Nur Amalina Aminuddin Baki0820121000 67

Snoring and Obstructive

Sleep Apnoea

Introduction

SnoringUndesirable disturbing sound

during sleep25% 15% Increase with age

Sleep apnoea Cessation of breathing that lasts for > 10s during sleep

Apnoea index Number of episodes of apnoea in an hour

Hypopnoea Reduction of airflow. Drop of 50% airflow from baseline associated

with EEG defined arousal 4% drop in oxygen saturation

Respiratory disturbance index (RDI) Aka apnoea –hypopnoea index Number of apnoea & hypopnoea per hour

Arousal Transient

awakening from sleep

Arousal index Number of

arousal events in 1 hour

Sleep efficiency Minutes of sleep minutes in bed after lights are turned off

Multiple sleep latency test / Nap study Latency period from wakefulness to onset

of sleep and REM sleep are measured

Mechanism of Snoring

Muscles of pharynx relax-

Partial obstruction

Soft palate, tonsillar pillars

and base of tongue

vibrates

Primary vs SecondaryComplicated

Aetiology Children

adenotonsillar hypertrophy Adult

Nose/nasopharynx- septal deviation, turbinate hypertrophy, nasal valve collapse, nasal polyps, tumours

Oral cavity- elongated soft palate and uvula, tonsillar enlargement, macroglossia, retrognathia, large base of tongue, tumours

Larynx/laryngopharynx- laryngeal stenosis, omega-shaped epiglottis

ObesityThick neck with collar >

42 cmUse of alcohol, sedatives

and hypnotics

Sites of Snoring

Soft palate Tonsillar pillars Hypopharynx

Symptoms Snoring-spouse syndromeWith OSA:

Excessive daytime sleepiness Morning headaches General fatigue Memory loss Irritability and depression Decrease libido Increase risk of RTA

Treatment Lifestyle changes Weight reduction Sleeping on side Removal of

obstructing lesion Performing

uvulopalatoplasty (UPP)

SLEEP APNOEA No movement of air at the level of nose and mouth

Physiology of Sleep 7-8 hours Non REM [ 75%] and REM [25%] Semiregular cycles (90-120min) 3-4 cycles of sleep

NON REM REMDuration 75-80% 20-25%Eye movements No Rapid conjugate

eye movementsAutonomic activity Less More Brain activity Minimal Active Muscular activity Functional, less Decreased EEG Alpha to delta

waves Mixed

Dreaming No Yes

Types Obstructive

Collapse of upper airway Obstructive condition

Central Patent but brain fails to

signal the muscles to breathe

Mixed

Hypoxia and retention of

carbon dioxide

Pulmonary constriction

CHF, bradycardia and cardia

hypoxia

Left heart failure, cardiac

arrythmias and sudden

death

Pathophysiology

Arousal sleep fragmentation

daytime sleepiness

EvaluationHistoryEpworth

sleepiness scale

Physical examination BMI Collar size Complete head

and neck examination

Muller’s manoeuvre

Systemic examination

Cephalometric radiographs

Polysomnography EEG,ECG,EOM,EMG,

pulse oximetry, nasal and oral blood flow, blood pressure

TreatmentNon-surgical

Change in lifestyle

Positional therapy

Intraoral devices CPAP

Surgical Tracheostomy Tonsillectomy and/or

adenoidectomy Nasal surgery Oropharyngeal surgery

(uvulopalatoplasty) Advancement genioplasty Hyoid myotomy and

suspension Tongue base

radiofrequency Maxillomandibular

advancement osteotomy

Referance PL dhingra, Disease of Ear, Nose and Throat, 6th edition , Elsevier