This presentation gives some basic information regarding the definition , etiology and pathophysiology of " obstructive sleep apnea" which is a serious sleep disorder .Treatment methods are briefly reviewed with special emphasis on the role of the oral surgeon and orthodontist in the management of this medical condition .
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
This presentation gives some basic information regarding the definition , etiology and pathophysiology of " obstructive sleep apnea" which is a serious sleep disorder .Treatment methods are briefly reviewed with special emphasis on the role of the oral surgeon and orthodontist in the management of this medical condition .
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
Presented by Dr Paulose at the International Live Surgical Workshop, held in Hyderabad, India at the Taj Deccan. For more information visit:
http://DrPaulose.com
http://SnoreFreeSleep.com
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
Presented by Dr Paulose at the International Live Surgical Workshop, held in Hyderabad, India at the Taj Deccan. For more information visit:
http://DrPaulose.com
http://SnoreFreeSleep.com
Sleep Apnea and Traffic Accidents: By Dr.K.O.Paulose. FRCS DLO
Consultant ENT Surgeon
Jubilee Hospital, Trivandrum,South India.
www.drpaulose.com www.snorefreesleep.com
Oscilloquartz has achieved an industry milestone with the launch of the OSA 5335 Modular Precision Time Protocol (PTP) Grandmaster. This is the first product of its kind to feature a modular design and extreme scalability at the same time. The OSA 5335 can support from 128 to over 3,000 remote PTP clients at 128 packets per second (PPS) - something that has never been done before.
Surgical procedures for the treatment ofBhagwat Kapse
Apnea” is the Greek word for “without breath.”
Obstructive sleep apnea (OSA) was
( 1837) First Charles Dickens term “Pickwickian syndrome”
described a similar presentation of a typical OSA patient; obese, somnolent, and with an excessive appetite.
Here I discuss about the current management guidelines from British Thyroid Association and American Thyroid Association comparing those with the current practice in Sri Lanka
Overview on "Obstructive Sleep Apnea" including Causes, Symptoms, Risk factors, Examination, Diagnostics, Management, and Treatement strategies. For more information, please contact us: 9779030507.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
6. Respiratory physiology during normal sleep
• Regulated by:
• 1. Chemical factors: O2, CO2, acidosis
• 2. Mechanical signals from lung, airway, and chest
receptors
7. • REM sleep: decreased sensory and motor function
->impairment of ventilatory responses->
hypoventilation
Respiratory physiology cont...
8. Hypoxic and hypercapnic ventilatory response during
sleep
• During sleep voluntary control of respiration
is lost
• Ventilatory responses to both low O2 and high Co2
levels blunted -> marked hypoxemia seen during
REM sleep
Respiratory physiology cont...
12. • Snoring:
• sound generated by the vibration of the pharyngeal
soft tissues.
• 40% of men and 20% of women
Classification cont...
13. Upper Airway Resistance Syndrome
• UARS is characterized by respiratory effort–related
arousals (RERAs).
• A RERA is defined as a sequence of breaths over at
least 10 seconds with increasing respiratory effort
that terminates with an arousal.
Classification cont...
14. • Obstructive Sleep Apnea Syndrome
• Five or more respiratory events (apneas,
hypopneas,or RERAs) in association with excessive
daytime somnolence, waking with gasping, choking,
or breath-holding, or witnessed reports of apneas,
loud snoring, or both.
Classification cont...
15. • EPIDEMIOLOGY and RISK FACTORS
• Obesity and Metabolic syndrome
• Neck size
• Adults and children with Down Syndrome
• Children with large tonsils and adenoids
17. Aetiopathogenesis
• Nose
• Nasal blockage might:
• Reduce nasal afferent reflexes that help to maintain
muscular tone of the upper airway
• Augment the tendency for mouth opening
21. • Pharyngeal soft tissues:
• Supine position
• MRI volumetric studies->tongue
size as a major predictor
• Sagittally oriented airways that were speculated to
result in unfavorable muscular mechanics for
reopening the airway
Aetiopathogenesis contd...
22. • Oral to palatal airspace is smaller, and the posterior
airspace behind both the tongue and palate is
narrower.
• Cross-sectional shape of the airway- elliptical
• Biomechanically weaker structure that is more easily
collapsed at less negative pressures.
Aetiopathogenesis contd...
