Obstructive Sleep Apnea

central sleep apnea (Cheyne Stokes syndrome)

• break in respiratory effort secondary to improper central command

• uncommon

• severe - up to 20% mortality rate w/in 5y of dx

obstructive sleep apnea

• soft tissues of the throat collapse & occlude airway, continually during sleep cycle → occlusion of airway leads to decreased blood O2

• brain then signals the body to wake up & breathe 

T

T/F: not everyone who snores has sleep apnea, but almost everyone w/ sleep apnea snores

gestational sleep apnea

• sleep apnea that develops during pregnancy or post-partum

• thought to be due to increased edema in airway tissues &/or hormonal factor

overweight men with large necks

what is the habitus of OSA patients?

apnea

each complete, 100% stop in breathing that lasts at least 10 seconds

hypopnea

each low, shallow breathing event of at least 10 seconds & at least 30% reduced air flow 

17

a neck circumference of __in or larger for men increases the risk of OSA

16

a neck circumference of __in or larger for women increases the risk of OSA

snoring, tiredness, observed stop in breathing, pressure (HTN), BMI (35kg/m2 & up), age >50, neck size, gender (male)

what is the STOP BANG acronym?

0-2

a score of _____ on STOP BANG indicates low risk for OSA

3-4

a score of _____ on STOP BANG indicates intermediate risk for OSA

5-8

a score of _____ on STOP BANG indicates high risk for OSA

snoring that stops

what is a very sensitive sign of OSA?

heart disease, HTN, stroke & atrial fibrillation, VTE, increased LDL/triglycerides/total cholesterol, decreased HDL, gout

what systemic complications are associated w/ OSA? 

T

T/F: OSA pts who have a non-fatal heart attack often have less residual damage

80, 90

___% of men & ___% of women are undiagnosed w/ OSA

2.5

cancer incidence was found to be ____x higher w/ OSA

3.4

cancer mortality was found to be ___x higher w/ OSA

86

untreated OSA was found to have a ___% higher mortality risk compared to non-OSA

35

CPAP treated OSA was found to have a ___% higher mortality risk compared to non-OSA

Epworth sleepiness scale

scale that uses self-report of likelihood of falling asleep during separate activities

1. Epworth sleepiness scale

2. pulse oximetry 

3. polysomnography 

4. apnea hypopnea index

5. respiratory disturbance index 

6. cardiosomnography (not commercially available yet) 

what can be used to dx OSA? 

1. weight loss

2. smoking cessation

3. alcohol avoidance

4. sleeping pill avoidance

5. sleep on side instead of back

6. acetazolamide

7. dental appliances

8. Pillar procedure

9. CPAP, auto-titrating CPAP, BiPAP

10. surgery (MMA, UPPP, tongue reduction)

11. Provent

12. Winx

13. Inspire

14. Vivos DNA

15. dronabinol

16. ADI09

17. Mounjoro

18. Zepbound

19. Didgeridoo

what are the tx options for OSA?

move the lower jaw forward to keep airway open

how do dental appliances for OSA work?

Pillar procedure

tx option for OSA; performed in office w/ anesthetic & syringe, inserts Dacron strips into soft palate to keep airway open

CPAP

tx option for OSA: a machine & mask combine to provide a continuous flow of air to force airway open; poor pt compliance due to being uncomfortable, noise, difficulty traveling, & no point of use satisfaction

auto titrating CPAP

CPAP that continually adjusts flow pressure automatically

BiPAP

CPAP that develops higher dosing & has a different pressure b/t inhaling & exhaling

Provent

tx option for OSA: band-aid like device covering each nostril w/ center valve creating pressure

Winx

tx option for OSA: small mouthpiece that rests inside the mouth & creates suction to open airway 

Inspire

tx option for OSA: upper airway stimulation: stimulates nerves to keep airway open; surgical procedure

Vivos DNA

tx option for OSA: daytime-nighttime appliance; looks like a retainer; worn for 9-18mo & expands the airway by lengthening the palate & trains the tongue to lie in a position that does not block the airway

1. floppy eyelid syndrome

2. keratoconus

3. NAION

4. glaucoma (NTG)

5. papilledema

6. ICSC

7. CPAP side effects

8. increased CRVO risk

9. increased risk of ME & PDR in diabetics

10. increased risk of AMD

what are the ocular SE of OSA?

1. deep retinal hemorrhages

2. CWS

3. vessel tortuosity 

4. isolated peripheral retinal hemorrhages 

what are the retinal changes associated w/ just having OSA? 

dry eye & irritation, bacterial conjunctivitis risk

what are the SE associated w/ CPAP use?

5

less than __% of people w/ OSA have FES, but a very large percentage of people w/ FES have OSA

floppy eyelid syndrome

• most commonly in overweight men

• lids are loose & rubbery & evert easily w/ minimal pressure

• associated w/ keratoconus

• high rate of substantial conjunctivochalasis

• lash ptosis common

• pt will describe irritation as improving throughout day

1. weight loss & OSA management

2. nighttime lubricating ointment

3. sleep w/ cylinder pillow

4. firm sleep mask

5. taping of lids

6. sleep tite/sleep rite adhesive pads

7. surgical resection 

what are the tx options for floppy eyelid syndrome? 

FES

FES

lash ptosis 

lash ptosis