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What is obstructive sleep apnea? What does this cause?

repetitive partial or complete obstruction of the airway during sleep causing:

-sleep disruption
-oxygen desaturation
-high catecholamine states

OSA is defined as having an AHI (apnea hypopnea index) or RDI (respiratory disturbance index) > 5


What is considered apnea? hypopnea? RERA?

apnea=complete (>90%) cessation of airflow for >10 seconds

hypopnea=partial (>30%) cessation of airflow for >10 seconds with oxygen desaturation (>3%) or cortical arousal

RERA=respiratory effort related arousal = inc reap effort and/or blunted nasal airflow > 10 sec with cortical arousal


What is AHI? RFI? What is OSA?

AHI=(apneas + hypopneas)/ hours of sleep

RDI= (apneas + hypopneas + RERAs) / hours of sleep


In patient with Acromegaly, which of the following is the mechanism for the development of obstructive sleep apnea?
A. Upper airway narrowing with tissue infiltration
B. Contraction of upper airway dilating muscle
C. Positive pressure during inspiration
D. Dystrophy of upper airway dilating muscle
E. Pressure from the neck muscles during inspiration

A. Upper airway narrowing with tissue infiltration


Who are some risk factors for OSA?

Obesity (BMI and neck circumference > 16")

Mallampati Class (I --> IV ) (IV =more occluded airway due to soft tissue

tonsillar hypertrophy

retrognathia/micrognathia (small chin compared to the mandible)

macroglossia (tongue scalloping)

narrow high arched palate

epworth sleepiness scale > 10 (excessively sleepy)

resistant HTN (> 3 drugs)

unexplained A fib



What is the testing for OSA?

attended polysomnogram (sleep study)

Embletta =portable testing


What are the indications for CPAP in OSA?

AHI > 15 events / hour or AHI 5-14 events/hour with clinical sequelae

Consider in pts with AHI of 5 with symptoms or who perform critical work


What are the adverse effects of CPAP?

dry mouth, rhinitis, congestion


How does a mandibular repositioning splint work? What OSA pts is this effective in?

Protrudes the mandible forward and holds the tongue anterior, away from the posterior pharyngeal wall

treat mild OSA


What kinds of behavioral modifications are recommended for OSA?

diet and exercise

no alcohol

no drugs

sleep positions


When is OSA surgery indicated? What are the different surgical options?

if CPAP is ineffective

Uvulopalapharyngoplasty (UPPP)-resection of uvula & soft palate

Craniofacial Reconstruction- tongue advancement or maxillo-mandibular osteotomy

Tracheostomy-tube into the airway bypasses obstruction and to be used for severe OSA