Mellss yr 4 ent snoring and obstructive sleep apnoea

  • View
    134

  • Download
    0

Embed Size (px)

Text of Mellss yr 4 ent snoring and obstructive sleep apnoea

Snoring and Obstructive Sleep Apnoea

Nur Amalina Aminuddin Baki0820121000 67Snoring and Obstructive Sleep Apnoea

Introduction

SnoringUndesirable disturbing sound during sleep25% 15% Increase with age

Sleep apnoea Cessation of breathing that lasts for > 10s during sleep

Apnoea indexNumber of episodes of apnoea in an hour

HypopnoeaReduction of airflow. Drop of 50% airflow from baseline associated with EEG defined arousal 4% drop in oxygen saturation

Respiratory disturbance index (RDI)Aka apnoea hypopnoea indexNumber of apnoea & hypopnoea per hour

Mild 5- 14 , mod: 15- 29, sev >305

ArousalTransient awakening from sleepArousal indexNumber of arousal events in 1 hour

6

Sleep efficiency Minutes of sleep minutes in bed after lights are turned off

Multiple sleep latency test / Nap study Latency period from wakefulness to onset of sleep and REM sleep are measured

Mechanism of SnoringPrimarySecondary

Primary vs Secondary

Complicated

1: without osa2: associated with osa9

AetiologyChildrenadenotonsillar hypertrophyAdultNose/nasopharynx- septal deviation, turbinate hypertrophy, nasal valve collapse, nasal polyps, tumoursOral cavity- elongated soft palate and uvula, tonsillar enlargement, macroglossia, retrognathia, large base of tongue, tumoursLarynx/laryngopharynx- laryngeal stenosis, omega-shaped epiglottis

ObesityThick neck with collar > 42 cmUse of alcohol, sedatives and hypnotics

Sites of SnoringSoft palateTonsillar pillarsHypopharynx

Symptoms Snoring-spouse syndromeWith OSA:Excessive daytime sleepinessMorning headachesGeneral fatigueMemory lossIrritability and depressionDecrease libidoIncrease risk of RTA

TreatmentLifestyle changesWeight reductionSleeping on sideRemoval of obstructing lesionPerforming uvulopalatoplasty (UPP)

SLEEP APNOEANo movement of air at the level of nose and mouth

Physiology of Sleep7-8 hours Non REM [ 75%] and REM [25%] Semiregular cycles (90-120min)3-4 cycles of sleep

Theta wave, k complexes, delta waves, 17

NON REMREMDuration 75-80%20-25%Eye movements No Rapid conjugate eye movementsAutonomic activityLess More Brain activityMinimal Active Muscular activityFunctional, lessDecreased EEGAlpha to delta waves Mixed Dreaming No Yes

Types ObstructiveCollapse of upper airwayObstructive conditionCentralPatent but brain fails to signal the muscles to breatheMixed

Pathophysiology Arousal sleep fragmentation daytime sleepiness

EvaluationHistoryEpworth sleepiness scale

Snoring, gasping, choking, apnoetic eventsFatigue, morning headaches , irritabilitySleep body position, alcohol, caffeine, sedative, mouth brething, HRT21

Physical examinationBMICollar sizeComplete head and neck examinationMullers manoeuvreSystemic examination

Cephalometric radiographsPolysomnography EEG,ECG,EOM,EMG, pulse oximetry, nasal and oral blood flow, blood pressure

Male, obese, > 40Cricothyroid membrane level ( 42, 37.5)Diff 1o snoring, pure osa, central sleep apnoe

22

TreatmentNon-surgicalChange in lifestylePositional therapyIntraoral devicesCPAP

SurgicalTracheostomyTonsillectomy and/or adenoidectomyNasal surgeryOropharyngeal surgery (uvulopalatoplasty)Advancement genioplasty Hyoid myotomy and suspensionTongue base radiofrequencyMaxillomandibular advancement osteotomy

Failed/ non compliant non surgicalSeptoplasty, turbinate reduction, polypectomy,

24

Referance PL dhingra, Disease of Ear, Nose and Throat, 6th edition , Elsevier