Sleep apnea and driving accidents
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SLEEP APNEA AND DRIVING SLEEP APNEA AND DRIVING ACCIDENTSACCIDENTS
Dr.K.O.Paulose FRCS DLODr.K.O.Paulose FRCS DLOConsultant ENT SurgeonConsultant ENT Surgeon
Jubilee Hospital, TrivandrumJubilee Hospital, TrivandrumSouth IndiaSouth India
www.drpaulose.com,www.snorefreesleep.comwww.drpaulose.com,www.snorefreesleep.com
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Avoid Falling Asleep While Driving
Every year, over 100,000 accident Every year, over 100,000 accident deaths deaths 2,500 deaths are caused by driver 2,500 deaths are caused by driver fatiguefatigue
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RTA related Sleep debtRTA related Sleep debt
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Sleep Apnea and Sleep DebtSleep Apnea and Sleep Debt
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Accidents more in early morningAccidents more in early morning
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Sleep Apnea can kill others tooSleep Apnea can kill others too
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Funeral DrivingFuneral Driving
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Lack of sleep affects
driver fatiguedriver fatigue
reaction timereaction time
judgment and ability judgment and ability to concentrateto concentrate
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When Is It Most Likely To Happen?
1 pm and 4 pm 1 pm and 4 pm and 2 am and 6 and 2 am and 6 am.am.
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Warning Signs of Drowsy DrivingWarning Signs of Drowsy Driving
YawningYawning
Inability to keep eyes open Inability to keep eyes open
Drifting out of the laneDrifting out of the lane
Hitting rumble strips Hitting rumble strips
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What Can Be Done?What Can Be Done?Caffeine, stimulants and other tricks, loud music, Caffeine, stimulants and other tricks, loud music, washing face-temporarywashing face-temporary
Avoid sleep debt- sleep 7-9 hrs/dayAvoid sleep debt- sleep 7-9 hrs/day
Take Breaks-will allow you to stretch, move and Take Breaks-will allow you to stretch, move and wake up wake up
Pull over in a safe area to nap Pull over in a safe area to nap
Awareness among patients, relatives, and Traffic Awareness among patients, relatives, and Traffic police-DLpolice-DL
The only long-lasting solution is to get adequate The only long-lasting solution is to get adequate sleep.sleep.
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Definition of Sleep Apnea
Apnea is defined as a cessation of oronasal Apnea is defined as a cessation of oronasal airflow of at least 10-30 seconds in durationairflow of at least 10-30 seconds in duration
When it occurs 30 or more times during a 7-When it occurs 30 or more times during a 7-hour period of nocturnal sleep.hour period of nocturnal sleep.
>10 episodes per night>10 episodes per night
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Types of Sleep Apnea
CSA- brain stem -bulbar polio stroke, a CSA- brain stem -bulbar polio stroke, a brain tumor, a viral brain infectionbrain tumor, a viral brain infection
OSA- upper airway obstructionOSA- upper airway obstruction
Mixed- with chronic respiratory diseaseMixed- with chronic respiratory disease
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Description of OSADescription of OSA
Upper airway narrowingUpper airway narrowing
Loud snoringLoud snoring
Wake upWake up
Gasping for airGasping for air
Fall back to sleepFall back to sleep
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Snoring and OSA can lead to divorceSnoring and OSA can lead to divorce
The spouse cannot The spouse cannot sleepsleep
Separate bed roomSeparate bed room
Marital discordMarital discord
Lack of sex driveLack of sex drive
EJDEJD
InfertilityInfertility
Lack of libidoLack of libido
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Causes of OSACauses of OSA
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Mechanism of Snoring and OSAMechanism of Snoring and OSA
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Symptoms of OSASymptoms of OSALoud snoringLoud snoringFrequent cessation of breathing (apnea) during sleep.Frequent cessation of breathing (apnea) during sleep.Choking sensation, Sudden awakeningsChoking sensation, Sudden awakeningsSnorting or gasping for breath during sleepingSnorting or gasping for breath during sleepingObeseObeseExtreme daytime sleepiness Extreme daytime sleepiness Problems concentrating Problems concentrating Memory loss Memory loss Poor judgment Poor judgment Personality changes such as irritation, depressionPersonality changes such as irritation, depressionlowest oxygen saturation lowest oxygen saturation (LSAT)>Hypoxia>Hypercarbia(LSAT)>Hypoxia>HypercarbiaPickwickian syndrome Pickwickian syndrome
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Obesity OSA DiabetesObesity OSA Diabetes
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Snoring is not funnySnoring is not funny
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Complications
Social-relationship, accidentsSocial-relationship, accidents
Pulmonary hypertensionPulmonary hypertension
Hypertension, arrhythmias Hypertension, arrhythmias
Type 2 DiabetesType 2 Diabetes
CVACVA
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Diagnosis
Good History: Talking to the patient Good History: Talking to the patient and the spouseand the spouse
Questionnaire. Epworth ScaleQuestionnaire. Epworth Scale
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Sleep Study or Polysomnogram (PSG)Sleep Study or Polysomnogram (PSG)Home Sleep Study or LabHome Sleep Study or Lab
Diagnostic Overnight PSGDiagnostic Overnight PSGEEG or electroencephalogram,EEG or electroencephalogram,EMG or electromyogram,EMG or electromyogram,EOG or electro-oculogramEOG or electro-oculogramECG or electrocardiogramECG or electrocardiogramNasal Airflow SensorNasal Airflow SensorOximeterOximeterSnore Microphone and video recordingSnore Microphone and video recording
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Sleep Lab StudySleep Lab Study
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Treatment of Sleep Apnea
Weight reduction, Diet, ExerciseWeight reduction, Diet, Exercise
Avoiding sleep on one's back.Avoiding sleep on one's back.
