Obstructive Sleep Apnea Syndrome

Presentation Transcript

Obstructive Sleep Apnea Syndrome Robert H. Stroud, M.D. Francis B. Quinn, M.D. February 4, 1998

History Charles Dickens - The Pickwick Papers William Osler - Pickwickian Syndrome 1918 Guilleminault - OSAS - 1973 Fujita - UPPP - 1981 Sullivan - CPAP - 1981

Epidemiology 85% men Prevalence - 2% in ladies, 4% in men 66% are corpulent elderly African-American

Pathophysiology Bernoulli standard and Venturi impact wheezing tissue laxity and repetitive mucosa anatomic irregularities diminished muscle tone with REM rest aviation route fall

Pathophysiology desaturation excitement with reclamation of aviation route rest discontinuity prompting to hypersomnolence

Pathophysiology - confusions desaturation with compensatory polycythemia hypercapnia with aspiratory hypertension systemic hypertension arrythmias

Evaluation finish H&P wheezing - qualities daytime sluggishness

anxious rest identity change weakened intellectual aptitudes weight pick up morning migraine nocturia/enuresis sexual brokenness narcotic utilize Evaluation - history

adenotonsillar hypertrophy nasal deterrent hypothyroidism acromegaly Down disorder micrognathia retrognathia corpulence vocal string loss of motion H&N masses Evaluation - history

Evaluation - physical exam retrognathia mouth-breathing "tired" appearance

Evaluation - physical exam Nasal obstacle - turbinate hypertrophy, polyposis, septal deviation oral cavity and oropharynx excess mucosa husky red prolonged uvula macroglossia AT hypertrophy

Evaluation - physical exam fiberoptic examination Mueller's move look at in prostrate position typically hard to confine one site of block

Polysomnography EEG EOG submental EMG nasal and oral wind current respiratory muscle exertion oxygen immersion ECG foremost tibialis EMG rest position Evaluation

Evaluation - polysomnography focal, obstructive, blended apneas apnea - end of stream for 10 secs hyponea - half decline in stream or EEG excitement

Evaluation - polysomnography respiratory unsettling influence list (RDI) - apneas + hyponeas every hour apnea length level of desaturation rest aggravation list - feelings of excitement every hour

Evaluation - radiography horizontal neck film in kids CT and MRI of constrained advantage somnofluoroscopy cephalometrics

Evaluation - different studies thyroid capacity tests blood vessel blood gas finish blood tally sound tape rhinomanometry multi rest dormancy test (MSLT)

Treatment raise intra-pharyngeal weight diminish pharyngeal shutting weight increment strong action

Treatment weight reduction evade tranquilizers pharmacotherapy orthodontic gadgets consistent positive aviation route weight

Treatment - CPAP 100% viable titrate weight poor consistence - 50-80%

Treatment - surgical adenotonsillectomy - favored treatment in youngsters tracheostomy - cure for OSAS utilized for disappointment of more moderate treatment life debilitating cardiopulmonary complexities elective procedures to decrease entanglements

Treatment - surgical Uvulopalatopharyngoplasty (UPPP) extract overabundance tissue from free edge of delicate sense of taste +/ - tracheostomy variable reaction - roughly half +/ - nasal surgery

Treatment - surgical laser midline glossectomy mandibular progression maxillary headway - LeFort I osteotomy hyoid suspension and mediocre sagittal mandibular osteotomy hyoid development

Treatment - intricacies inability to accomplish help troublesome aviation route, soporific hazard diminished respiratory drive dying, contamination, torment velopharyngeal ineptitude nasopharyngeal stenosis post-obstructive pneumonic edema

Conclusion life undermining difficulties problematic treatment either because of poor reaction or restricted consistence great patient choice and long haul development