Obstructive Sleep Apnea

Dr Awofisoye O.I
 Outline
• Historical background
• Definition
• Pathophysiology
• Risk Factors
• Clinical Features
• Evaluation
• Investigations
• Management
• Complications
 Historical Background
• Charles Dickens: Pickwick papers
• William Osler : Pickwickian syndrome
• Guilleminault: OSAS,1973
• Sullivan: CPAP, 1981
 Definitions
• Apnea
• Hypopnea
• OSA/OSAHS
• Apnea: Spontaneaous Transient Ceasation of
Breathing for 10secs or more, usually up to
30secs.
• Hypopnea Transient Shallow respiration with
reduction in airflow up to 50% lasting at least
10 seconds or up to 30% with reduction in O2
saturation(4%)
• OSA:
 Pathophysiology
• Sleep
• Sleep and Respiration
• OSAHS
• Sleep fragmentation & hypoxaemia
Structural anomalies
Apnea cycle
 Risk Factors
• Obesity
• Large Neck
• Anatomical deformities: small lower jaw(retrognathia),PRS,
congeintal malf, tonsillar hypertrophy,pharyngeal masses
• Male Sex
• Older age(40-65)
• Alcohol
• Sedatives
• Smoking
• Snoring
• Acromegaly
• Hypothyroidism
• Mucopolysaccharidosis
• Family history
 Clinical Features
• Snoring
• Restless sleep
• Spouse report of apnea in sleep
• Non-restorative sleep
• Daytime sleepiness
• Impaired Cognitive skills
• Poor performance at work
• Depression
• Sexual dysfunction
• Nocturia
 Clinical features
• Tired appearance
• Features: signs & symptoms of risk factors
 Systemic effects
• Hypertension
• Insulin Resistance/Diabetes Mellitus
• LVH
• Sympathetic activation
• Arrythmias
• Increased risk of Cardiovascular events esp
Stroke
• Liver disease
• Sexual Dysfunction
• Anasthetic problems
 Other Evaluation
• Daytime Sleepiness: Epworths sleepiness
scale, multiple sleep latency tests
• Cephalometry
• BMI (>30)
• Neck circumference(>40cm)
 Differential Diagnosis
• Insufficient Sleep
• Nacrolepsy
• Shift work related sleep disorder
• Drugs
• Idiopathis Hypersomnlonence
• Simple Snoring
• Sleep Related Breathing Disorder
 Investigations
• Polysmonogrpahy :
• Limited sleep studies/Portable Home
Monitors:(recording respiratory and oxygenation patterns overnight without
neurophysiologic recording.)

• Investigate underlying causes/associated

problems
Polysmnography
 Polysmnogrraphy
EEG
EOG
EMG; Submental,Limbs
Airflow monitor(nasal, oral)
Pulse oximetry
Respiratory effort(Intercostal
EMG)
Body position
ECG
Snoring Monitor
 Treatment
• Patient education and support
• Conservative Rx: Positioning, Weight loss, avoiding
aggravators
• NCPAP
• Oral devices
• Surgery: Tonsillectomy,Uvulopalatopharyngoplasty,
Jaw/Tounge advancement, Tracheostomy
• Adjunct pharmacotheraphy
Continous Positive Airway Pressure
 CPAP
• Best proven treatment
• Optimal pressure is titrated then maintained,
usually 5-20cmH20.
• Rapid resolution of symptoms
• Poor compliance
Oral devices
Oral Devices
 Surgery
• Adenotonsillectomy: in children
• Uvulopalatopharyngoplasty: excess tisuue
excised from margins of soft palate
• Nasal surgery
• Tracheostomy
• Laser glossectomy
• Mandibular advancement
 Complications
• Of Excessive daytime sleepiness
• Of OSA/HS
• Of treatments
 Conclusion
• OSA/HS is a common underrecognised disease
with far reaching consequences in the
untreated patient. There should be increased
awareness of this condition at all cadres of
heathcare with prompt referral for diagnosis
and treatment.
Thank You!!!