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Obstructive Sleep Apnoea

Introduction

Definition:a syndrome of upper airway collapse leading to sleep disruption which results in symptoms (usually daytime somnolence).

NB. Pickwickian syndrome = OSA in the obese patient (but 50 % of patients with OSA are NOT obese)

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Differential diagnosis

Control of breathing
- brainstem (drugs - hypnotics, pre-terminal event)
- motor weakness (motor neuron disease)

Obstruction
- pharynx (OSA)
- lungs (COPD)

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Causes

Anatomical
- neck obesity
- retrognathia
- tonsillar enlargement

Endocrine
- acromegaly
- hypothyroidism

Neuromuscular
- hypotonia
- myopathy

Drugs
- EtOH
- sedatives

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Symptoms

Night
- snoring
- periods of apnoea terminating with a loud gasp

Day
- somnolence
- morning HA
- poor concentration
- impotence

Complications
- poor performance at work
- RTA (road traffic accidents)´ 7

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Examination findings

Cause
- obesity (50%)
- retrognathism (maxillary / mandibular hypoplasia)

Effect
- plethora / cyanosis
- systemic hypertension
- pulmonary hypertension
- cor pulmonale

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Investigation

Simple studies
- SaO2
- video recordings

Polysomnography
- SaO2
- air flow (oral / nasal)
- EEG
- ECG
- EMG (chest movement)

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Management

Conservative
Lifestyle
- weight reduction
- avoidance of: EtOH, smoking, sedatives

Physical devices
- mandibular advancement

Medical
Drugs
- modafinil: stimulant (NOT related to amphetamines)
- nocturnal ventilation (CPAP = tight-fitting nasal mask)

Surgical
Children
- tonsillectomy

Adults
- UVPP (uvulopalatopharyngoplasty)
- linguloplasty
- uvular remodelling (laser treatment)
- mandibular advancement

Last resort
- tracheostomy

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