Mellss yr 4 ent snoring and obstructive sleep apnoea
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Transcript of Mellss yr 4 ent snoring and obstructive sleep apnoea
Nur Amalina Aminuddin Baki0820121000 67
Snoring and Obstructive
Sleep Apnoea
Introduction
SnoringUndesirable disturbing sound
during sleep25% 15% Increase with age
Sleep apnoea Cessation of breathing that lasts for > 10s during sleep
Apnoea index Number of episodes of apnoea in an hour
Hypopnoea Reduction of airflow. Drop of 50% airflow from baseline associated
with EEG defined arousal 4% drop in oxygen saturation
Respiratory disturbance index (RDI) Aka apnoea –hypopnoea index Number of apnoea & hypopnoea per hour
Arousal Transient
awakening from sleep
Arousal index Number of
arousal events in 1 hour
Sleep efficiency Minutes of sleep minutes in bed after lights are turned off
Multiple sleep latency test / Nap study Latency period from wakefulness to onset
of sleep and REM sleep are measured
Mechanism of Snoring
Muscles of pharynx relax-
Partial obstruction
Soft palate, tonsillar pillars
and base of tongue
vibrates
Primary vs SecondaryComplicated
Aetiology Children
adenotonsillar hypertrophy Adult
Nose/nasopharynx- septal deviation, turbinate hypertrophy, nasal valve collapse, nasal polyps, tumours
Oral cavity- elongated soft palate and uvula, tonsillar enlargement, macroglossia, retrognathia, large base of tongue, tumours
Larynx/laryngopharynx- laryngeal stenosis, omega-shaped epiglottis
ObesityThick neck with collar >
42 cmUse of alcohol, sedatives
and hypnotics
Sites of Snoring
Soft palate Tonsillar pillars Hypopharynx
Symptoms Snoring-spouse syndromeWith OSA:
Excessive daytime sleepiness Morning headaches General fatigue Memory loss Irritability and depression Decrease libido Increase risk of RTA
Treatment Lifestyle changes Weight reduction Sleeping on side Removal of
obstructing lesion Performing
uvulopalatoplasty (UPP)
SLEEP APNOEA No movement of air at the level of nose and mouth
Physiology of Sleep 7-8 hours Non REM [ 75%] and REM [25%] Semiregular cycles (90-120min) 3-4 cycles of sleep
NON REM REMDuration 75-80% 20-25%Eye movements No Rapid conjugate
eye movementsAutonomic activity Less More Brain activity Minimal Active Muscular activity Functional, less Decreased EEG Alpha to delta
waves Mixed
Dreaming No Yes
Types Obstructive
Collapse of upper airway Obstructive condition
Central Patent but brain fails to
signal the muscles to breathe
Mixed
Hypoxia and retention of
carbon dioxide
Pulmonary constriction
CHF, bradycardia and cardia
hypoxia
Left heart failure, cardiac
arrythmias and sudden
death
Pathophysiology
Arousal sleep fragmentation
daytime sleepiness
EvaluationHistoryEpworth
sleepiness scale
Physical examination BMI Collar size Complete head
and neck examination
Muller’s manoeuvre
Systemic examination
Cephalometric radiographs
Polysomnography EEG,ECG,EOM,EMG,
pulse oximetry, nasal and oral blood flow, blood pressure
TreatmentNon-surgical
Change in lifestyle
Positional therapy
Intraoral devices CPAP
Surgical Tracheostomy Tonsillectomy and/or
adenoidectomy Nasal surgery Oropharyngeal surgery
(uvulopalatoplasty) Advancement genioplasty Hyoid myotomy and
suspension Tongue base
radiofrequency Maxillomandibular
advancement osteotomy
Referance PL dhingra, Disease of Ear, Nose and Throat, 6th edition , Elsevier