CH1 Obstructive Sleep Apnea

what happens with OSA

breathing stops during sleep for > or = to 10s and > or = 5x/hr

pathophysiology of OSA

muscles relax during sleep, tongue and neck structures are displaced, upper airway is obstructed but chest mvmt is not affected

what does the apnea lead to

hypoxemia, hypercapnia and decreased pH causing the sleeper to wake up and correct the obstruction, then cycle repeats causing sleep deprivation

cause of OSA

upper airway obstruction by the soft palate or tongue

what does chronic OSA cause

increased risk of htn, stroke, cognitive deficits, wt gain, DM, pulmonary and cardiovascular diseases

expected findings with OSA

snoring, excessive daytime sleepiness, inability to concentrate, irritability, bedwetting, excessive urination at night, reduced sex drive, fatigue, depression, pharyngeal edema

risk factors for OSA

obesity, large uvula, short neck, smoking, enlarged tonsils or adenoids, oropharyngeal edema

diagnostics for OSA

STOP & BANG tests, pulmonary fit tests (PFTs) and polysomnography

STOP & BANG

sleep apnea questionnaires, yes score higher than three items indicates high risk for OSA

parts of the STOP questionnaire

Snore loudly, often feel Tired, has anyone Observed you stop breathing or gasping, do you have high blood Pressure

parts of the BANG questionnaire

BMI more than 35, Age over 50, Neck circumference >17" for male and >16" for female, Gender - male?

polysomnography

overnight sleep study, directly observed for symptoms like depth of sleep, type of sleep with EEG, respiratory effort with ECG, O2 sat using pulse ox and muscle movement using EMG

medications for OSA

modafinil (Provigil)

modafinil (Provigil)

not first line of therapy, promotes daytime wakefulness, may help patients with narcolepsy, does not treat the cause

procedures for OSA, surgical management

referral to an ENT for adenoidectomy, uvulectomy, uvuvlopalatopharyngoplasty or trach for severe cases

nonsurgical management for OSA

change of sleep position, weight loss, decrease ETOH, avoid sedative meds, positive pressure ventilation, nasal or full face mask

BiPAP

bilevel airway pressure, set inspire and airway pressure at beginning of each breath, there is more pressure when breathing in and less pressure when breathing out

CPAP

continuous positive airway pressure, set positive airway pressure continuously during each cycle of inhalation and exhalation, constant airflow

APAP

auto titrating positive airway pressure, adjusts continually and resets pressure to meet breathing cycle needs, algorithmic control