OSA

Question 1

OSA

what is OSA

Answer 1

Periodic reduction (hypopnea) or cessation (apnea) of breathing due to a narrowing or occlusion of the upper airway during sleep.

Question 2

OSA

OSA epidemiology (age, sex, risk factors)

Answer 2

Age >65 
M > F
Risks: 
 - obesity
 - increased neck cirumference 
 - hypertension
 - hypothyroidism
 - post menopausal 
 - diabetes
 - alcohol
 - allergic rhinitis/tonsillar hypertrophy
 - meds 
 - fmhx 
 - genetics

Question 3

OSA

complications

Answer 3

• linked to traffic accidents, cardiac diseases, stroke, diabetes, and visceral obesity
• associated with nocturnal cardiac arrhythmias, chronic and acute cardiac events

Question 4

OSA

subjective hx

Answer 4

• daytime sleepiness?
• naps?
• partner c/o snoring/gasping/snorting?
• meds
• ETOH
• Epworth Sleepiness Scale
• men: erectile dysfunction

Question 5

OSA

ddx

Answer 5

• Primary snoring
• Narcolepsy
• Restless leg syndrome
• tonsillar hypertrophy
• obesity hypoventilation syndrome

Question 6

OSA

Dx criteria

Answer 6

15 or more apneas, hypopneas, or respiratory effort- related arousals per hour of sleep in an asymptomatic patient. >75% of the apneas and hypopneas must be obstructive.

5 or more obstructive apneas, obstructive hypopneas, or respiratory effort-related arousals per hour of sleep in a patient with symptoms or signs of disturbed sleep. >75% of the apneas or hypopneas must be obstructive.

Question 7

OSA

Investigations

Answer 7

polysomnography (PSG) - glold standard

If unavailable - can screen w/overnight oximetry

Question 8

OSA

Tx

Answer 8

• lifestyle mods (weight loss 10-20%, smoking cessation, ETOH, sleep with elevated HOB)
• CPAP/biPAP
• dentist for appliance
• surgical tx (last resort)
  - adenotonsillectomy (tonsillar or adenoid hypertrophy)
  - Tracheostomy can eliminate OSA but not central hypoventilation syndromes
  - Maxillomandibular advancement (MMA) when the patient cannot tolerate/refuses CPAP and an OA is not appropriate/effective.