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What is apnea?
- 1. Time when someone stops breathing for 10+ seconds
- 2. Stoppage of airflow
- 3. 4% drop of O2 in blood
What happens during sleep apnea?
Person comes out of deep sleep and into more shallow sleep
How is severity of apnea calculated?
- # of apnea episodes ÷ # hours of sleep --> apnea index ÷ hour
- *the greater the AI, the more severe the apnea
Clinical definition of sleep apnea
AHI (apnea/hypoapnea index) at least 15 episodes/hr --> about 1 apnea/hypoapnea every 4 minutes
AHI of at least 5 episodes/hour result in what symptoms?
daytime sleepiness, mood disorders, insomnia, high b.p., pulmonary hypertension, stroke, congestive heart failure
General sleep apnea symptoms & complications
- - feeling unrefreshed, memory loss, impaired concentration, irritability, depression, poor performance
- - high b.p., stroke, heart failure, irregular heart-beats, heart attacks, pulmonary hypertension
- - insulin resistance --> Diabetes
- - morning headaches, worsening of ADHD, decreased sex drive, death
3 types of sleep apnea
- 1. Central sleep apnea--brain doesn't send the signal to the muscles to take a breath, and there is no muscular effort to take a breath
- 2. Obstructive sleep apnea--brain sends signals, but signals are unsuccessful bc the airway becomes obstructed and prevents an adequate flow of air3. Mixed
In whom does CSA (central sleep apnea) occur/What causes it?
- 1. Infants
- 2. Adults with heart, cerebrovascular, or congenital diseases
- 3. Some medications
- 4. High altitudes
- - Repetitive cycles of fast breathing followed by slow breathing and apnea
- - In a chronic (long term) increase in blood CO2, the brain ultimately ignores O2 level and monitors the blood CO2 level to determine the next breath --> There is more tolerance to CO2 levels
How is CSA treated in 1) Adults, 2) Infants?
- 1) treating the underlying heart disease, medication interaction, high altitude, or other primary problem
- 2) apnea alarm *Most infants “out-grow” the CSA episodes unless there is a congenital problem
What happens during OSA (obstructive sleep apnea)?
- 1. Airway collapses or becomes obstructed. *During an attempt to breathe, the obstructing tissues are sucked together by the negative pressure
- 2. Unsuccessful effort to take a breath *The harder the chest tries to pull air in, the greater the negative pressure and the more the tissues of the airway are sealed together
- 3. Blood oxygen levels drops
- 4. The brain awakens to a more shallow level of sleep, that signals the body to wake up and take a breath (gasp of air)
Who is at risk for sleep apnea?
- - if before 50 y/o, males > female // after 50, it's equal
- - African Americans
- - obese people + large neck size
- - patients with heart disease, stroke, family history of sleep apnea, GERD, nasal obstruction due to deviated septum, allergies, or sinus problems
Major symptom for OSA
Main objective way OSA is diagnosed and evaluated
Polysomnography (sleep study) --> measures physical and physiological parameters while a subject is asleep; technician observes a person sleeping and monitors recording equipment in the setting of a sleep laboratory
Which parameters are measured in a polysomnography?
- 1. Brain waves with EEG (electroencephalogram)
- 2. Eye movements with EOG (electro-oculogram)
- 3. Muscle activity with EMG (electromyogram)
- 4. Oral and nasal airflow
- 5. Chest and abdominal movement
- 6. Audio recording of the loudness of snoring
- 7. Blood oxygen levels (Oximetry)
- 8. Video monitoring of the subject during the study
Surgical treatment sites for OSA
- Depends on specific anatomy and severity of apnea:
- 1. Nose
- 2. Palate, tongue, jaw
- 3. Neck
- 4. Obesity, or several of these areas
- 5. Palate implants *
- 7. Uvulopalatopharyngoplasty *
- 8. Genioglossus advancement *
- 9. Maxillomandibular procedures *
What is Uvulopalatopharyngoplasty (UPPP), one of the surgical procedures for OSA?
- - procedure that removes tissue from the rear of mouth and top of throat, tonsils & adenoids
- - surgery may be successful in stopping throat structures from vibrating and causing snoring
What is maxillomandibular advancement, one of the surgical procedures for OSA?
- - Jaw correction: upper and lower parts of jaw are moved forward from the rest of your facial bones
- - This enlarges the space behind the tongue and soft palate, making obstruction less likely
What are palate implants, one of the surgical procedures for OSA?
- - Pillar Procedure: a minimally invasive treatment that involves placement of three tiny polyester rods in the soft palate
- - These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring
What are the nonsurgical treatments for OSA?
behavior therapy, medications, dental appliances, CPAP (and similar)
How do dental appliances (a non-surgical treatment for OSA) help?
holds the jaw and tongue forward and the palate up, thus preventing closure of the airway