Obstructive Sleep Apnea Syndrome

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

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

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

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

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

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

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Evaluation finish H&P wheezing - qualities daytime sluggishness

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

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

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

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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

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