Disease Information for Sleep apnea, obstructive type: Definition

  • Obstructive Sleep apnea syndrome:Usually Obesity issue; males> females (60-40%); Cardinal symptom is excessive daytime sleepiness (EDS); Loud snoring; Complaints of disrupted sleep; Repetitive awakenings with transient sensation of shortness of breath or for unclear reasons; Tired and unrefreshed upon AM awakening ;Witnessed apneas at night; Complaints of poor concentration, memory problems, irritability; Morning headaches; Short-tempered; Decreased libido; Depression ; Systemic and pulmonary hypertension; CAUSES; Upper airway narrowing may be due to obesity, enlarged tonsils or uvula, low soft palate, redundant tissue in soft palate or tonsillar pillars, large or posteriorly located tongue or craniofacial abnormalities; Anatomical narrowing superimposed upon a coexistent abnormality of neurological control of upper airway muscle tone or ventilatory control during sleep; Risk Factors; Obesity; Nasal obstruction (due to polyps, rhinitis, Allergy, or deviated septum); Hypothyroidism; Macroglossia; Micrognathia (retrognathia); Acromegaly; Persons with hypertension, cardiovascular or arteriovascular disease or alveolar hypoventilation have a much higher risk of obstructive sleep apnea (OSA); Alcohol intake before bedtime; DDX: Other causes of EDS such as narcolepsy, idiopathic daytime hypersomnolence, inadequate sleep time, depressive episodes with EDS, periodic limb movements of sleep; Respiratory disorders with nocturnal awakenings such as asthma, COPD, CHF; Central sleep apnea may mimic OSA; Sudden nocturnal awakenings due to panic attacks; Sleep-related choking or laryngospasm; Gastroesophageal reflux may also present with similar symptoms; Sleep associated seizures (temporal lobe epilepsy);Pathology: Anatomically small upper airway common; CNS abnormalities rare; TESTS: Echocardiography may demonstrate right and/or left ventricular enlargement

    or pulmonary hypertension; Polysomnogram (nighttime sleep study) including O2 saturation, CO2; Multiple sleep latency testing (MSLT) provides an objective measurement of

    daytime sleepiness; Cephalometric measurements from lateral head and neck x-rays are occasionally useful if surgery is contemplated; MRI, CT scans or fiberoptic evaluation of upper airway occasionally helpful; DX: Nighttime sleep study (polysomnogram)shows repetitive episodes of cessation or marked reduction in airflow despite continued respiratory efforts; These apneic episodes must last at least 10 seconds and occur 10-15 times per hour to be considered clinically significant; Polysomnogram demonstrates severity of hypoxemia, sleep disruption and

    cardiac arrhythmias associated with OSA and elevated end tidal CO2; RX: For patients with significant EDS and 15-20 apneas per hour or more, CPAP is probably the best treatment;