Login | Signup | Support
  • 0
  • ×

    Add as FriendSleep Apnea

    by: Mofazzol

    Current Rating : Rate It :



    1 : Sleep Apnea: A Silent Monster
    2 : Age: 45 yrs Profession: Business executive, 9-5pm, 5/7D Problems: Recent difficulties in office work- Late, Dodges/snores in office meeting Energy to work Quality of work Wife sleeps in separate bed room, complains of loud snoring with regular10-30 sec pause Nocturia, diaphoresis, feels warm in cooler environment Headache, dry mouth Story of Mr. X
    3 : Mr. X has pedal edema, Antropometry-102kg, 5’9” BP-145/88 mm Hg; Medication- v Neck cicumference-17.8” Face: Retrognathia and dental overject Blood sugar- Fasting 7.5mmol, ABF-11mmol, HbA1C- 7.8% Diagnosis- Obstructive Sleep Apnea (OSA) with Hypertension and Uncontrolled DM Story contd…
    4 : Recurrent apneic/hypopneic episodes during sleep lasting >10 seconds Oxygen desaturations Repeated arousals Adverse daytime functional and physical consequences Kryger-Roth-Dement. Principles and Practice of Sleep Medicine, 4th Ed, 2005, Elsevier-Saunders, USA What is OSA
    5 : 2-4% 30-60 yrs in US 3.5% among Indian 2% children Bangladesh: 62% attended a sleep clinic 35% reported snoring in a respiratory clinic 7% children snores The occurrence of sleep disordered breathing in middle-aged adults. NEJM, 1993 Chest 2004, Poster presentation Presentation in the Asian Society of Sleep research 2006, Seoul, S Korea Presented in BPPF National Congress, 2007 Is it common!
    6 : 29-59 yrs: 36.06% 47,066,488 OSAS: Bangladesh: 1,647,327 Narcolepsy: Finland: 0.026% Bangladesh: 30,104 BBS 2006 Chest 2006;130:49-56 J Int Med 1996;239: 417-423 Bangladesh: ? Patients
    7 : Air flow through pharynx is unhindered in normal person during sleep OSA repeated obstruction occurs at the pharynx Obstruction relieved by brief arousal Obstruction-arousal occurs many times in a night Obstruction-apnea-hypoxia-arousal causes activation of many neural, humoral and metabolic consequences What happens in sleep apnea?
    8 : Hypertension: 30-70% CAD: 1.28 (Odds ratio) Heart: Structural and functional change Increased thickness of IVS LVED volume reduced LV dysfunction Increased chance of stroke (Odds ratio 2.58) Chest 2007,131:1379-1386 J Hypertension, 2001, 19:2271-7 Chest 1991,99:861-866 Cardiovascular consequences
    9 : DM- delta sleep causes insulin resistance Poor control Nocturia: 24%, 4-7 trips/night Pedal edema Esra Tsali, National Academy of Sciences Meeting, Dec. 2001 Kryger-Roth-Dement. Principles and Practice of Sleep Medicine, 4th Ed, 2005, Elsevier-Saunders, USA Humoral consequences
    10 : Metabolic syndrome Weight gain Increased serum cardiovascular risk factors DM Chest 2007, 131;1387-92 Rev Port Pnemol 2007,13:48-9 Arch Mal Coeur Vaiss 2007;100:437-41 Chest 2007,132:843-51 Metabolic consequences
    11 : Decreased libido and erectile impotence Increased of familial disharmony Others
    12 : Poor school performance ADHD like activity in children Aggressiveness FTT Subtle behavioral changes Social withdrawal Excessive daytime sleepiness Secondary enuresis Mouth breathing Upper airway narrowing on radiograph Kryger-Roth-Dement. Principles and Practice of Sleep Medicine, 4th Ed, 2005, Elsevier-Saunders, USA Hong Kong Med J 2004,10:406-13 Presentations in children
    13 : Downs syndrome Pierre Robin anomaly and others Laryngomalacia MPS Spina bifida CP Previous palatal surgery Prematurity Neuromuscular disorder- DMD Guideline on OSA, Pediatric Society of New Zealand, 2005 Higher risk children
    14 : Facial profile: Receding chin Small maxilla and mandible Dental overject Oral cavity: Dental crowding High arched palate Large tongue Nose- DNS, allergic rhinitis, HIT, nasal polyp Throat- Tonsil-uvula-arch not visible (Malampati staging) Enlarged tonsil Long inflamed edematous uvula Physical findings
    15 : Obesity- Upper body obesity Neck circumference- Male: 17”; Female-16.5” Waist: Male->94cm Female->80cm BP: Hypertension Leg: Edema Heart- Signs of heart failure Tests for cognitive processing, memory executive functioning are impaired J Bras Pneumol 2007,33:93-100
    16 : Polyomnography- Overnight sleep test Electrodes on scalp, chin & eye– Sleep stage Nose & mouth- Airflow Chest and abdominal belt- Respiratory effort Pulse oximetry- O2 Saturation Throat microphone- Snore Legs Recorded digitally and analyzed manually How to diagnose
    17 : Apnea-Hypopnea Index (AHI): Number of Apneic & hypopneic episodes per hour Grading of OSA Mild - AHI 5-15/Hour Moderate - AHI 15-30/Hour Severe - AHI >30/Hour Kryger-Roth-Dement. Principles and Practice of Sleep Medicine, 4th Ed, 2005, Elsevier-Saunders, USA Interpretation
    18 : Medical therapy Pressure therapy- CPAP, BiPAP Surgical Dental appliances Treatment
    19 : Weight reduction Smoking cessation Alcohol avoidance Sleep hygiene Body position Avoid sedative Oxygen Medication Endocrine therapy Medical therapy
    20 : A pressure device that counteract the collapse of the airway Makes a pneumatic splint at the pharyngeal level CPAP therapy
    21 : Increased daytime alertness and performance Decreased nocturnal awakening Improved nocturnal quality of sleep Reduce blood pressure Reduce risk of cardiovascular events Improve insulin sensitivity and decrease HbA1C Improved and increased sleep time of bed partner Benefits of CPAP
    22 : Adenotonsilletomy Nasal dilatation UPPP (Uvulo-Palato-Pharyngoplasty) Hyoid advancement Genioglossus advancement Maxillo-Mandibular advancement Surgery
    23 :
    24 : Thanks
    25 : Skin abrasion Conjunctivitis from air leak Chest discomfort Sinus discomfort Epistaxis Dryness of mouth Cumbersome Spousal intolerance Side effects of CPAP
    26 : Hypoxia Increased sympathetic activity Decreased strike volume Increased sympathetic and pulmonary hypertension Trachy-Bradyarrythmia Cardiovascular stress during apnea hypopnea
    27 :
    28 : Arrhythmias & OSA
    29 : Upper airway soft tissue enlargement Edema from repeated negative pressure during airway closure Soft palate, uvula- liable to edema Tongue- edema of genioglossus Obesity- Fat deposition- Parapharynx & uvula Increase muscle tissue around pharynx Muscle fiber change More type 1 in tongue Gender Genetic Pathophysiology: Narrow upper airway- Pharynx

    Presentation Tags

    Copyright © 2019 All rights reserved.