnea

• Epworth Sleepiness Scale

• STOP-BANG

diagnosis of sleep apnea

• history

• upper airway exam

• PFT

• labs: CBC, thyroid hormones, bicarb, ABG

• CXR, EKG

• polysomnogram

  • EEG, EOG, EMG, nasal/oral flow, snoring, chest/abdominal movement, S_pO₂, HR

AHI apnea criteria

≥ 10 sec with ≥ 90% airflow reduction

AHI hypopnea criteria

≥ 30% airflow reduction and O₂ desaturation ≥ 4%

AHI ranges

normal	< 5 events/hr
mild	5-15 events/hr
moderate	15-30 events/hr
severe	> 30 events/hr

management of sleep apnea

• PAP

• CPAP

• BiPAP

• auto-PAP (ASV)

management of sleep apnea

• PAP compliance

≥ 4 hours/night, 70% of days for 30 days

management of sleep apnea

• interventions

• weight loss

• sleep posture

• O₂

• meds: REM inhibitors

• dental devices

• hypoglossal nerve stimulation

• phrenic nerve pacer

• tracheostomy

management of sleep apnea

• lifestyle modifications

• diet and exercise

• avoid alcohol and sedatives

management of sleep apnea

• surgery

• uvulopalatopharyngoplasty

• laser-assisted uvulopalatoplasty

• nasal surgery

• tracheostomy

• mandibular advancement surgery