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sleep apnea Flashcards

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1
Q

snoring definition

A

partial airway obstruction that reduces airflow but does not cause arousal from sleep

like hypnoapnea

you can snore and not have sleep apnea

25 % of men and 15% of woman are habitual snorers

30-50% of asymptomatic snorers have sleep apnea

snoring is risk factor for
- HTN, CVA, MI

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2
Q

upper airway resistance syndrome

A

exaggerated breathing effort and snoring created by high resistance to airflow in the upper airway

this causes fragmented sleep and significant daytime drowsiness (no evidnece of apnea on testing)

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3
Q

general effect of upper airway resistance syndrome

A

this causes fragmented sleep and significant daytime drowsiness (no evidnece of apnea on testing)

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4
Q

evidence of apnea with upper airway resistance syndrome

A

no

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5
Q

evidence of apnea with upper airway resistance syndrome

A

no

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6
Q

snoring and sleep apnea relationship

A

30% of snoreers have sleep apnea

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7
Q

obstructive sleep apnea syndrom definition

A

stoppage of breathing for 10 seconds or more for at least 5 x a hour

oxyen saturation in the blood decreases more than 4%

apnea events end with an arousal from sleep

arousals lead to chronic daytime sleepiness and other symptoms

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8
Q

apnea events ends when

A

with an arousal from sleep

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9
Q

arousals lead to

A

chronic daytime sleepiness and other symptom

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10
Q

hyponea definition

A

decrease in airflow with oxygen deaturations greater than 4% and an arousal from sleep

snoring usually associated

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11
Q

risks of OSA

A

increased rate of motor vehicle accidents

increased risk of unemploment

unisuraility

marital discord

cardiovascular consequences

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12
Q

apnea hyponea index (AHI)

A

the average number of apneas plus hypopneas per hour of sleep

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13
Q

predisposing factors for OSA

A

increaseed age

increased weight / obesity

male gender

disproportionate upper airway anatomy

alcohol

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14
Q

OSA syndtom

A

loud snoring

irregular breathing

restless sleeep

excessive daytime sleepiness

witnessed apnea by partner in bed

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15
Q

major risk factor for OSA

A

obesity

  • losing weight can signficanttly improve sleep apnea

need to lose over 10 kg weight

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16
Q

severity of apnea defined by

A

length of time of apnea event and percentage of oxygen desaturation

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17
Q

mild OSA

apnea- hypnea index

A

5-15 events / hour

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18
Q

moderate OSA

apnea- hypnea index

A

10-40 events / hour

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19
Q

severe OSA

apnea- hypnea index

A

over 40 events/ hour

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20
Q

anatomic predisposition

A

reduced posterior airway space

posterior rotation of mandible

tongue posterior and inferior

hyoid inferior placed

decreased A-P diameter of cranial base

decreased
A-P diameter of maxilla/ manidble

decreased posterior facial height (VME)

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21
Q

polysomnogram aka?

looks at?