Avoid alcoholic beverages, smoking , hypnotic or Avoid alcoholic beverages, smoking , hypnotic or sedative drugs.sedative drugs.
Dental appliances, oral devices, and lower jaw Dental appliances, oral devices, and lower jaw adjustment devicesadjustment devices
Medical- Nasal decongestants, physostigmine, Medical- Nasal decongestants, physostigmine, provilgil (increase daytime alertness)provilgil (increase daytime alertness)
CSA-Mechanical ventilatorCSA-Mechanical ventilator
CPAP -CPAP is not a cure, but a support measureCPAP -CPAP is not a cure, but a support measure
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CPAPCPAP
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CPAP in Children?CPAP in Children?
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Surgical TreatmentHyoid Advancement Hyoid Advancement
Lingualoplasty-tongue reductionLingualoplasty-tongue reduction
Mandibular osteotomyMandibular osteotomy
Nasal SurgeryNasal Surgery
TS ADS in ChildrenTS ADS in Children
Somnoplasty( RF soft palate)Somnoplasty( RF soft palate)
Uvulopalatopharyngoplasty (UPPP) Uvulopalatopharyngoplasty (UPPP)
Tracheostomy- *last optionTracheostomy- *last option
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LASER ASSISTED UVULOPLASTY
LAUP and LAPT: to cure snoring and LAUP and LAPT: to cure snoring and sleep apneasleep apnea
Started doing Laser since 1996Started doing Laser since 1996
More than 1000 cases since thenMore than 1000 cases since then
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Laser Surgery as OPD ProcedureLaser Surgery as OPD Procedure
Laser Surgery was Laser Surgery was done in OPDdone in OPD
Patient discomfortPatient discomfort
Vasovagal SyncopeVasovagal Syncope
Bad smell of burning Bad smell of burning tissuetissue
Complaints from Complaints from neighboring clinicsneighboring clinics
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OPD Set Up of Laser OPD Set Up of Laser
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Laser surgery Started in SUT Hospital 2007Laser surgery Started in SUT Hospital 2007
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Laser TeamLaser Team
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Laser SurgeonLaser Surgeon
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Anatomy of ThroatAnatomy of Throat
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Anatomy of NoseAnatomy of Nose
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Elongated Uvula and Soft palateElongated Uvula and Soft palate
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LAUP in OPDLAUP in OPD
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LAUP Procedure under LA
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After LAUPAfter LAUP
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Snoring in WomenSnoring in Women
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LAUP in Women
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Laser surgery of NoseLaser surgery of Nose
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Before LAUP
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After LAUPAfter LAUP
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Laser Surgery Nose:LAPT
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Laser Surgery NoseLaser Surgery Nose
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Laser Surgery of Nose:polypsLaser Surgery of Nose:polyps
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Laser Septoplasty:LALaser Septoplasty:LA
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Laser cautery of NoseLaser cautery of Nose
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Laser surgery ThroatLaser surgery Throat
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Laser Surgery TongueLaser Surgery Tongue
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Pre Op EndoscopyPre Op Endoscopy
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Narrow Retro palatal AreaNarrow Retro palatal Area
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www.drpaulose.comwww.drpaulose.com
www.snorefreesleep.com