obstructive sleep apnea syndrome l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Obstructive Sleep Apnea Syndrome PowerPoint Presentation
Download Presentation
Obstructive Sleep Apnea Syndrome

Loading in 2 Seconds...

play fullscreen
1 / 25

Obstructive Sleep Apnea Syndrome - PowerPoint PPT Presentation


  • 492 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Obstructive Sleep Apnea Syndrome


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
obstructive sleep apnea syndrome

Obstructive Sleep Apnea Syndrome

Robert H. Stroud, M.D.

Francis B. Quinn, M.D.

February 4, 1998

history
History
  • Charles Dickens - The Pickwick Papers
  • William Osler - Pickwickian Syndrome 1918
  • Guilleminault - OSAS - 1973
  • Fujita - UPPP - 1981
  • Sullivan - CPAP - 1981
epidemiology
Epidemiology
  • 85% men
  • Prevalence - 2% in women, 4% in men
  • two thirds are obese
  • elderly
  • African-American
pathophysiology
Pathophysiology
  • Bernoulli principle and Venturi effect
  • snoring
  • tissue laxity and redundant mucosa
  • anatomic abnormalities
  • decreased muscle tone with REM sleep
  • airway collapse
pathophysiology5
Pathophysiology
  • desaturation
  • arousal with restoration of airway
  • sleep fragmentation leading to hypersomnolence
pathophysiology complications
Pathophysiology - complications
  • desaturation with compensatory polycythemia
  • hypercapnia with pulmonary hypertension
  • systemic hypertension
  • arrythmias
evaluation
Evaluation
  • complete H&P
  • snoring - characteristics
  • daytime sleepiness
evaluation history
restless sleep

personality change

impaired cognitive skills

weight gain

morning headache

nocturia/enuresis

sexual dysfunction

sedative use

Evaluation - history
evaluation history9
adenotonsillar hypertrophy

nasal obstruction

hypothyroidism

acromegaly

Down syndrome

micrognathia

retrognathia

obesity

vocal cord paralysis

H&N masses

Evaluation - history
evaluation physical exam
Evaluation - physical exam
  • retrognathia
  • mouth-breathing
  • “tired” appearance
evaluation physical exam11
Evaluation - physical exam
  • Nasal obstruction - turbinate hypertrophy, polyposis, septal deviation
  • oral cavity and oropharynx
    • redundant mucosa
    • beefy red
    • elongated uvula
    • macroglossia
    • AT hypertrophy
evaluation physical exam12
Evaluation - physical exam
  • fiberoptic examination
  • Mueller’s maneuver
  • examine in supine position
  • usually difficult to localize one site of obstruction
evaluation13
Polysomnography

EEG

EOG

submental EMG

nasal and oral airflow

respiratory muscle effort

oxygen saturation

ECG

anterior tibialis EMG

sleep position

Evaluation
evaluation polysomnography
Evaluation - polysomnography
  • central, obstructive, mixed apneas
  • apnea - cessation of flow for 10 secs
  • hyponea - 50% decrease in flow or EEG arousal
evaluation polysomnography15
Evaluation - polysomnography
  • respiratory disturbance index (RDI) - apneas + hyponeas per hour
  • apnea duration
  • degree of desaturation
  • sleep disturbance index - arousals per hour
evaluation radiography
Evaluation - radiography
  • lateral neck film in children
  • CT and MRI of limited benefit
  • somnofluoroscopy
  • cephalometrics
evaluation other studies
Evaluation - other studies
  • thyroid function tests
  • arterial blood gas
  • complete blood count
  • audio tape
  • rhinomanometry
  • multi sleep latency test (MSLT)
treatment
Treatment
  • raise intra-pharyngeal pressure
  • decrease pharyngeal closing pressure
  • increase muscular activity
treatment19
Treatment
  • weight loss
  • avoid sedatives
  • pharmacotherapy
  • orthodontic devices
  • continuous positive airway pressure
treatment cpap
Treatment - CPAP
  • 100% effective
  • titrate pressure
  • poor compliance - 50-80%
treatment surgical
Treatment - surgical
  • adenotonsillectomy - preferred treatment in children
  • tracheostomy - cure for OSAS
    • used for failure of more conservative treatment
    • life threatening cardiopulmonary complications
    • alternative techniques to lessen complications
treatment surgical22
Treatment - surgical
  • Uvulopalatopharyngoplasty (UPPP)
    • excise excess tissue from free margin of soft palate
    • +/- tracheostomy
    • variable response - approximately 50%
    • +/- nasal surgery
treatment surgical23
Treatment - surgical
  • laser midline glossectomy
  • mandibular advancement
  • maxillary advancement - LeFort I osteotomy
  • hyoid suspension and inferior sagittal mandibular osteotomy
  • hyoid expansion
treatment complications
Treatment - complications
  • failure to achieve relief
  • difficult airway, anesthetic risk
  • decreased respiratory drive
  • bleeding, infection, pain
  • velopharyngeal incompetence
  • nasopharyngeal stenosis
  • post-obstructive pulmonary edema
conclusion
Conclusion
  • life threatening complications
  • suboptimal treatment either due to poor response or limited compliance
  • good patient selection and long-term follow- up