Definition of SDB
General term for breathing difficulties during sleep
- ranges from snoring to OSA
Definition of SDB
General term for breathing difficulties during sleep
- ranges from snoring to OSA
Types of sleep apnea
- Central
- Obstructive
- Complex
Definition of OSA
Interrupted airflow despite persistent respiratory effort.
Apenea: <20% airflow from baseline for 10 sec (adults)
50% 6 sec (children)
What is RERA
Respiratory Efffort Related Arousal:
breathing and ozygenation maintained at the expense of great increase in resp. effort due to increased upper ariway resistance
Prevalence
- Gender
M x2> F (reduce with age, same by 50y.o)
Sg (Tan et al., 2016):
30% mod-severe
90% undiagnosed/ untx
Chinese more likely to develop and more severe than Europeans
Risk factors + Evidence
(Yow & Lye, 2014)
- Obesity: morbidly obsese increase incidence by 12-30x
- Age
- Gender
- Post stroke
- Craniofacial anomalies/ morph
What are the craniofacial anomalies
Retro Mn Dolicofacial Narrow deep palate Increase Mn plane angle Lower hyoid position
Evidence re craniofacial anomalies and OSA
Behrents et al, 2019
NOT well est
Kim et al., 2015
Mouth breathing + certain malocclusions rs DEBATABLE
Famous monkey experiment
Harvold, 1973
Rhesus monkey
- show rs between mod. facial growth and mouth breathing
- suggest vert. growth pattern with mouth breathing and obstruction of pharyngeal airway
Ortho role
1) History taking
2) Clinical exam
3) Radiographic
4) PSG - REFER to sleep clinic for baseline
Things to do in history taking
1) MHx
2) Sign and symptoms of OSA
3) STOPBANG
4) Epworth sleepiness scale
STOP BANG
Snoring
Tiredness
Observed choking/ breathing difficulties
Pressure: high BP
BMI >10% of normal
Age >50
Neck size >43 M >37 F
Gender
STOP BANG risk levels
Low: 2
Intermediate: 3-4
High: 5-8 or M/Fat/Neck + 2 STOP
Things to lookout for in LC +
EVIDENCE
Kim, 2015
1) Posterior airway space <11mm
2) Hyoid to Mn distance >15.4
- compensatory to alleviate increase airway resistance
3) Airway smallest cross-sectional area <63.3mm2
4) >51% of nasophargyngeal area occupied by adenoid mass
5) Increased total and LAFH
- reduced cranial base length
- long thick soft palate
- increased tongue area
- retro mx/mn
Adult consequences of OSA
- increase morbidity and mortality
- traffic accidents
- poor work performance
- cardiovascular diseases
Paeds consequences of OSA
- Poor sch performance/ learning skills
- AHDH
- Hyperactivity
- Depression
- Beharviourial prob
First line of tx for paeds OSA + EVIDENCE
Adenotonsillectomy (Kim et al., 2020)
- 60% achieve AHI <1 (Friedman, 2009)
Dx of residual paeds OSA
Sk vs ST abnormality
SK -> GM:
- VME: High pull HG
- Constricted Mx: RME
- Retro Mn: Functional app
- Retro Mx: PFM
ST:
- Neuromotor dysfunction: CPAP
- Chronic inflammation of UA: Meds
- Obesity: Weight loss
Outcome of RME for OSA
- enlarge nasal cavity
- increase P vault
- increase nasal airflow
- reduce resistance and phayrgngeal collapsibility
CONVERT to nasal breathing
Outcome of FM in OSA
Naso-velo-pharyngeal enlargement
sig. increase in nasopharyngeal airway dimensions (Ming et al., 2018)
Whats required for TB
- good growth potential/ pattern
- compliance
Outcome of TB in OSA + evidence
Mn adv-> open oropharyngeal airwar-> increase O2 sat and reduce suppression of growth hormone -> increase growth potential to treat OSA and face
Yanyan,2018:
Mean diff of 1.75 event/hr in AHI
at least 6mth more eff. than short term
Adult OSA mx
1) Weight loss
2) CPAP
3) MAD
4) MARPE/SARPE
5) MMA
