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MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA

Members:

Racho, Kim Szydney

Ramos, Celber Vic

Reburon, Eva Maricon

Sarno, Myrem JesameSibayan, Danyka Danielle

Tabin, Charmaine

Tjakraa!ira, "#nes

$jano, S%ehen

$ano, Celimar Mone%%e

Objectives for te to!ic:

To kno! %he #eneral mana#emen% o& obs%ruc%ive slee anea

To e'lain %he uses o& %he di&&eren% seci&ic %rea%men% modali%ies o& obs%ruc%ive slee anea

"#OM TO TREAT

Trea%men% imroves sym%oms, sleeiness, drivin#, co#ni%ion, mood, (uali%y o& li&e, and blood

ressure in a%ien%s !ho have)

E!or%h Score *++, %roublesome sleeiness !hile drivin# or !orkin#,

E!or%h Score *+ aneas -hyoneas er hour o& slee.

/or %hose !i%h similar de#rees o& sleeiness and 0+ even%s er hour o& slee,

RCTs indica%e imrovemen%s in sym%oms, includin# subjec%ive sleeiness, !i%h

less s%ron# evidence indica%in# #ains in co#ni%ion and (uali%y o& li&e. There is no evidence o&

blood ressure imrovemen%s in %his #rou.

There is no robus% evidence %ha% %rea%in# nonsleey subjec%s imroves %heir

sym%oms, &unc%ion, or blood ressure, and so %rea%men% canno% be advoca%ed &or %his lar#e#rou, al%hou#h %his may chan#e !i%h &ur%her RCTs or less ob%rusive %heray.

#O" TO TREAT $GENERAL MANAGEMENT%

"ll a%ien%s dia#nosed !i%h 1S"2S should have %he condi%ion and i%s si#ni&icance

e'lained %o %hem and %heir ar%ners.

accomanied by !ri%%en and3or 4eb5based in&orma%ion and a discussion o& %he imlica%ions o&

%he local drivin# re#ula%ions.

Rec%i&iable redisosi%ions should be discussed6 %his o&%en includes !ei#h% loss and

alcohol reduc%ion bo%h %o reduce !ei#h% and because alcohol acu%ely decreases uer5air!ay

dila%in# muscle %one, %hus redisosin# %o obs%ruc%ed brea%hin#.Seda%ive dru#s, !hich also imair air!ay %one, should be care&ully !i%hdra!n

Co&ti&'o's Positive Air()* Press're $CPAP%

!orks by blo!in# %he air!ay oen durin# slee, usually !i%h ressures o& 078 mm2#

sho!n in randomized lacebo5con%rolled %rials %o imrove brea%hin# durin# slee, slee

(uali%y, sleeiness, blood ressure, vi#ilance, co#ni%ion,and drivin# abili%y as !ell as

mood and (uali%y o& li&e in a%ien%s !i%h 1S"2S

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"n overni#h% moni%ored %rial o& C9"9 is used %o iden%i&y %he ressure re(uired %o kee %he

a%ien%:s air!ay a%en%. The develomen% o& ressure5varyin# C9"9 machines has made

an in5lab C9"9 ni#h% %rial unnecessary, bu% %rea%men% mus% be ini%ia%ed in a suor%ive

environmen%. 9a%ien%s can be %rea%ed !i%h &i'ed5ressure C9"9 machines se% a% %he

de%ermined ressure or !i%h a sel&5adjus%in# in%elli#en% C9"9 device.

I&iti)tio&+ &indin# %he mos% com&or%able mask &rom %he ran#es o& several manu&ac%urers and %ryin#

%he sys%em &or a% leas% ;8 min durin# %he day %o reare &or %he overni#h% %rial

Si,e effect) air!ay dryin#, !hich can be coun%ered by usin# an in%e#ral hea%ed

humidi&ier C9"9 use is imer&ec%, bu% around o& a%ien%s !i%h severe 1S"2S are

s%ill usin# %heir %heray a&%er years on objec%ive moni%orin#

MRS

SURGER-

Fo'r forms of s'r.er* i& OSA#S

? B)ri)tric s'r.er* 5 cura%ive in %he morbidly obese

? To&si//ectom* 5 hi#hly e&&ec%ive in children bu% rarely in adul%s

? Tr)ceostom*5 byasses %he si%e o& uer air!ay obs%ruc%ion

5 makes seech di&&icul% and is reserved &or only %he mos% severe cases and &or

a%ien%s !i%h concomi%an% hyoven%ila%ion syndromes %ha% do no% resond %o noninvasive &orms

o& 9"9

? 0)( ),v)&ceme&t s'r.er* $m)1i//om)&,ib'/)r osteotom*%

5 e&&ec%ive in %hose !i%h re%ro#na%hia @os%erior dislacemen% o& %he mandibleA

5 should be considered ar%icularly in youn# and %hin a%ien%s

Uv'/o!)/)to!)r*&.o!/)st*

9rocedures %o reduce uvular or ala%al %issue

no% recommended as &irs%5line %heray %o %rea% sym%oma%ic 1S" a%ien%s

References: Harrisons Principles of Internal Medicine,18thedition

Goldmans Cecil Medicine, 24thedition

2r'. Ter)!*

5 $n&or%una%ely, %here are no dru#s clinically use&ul &or reven%ion or reduc%ion o& aneas or

hyoneas. Thou#h...

Mo,)fi&i/ $Provi.i/%

5 Classi&ica%ion) 4ake&ulness5romo%in# a#en% or Eu#eroic

5 B% is believed %o !ork by chan#in# %he amoun%s o& cer%ain na%ural subs%ances @monoaminesA in

%he area o& %he brain %ha% con%rols slee and !ake&ulness. @Medine 9lus, 78+A

5 9romo%es mar#inal imrovemen% in sleeiness in a%ien%s !ho remain sleey desi%e C9"9

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5 Clinical value is deba%able and &inancial cos% is si#ni&ican%

5 Classi&ied as ca%e#ory BV con%rolled subs%ances, indica%in# %ha% %hey have a o%en%ial &or abuseand can lead %o hysical or sycholo#ical deendence. @$S a%ional ibrary o& Medicine, iverTo')Clinical and Research Bn&orma%ion on Dru#5Bnduced iver Bnjury, 78+=A

Coice of Tre)tme&t

? C9"9 and MRS are %he %!o mos% !idely used and bes% evidence5based %heraies.

? S%udies sho! be%%er ou%comes !i%h C9"9 in %erms o& aneas and hyoneas, noc%urnal

o'y#ena%ion, sym%oms, (uali%y o& li&e, mood, and vi#ilance.

? "dherence %o C9"9 is be%%er %han MRS, and %here is evidence %ha% C9"9 imroves

drivin#.

? C9"9 is %he curren% %rea%men% o& choice.

? MRSs are evidence5based second5line %heray in %hose !ho &ail C9"9.

? Bn youn#er, %hinner a%ien%s, ma'illomandibular advancemen% should be considered.