Week 6 Abdalla- OSA

Question 1

Describe sleep cycle

Answer 1

REM: 25% of sleep in a night (every 90 minutes and gets progressively longer)
Stage 1: light sleep
Stage 2: deep sleep
Stage 3-4: deepest sleep

Question 2

Approx how many patients have OSA?

Answer 2

5%

Question 3

What is insomnia?

Answer 3

Difficulty falling and / or staying asleep

Question 4

What is parasomnia?

Answer 4

Sleep walking, talking, abnormal movements, night terrors

Question 5

What are sleep related breathing disorders?

Answer 5

Snoring, CSA, OSA

Question 6

What are sleep related movement disorders?

Answer 6

Restless leg syndrome, nocturnal bruxism

Question 7

What is narcolepsy?

Answer 7

Overwhelming daytime drowsiness leading to daytime sleeping

Question 8

What are circadian rhythm sleep disorders?

Answer 8

Jet lag, shift work

Question 9

What conditions are greater risk in patients with sleep disorders?

Answer 9

Greater risk of heart failure, heart attack, diabetes, depression/anxiety, schizophrenia

Question 10

What is central sleep apneoa?

Answer 10

Airflow ceases due to a temporary lack of inspiration (CNS issue). Can be associated with:

• polymyelitis
• spinal cord injury
• encephalitis

Question 11

What is obstructive sleep apneoa?

Answer 11

Airflow stops due to physical obstruction

Question 12

What are the 3 types of sleep apneoa?

Answer 12

Central
Obstructive
Complex (combination)

Question 13

What is apneoa vs hypopnea?

Answer 13

• Apnoea: Total cessation of airflow for at least 10 seconds
• Hypopnea: Reduced airflow for at least 10 secs accompanied by arousal or drop in O2 saturation

Question 14

What is the sleep cycle for OSA?

Answer 14

• Inc breathing effort (dec O2, inc CO2)
• Arousal
• Hyperventilation
• Return to sleep
• Hyperventilation
• Upper airway narrowing/collapse

Question 15

What are symptoms of sleep apneoa?

Answer 15

• Poor concentration
• Low mood
• Restless sleep
• Heart burn
• Waking up with dry mouth
• Night sweats
• Insomnia
• Waking up dizzy
• Weight gain
• Fatigue, lack of energy
• Forgetfulness
• Irritability
• Frequent night time urination

Question 16

What are risk factors for OSA?

Answer 16

• Obesity*
• Smoking
• Alcohol use
• Upper airway collapsibility
• Male
• Older age
• Genetics

Question 17

What are dental risk factors for OSA?

Answer 17

• High narrow palate
• Narrow dental arches
• Increased anterior face height
• Increased overjet
• Retrognathia
• Large tongue
• Tonsillar hypertrophy

Question 18

What is most common risk factor for OSA in children?

Answer 18

Enlarged tonsils and/or adenoids

Question 19

How to manage adults with OSA?

Answer 19

• Weight management
• Smoking cessation
• Alcohol cessation (evenings)
• Sleeping position (not supine)
• CPAP

Question 20

How to manage children with OSA?

Answer 20

• Referral to sleep specialist
• Adenotonsillectomy
• Pharmacological agents to reduce lymphoid tissue- not that effective
• Wight loss if obese
• (avoid CPAP as can cause mx retrusion)

Question 21

What are implications of OSA for dentist?

Answer 21

• Often underdiagnosed and under reported
• Dentists can have role in management of pts through provision of MAS- this would always be done under guidance of specialist sleep physician

Question 22

How to screen adults for OSA?

Answer 22

• Mallampati (friedman) score
• May have scalloped tongue (sign of sleep bruxism)

Question 23

What questions to ask adults at risk of OSA (STOP-BANG)?

Answer 23

• Snoring: Do you snore? Is it as loud as or louder than talking
• Tiredness: Do you wake up tired, or do you become tired during the day
• Observed Apnoeas: Have you felt or has anyone else told you that you stop breathing in your sleep?
• Hypertension: Do you have high blood pressure, or are you on medication for high blood pressure?
• BMI >35kg/m²
• Age: >50 years
• Neck circumference: >40cm
• Gender: male

Question 24

How to screen children at risk of OSA?

Answer 24

• History snoring, daytime sleepiness, difficulty concentrating, ADHD
• Paediatric sleep questionnaire
• Epworth Sleepiness Scale for Children and Adolescents
• Enlarged tonsils (Brodsky scale)
• Skeletal risk factors (mandibular retrognathia, narrow maxilla)

Question 25

How to diagnose OSA?

Answer 25

Polysomnography

Question 26

What should you do if you suspect OSA?

Answer 26

Refer pt for medical assessment. Use of oral appliances to treat snoring without medical exam/investigation is innapropriate

Question 27

Why is it important to know if patient has OSA?

Answer 27

Increased risk of respiratory arrest from sedation and GA- procedures should be undertaken in hospital and anaesthetist present

Question 28

Who can MAS be used in?

Answer 28

Adults with mild to moderate OSA who do not tolerate CPAP

Question 29

What are MAS?

Answer 29

• Better tolerated than CPAP
• Less effective in more severe cases
• Can cause changes to the occlusion over time
• Adults need to be dentate for most appliances

Question 30

How can OSA be treated?

Answer 30

• CPAP
• MAS
• Orthognathic surgery

Question 31

What are risk factors for smaller airways in children?

Answer 31

• Narrow mx
• Retrogthnathic md

Question 32

Are appliances useful for increasing airway in children?

Answer 32

RME doesn’t have much of an effect on increasing airway

Difficult to research as there is huge variation in children and airway increases as they grow