The patient inserts their tongue into the bulb at the front of the appliance. This device is sealed at the front so that the patient must be able to breathe quite well through the nose in order to use it. Also, the patient cannot swallow very easily when wearing it.
!! Bariatric Surgery
Sleep apnea & its treatment
Dr.Jitendra Patel, ENT Specialist ENT Sleep Well Clinic,Noor Specialist Hospital, MANAMA, BAHRAIN,Phone : 00973-17242288
IntroductionOne-half to one-third of life asleepObstructive sleep apnea is a commonly encountered health problem and is usually overlooked.the prevalence of OSA in people aged 30-60 years is 9-24 % for men and 4-9 % for women.an individual with sleep apnea is rarely aware of having difficulty in breathing !
DefinationSleep apnoea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low breathing event is called a hypopnea. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or "sleep study".
Classification1. Central – 0.4 % - lack of respiratory effort2. Obstructive – 84 % - breathing is interrupted by a physical block to airflow despite respiratory effort, and SNORING is common.3. Mixed – 15 %
Symptoms Symptoms Symptoms 1 Loud Snoring 7 Excessive day time sleepiness 2 Frequent wake-up 8 Morning headache 3 Gasping during night 9 Morning tiredness 4 Low concentration 10 Non refreshing sleep 5 Poor Work Performance 11 Sexual Dysfunction 6 Poor Short term MemorySleep apnea affects not only adults but some children as well .
Health Related Outcomes• Non-Cardiovascular •Cardiovascular • Poor nocturnal sleep •Arrhythmias • Daytime sleepiness, •Systemic Hypertension vision problem •Pulmonary Hypertension • Motor vehicle accidents •Coronary artery • The part of the brain that disease uses memory and learning •Stroke is also affected • Impaired quality of life • central cyanosis • sudden death
• The accident at the Chernobyl nuclear power plant in the Ukraine is the worst nuclear disaster in the history. The cause of the disaster has been partially attributed to human error caused by sleep apnea.
• Auto Accidents : According to the National Highway Traffic Safety Administration (NHTSA)- USA, "drowsy driving" causes over 100,000 car crashes each year.
Risk Factors– Age (predominantly 40 - 70 years)– Male gender– Obesity– Pharmacologic agents - alcohol, Sedatives , etc.– Upper airway anatomical abnormalities– Hypothyroidism– Postmenopausal state
Flexible nasopharyngoscopy with) 5Müller Maneuver was done to detect .the degree of collapse of soft palate
Full channel polysomnographywas performed for 8 hrs .The following: parameters were studied – Electromyogram (EMG) – Electrocardiogram (ECG) – Electro-oculogram (EOG) – Electroencephalogram (EEG) – Airflow – Chest and Abdominal Wall Effort – Body Position – Oxyhemoglobin Saturation
.American Academy of Sleep Medicine Diagnostic criteria ( A OR B + C)A. Excessive daytime sleepiness that is not better explained by other factors.B. Two or more of the following that are not explained by other factors: - Choking or gasping during sleep. - Recurrent awakening from sleep. - Non-refreshing sleep. - Impaired concentrationC. PSG shows 5 or more obstructed breathing events per hr during sleep.
Severity of OSA(According to Sleep Study Report) Mild: AHI : 5 to 15Moderate: AHI : 15 to 30Severe: AHI > 30
Clinically Significant OSAAHI ≥15, or AHI between 5 and 14 with any of the following associated symptoms: Excessive daytime sleepiness Impaired cognition Mood disorders Insomnia Documented hypertension Ischemic heart disease History of stroke.
Take home message1. Severity of OSA highly predicted clinically & by AHI2. Epworth Scale , BMI & Neck Circumference are Highly sensitive parameters for OSA .
3. AHI , O2 saturation can be easily done with Home base sleep device.4. Outcome of surgical intervention should be predictable .5. Severe OSA + high BMI +(NC > 17, Low O2 , high ESS ) -----> poor out come.
6. Diagnostic tool: Clinical + PSG7. Treatment options : Multilevel surgery , CPAP , Sleep hygiene .8. Sleep Medicine …Gray area !!
ENT Speicalist is the right discipline to diagnose and treat OSA and predict the out come .
OSA in Children bedwettingchoking or droolingexcessive sweating at nightinward movement of the ribcage when inhalinglearning and behavioral disorderspoor school performancesluggishness or sleepiness (often misinterpreted as laziness in the classroom)snoringteeth grindingrestlessness in bedpauses or absence of breathing
Treatment SummaryDiagnosis of Non-Surgical SurgicalObstructive Treatment TreatmentSleep Apnea Options Options Palate CPAP Nasal OTC Weight Loss Remedies Oral Sleep Position Oral Bariatric Training Appliances
BMI !! HOW to be controlled ??Sleep wellDietExerciseBariatric surgery ??
Expected Benefits from Thetreatment of OSA.• Better blood pressure control• Lower MI and CVA risk• Fewer arrhythmias• Lower mortality through less incidence of cvs• Slow the progression of renal failure• Improved diabetes control• Better quality of life