A

sleep study

EEG - brain waves
EMG - muscles
ECG - heart

respiratory airflow and effort

blood oxygen ssaturation

pulse rate

body position

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22
Q

what your dentist might if you snore or have obstructive sleep apnea

A

elongated uvula and soft palate that can contact the tongue

enlarged tonsils which partially obscure the airway

the tongue is large and usually rests above the biting surface of the teeth

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23
Q

what your dentist might if you snore or have obstructive sleep apnea

A

elongated uvula and soft palate that can contact the tongue

enlarged tonsils which partially obscure the airway

long uvula

the tongue is large and usually rests above the biting surface of the teeth

a normal class I tongue is at or below the level of occlusal plane

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24
Q

effects of oral appliances

A

bring mandible and base of tongue forward palate and mandibular rotation

prevention of mandibular opening during sleep

downward mandibular rotation

support soft palate and uvula

increased genioglossus activity

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25
goals of oral repositioning devices
50-75% of maximum protrusion start movement slowly vertical dimension increased by 5 mm
26
indications for use of oral appliances
primary snoring mild to moderate OSA poor tolerance of nasal CPAP failure of UPPP - surgical technique to remove uvula and soft palate use of appliance during travel use in combination with other treatmetns
27
benefits of CPAP
always eliminates snoring if properly titrated elimniates or reduces dangerous OSA, hypopnea and oxygen desaturation of blood
28
protocol for for oral appliances
trial evaluation for 2-3 months subjective symptom assessment ceph with appliance in place repear overnight sleep study repeat evaluation / recall
29
protocol for for oral appliances
medical assessment and polysomnography by sleep specialist FIRST - oro-facial / dental evaluation - design, fabricate, fitting, training, adjustment trial evaluation for 2-3 months subjective symptom assessment ceph with appliance in place repear overnight sleep study repeat evaluation / recall
30
contraindications for oral appliances
severe sleep apnea obesity TMJ problems poor dentition - like perio and could extract the teeth with appliance use steep mandibular plane angle
31
sleep deprivation statistics
32 % of americans sleep 6 hour or less per night 23% of adults fell asleep at the wheel during the past year sleep time has decreased 20% over last century
32
statistics of snoring
approx 40% of adults over 40 snore
33
stastics of signs of OSA on testing
9% of men 4% of woman HAVE SIGNS ON TESTING
34
statistics of signs and SYMPTOMS of OSA
4% of men and 2% of woman
35
general prevelance of OSA
as prevalent as diabetes or asthma!!!
36
tx for snoring
``` avoid alcohol weight loss CPAP - prob overkill - position therapy oral appliances * ```
37
T/F pulse oximetry is a poor screening tool
true we need sleep study
38
severity of apnea defined by?
length of time of apnea event percentage of time apnea event percent of oxygen desaturation
39
apnea - hypoapnea ndex is
mild - 5-15 (5-20 on other slide) events/hour moderate 15-40 (20-40 on other slide) events/ hours severe over 40 events/ hour
40
risks of OSA
increased rate of motor vehicle accidents increased risk of unemployment uninsurability martial discord cardiovascular consequences
41
sleep breathing disorder continuim
snoring --> UARS--> Hypopnea --> apnea --> hypoventilation
42
signs and symptoms of OSA
1. snoring and intermittent pauses 2. excessive daytime sleepiness 3. awakness due to gasping and choking 4. fragmented, non-refreshing sleep 5. poor memory and clouded intellect 6. personality changes 7. decreased sex drive 8. morning headaches
43
predisposing factors for OSA
1. increased age 2. increased weight / obesity 3. male gender 4. disproportionate upper airway anatomy 5. alcohol and sedative hyptonics 6. hypothyroidism
44
collar size and neck size
men over 17 and woman over 15 increased risk
45
upper airway configuration in apneics
apneic airway has an A-P configuration NARROWED LATERALLY due to the lateral soft tissue structures -- pharyngeal wall and fat pads VOLUME of lateral pharyngeal walls, soft palate and fat pads are SIGNIFICANTLY LARGER in apneic patients
46
primary screening tool
epworth questions over 10 = OSA
47
epworth norms | - breakdown
normal is 5.9 (so 6 or less) OSA = 11.7 Narcolepsy = 17.5
48
behavior treatment and avoidance with OSA
weight loss body positioning avoidance of CNS depressants avoidance of upper airway irritants
49
only one that really raises oxygen saturation
CPAP | continuous positive airway pressure
50
side effects of oral appliances
excessive salivation transient discomfort of teeth, TMJ dry mouth - xerostomia soft tissue irritation occlusal changes
51
effectiveness of oral appliances
85-90 % effective in snoring 60-70% effective in mild - moderate OSA 10% complication rate success is highly variable and DOES NOT IMPROVE lowest sa02 levels
52
george gauge
intra-oral device used to register correct jaw position for mandibular repositioning appliances measures prottrusion and retrusion of mandible start at HALF OF MAXIMUM
53
CLASSIFICATION of oral appliances
mandibular repositioning devices tongue retaining devices
54
tongue retaining devices for?
edentulous
55
CPAP success?
80-90% but 40-60% non- compliance issues 20% complication rate increases lowerst Sa 02
56
general over arching treatment of snoring
1. behavioral tx and avoidance of risk factors 2. contious positive airway irritants 3. oral appliance therapy 4. surgery
57
downfall of Uvulopalatopharynggoplasty
painful removes the uvula palate and tonisls ONLY 40% SUCCESS WHEN PERFORMED ALONE ONLY
58
phase I sureries
UPPP/ tonsilectomy mandibular anterior segmental osteotomy with genioglossus muscle advancement possibly include hyoid bone stabilization success increases when do them together like UPPP alone = 40-50 all three together = 60-70%
59
phase II surgeries success? implicatino
maxillomandibular advancement (MMA) maxilla and mandible advanced forward 10 mm - usually combined with advancement of genial tubercles / genioglossus muscle (total of 20 mm for genioglossus) success rate of approx 97% -- bt invasive and a lot of surgery
60
airway is increased at multiple levels
tongue base palate nasal valve
61
maxillomandibular advancement success rate
90-98%

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