25. • Fujita classified ( Anatomical basis)
• Type I- collapse in the retropalatal region
• Type II- collapse in both retropalatal and retrolingual
regions
• Type III- collapse in the retrolingual region only
29. • BMI
• Neck circumference
• Complete head and neck examination
• Muller’s manoeuvre
Clinical Presentation contd...
30. Diagnosis
• Detailed history:
• Obtained in three settings
• First- routine health maintenance evaluation
• Second- evaluation of symptoms of OSA
• Third- comprehensive evaluation of patients of high
risk for OSA
31. • Overnight oximetry:
• Oxygen desaturation index
subject with ODI of 55, 4 percent oxygen dips per hour. This trace shows the whole night's
data. Minimum oxygen saturation is approximately 45 percent
34. • Four types of sleep studies
• Level I:
• Standard PSG with a minimum of seven parameters
measured, including EEG, EOG, EMG, and EKG, as
well as monitors for airflow, respiratory effort, and
oxygen saturation.
35. • Level II:
• Comprehensive portable PSG studies are essentially
the same, except that a heart rate monitor can
replace the ECG
36. • Level III
• Modified portable sleep apnea testing is a
cardiorespiratory study in which a minimum of 4
parameters must be measured, including
ventilation , heart rate or EKG, and oxygen saturation
37. • Level IV:
• Continuous (single or dual) bioparameter recordings
where devices that measure a minimum of one
parameter, usually oxygen saturation are utilized
41. • Polysomnography can also diagnose other sleep
disorders:
• Narcolepsy
• Periodic limb movements disorder (moving your legs
often during sleep)
• REM behavior disorder
42. Indices of Sleep-Disordered Breathing
• Apnea index- Number of apneas per hour of
total sleep time
• Hypopnea index- Number of hypopneas per hour of
total sleep time
• Apnea-hypopnea index Number of apneas and
hypopneas per hour of total sleep time
43. • Respiratory effort–related arousals (RERAs) index-
Number of RERAs per hour of total sleep time
• Respiratory disturbance index (RDI)-Number of
apneas, hypopneas, and RERAs per hour of total
sleep time
Indices of Sleep cont....
44. • Central apnea index- Number of central apneas per
hour of total sleep time
Indices of Sleep cont....
45. • Types
• Mild OSA: AHI of 5-15
• Involuntary sleepiness during activities that require little
attention, such as watching TV or reading
• Moderate OSA: AHI of 15-30
• Involuntary sleepiness during activities that require some
attention, such as meetings or presentations
Classification cont...
46. • Severe OSA: AHI of more than 30
• Involuntary sleepiness during activities that require
more active attention, such as talking or driving
Classification cont...
47. • Pulse transit time: interval between the R wave on an
electrocardiogram (ECG) and the arrival of the pulse
at the finger.
• Increased in increased respiratory effort and
decreased in the presence of tachycardia associated
with arousal.
50. Consequences of Untreated Obstructive
Sleep Apnea
• He and colleagues- apnea index >20 increased
mortality
• Motor vehicle accidents by 2.5-fold
• Threefold increase in fatal and nonfatal
cardiovascular events
OSA: regarded as a condition characterized by repetitive upper airway obstruction leading to sleep fragmentation, cardiovascular stimulation and oxygen desaturation during sleep. Together, these lead to symptoms such as snoring, unrefreshing sleep, excessive daytime sleepiness (EDS), and the increased risk of cardiovascular disease, hypertension, insulin resistance, cerebrovascular disease and road traffic accidents.
Complet cessation at ant nares for 10 sec whether asso O2 desat or arousal, Hypoap: reduc of airflo of betw 50 to 90%(with or without 3% or more O2 desat and/or arousal
Sleep: 7-8hr, Stage I- alpha and theta,easily aroused stage II- sleep spindles or K complexes, Stage III &IV- delta, deep sleep
Muscles tone reduced, EEG: mixed frequency with low voltage, saw tooth waves
Inhibition of both presynaptic and postsynaptic afferent neurons results in an increase in sensory arousal thresholds to external stimuli
Hypoxia: many subjects remain asleep with oxygen saturation as low as 70% ,Patients with sleep apnea reduced arousal sensitivity to hypoxia during periods of asphyxia
Hypercapnia: most subjects are awake before the end-tidal Co2 rises by 15 mm Hg above the level in wakefulness
1. exacerbated by ingestion of alcohol, sedative use, and weight gain. 2. accidents and increased cardiovascular morbidity and mortality
Smoking; through oxidative stress, endothelial dysfunction and abnormal inflammatory response
which destabilizes the lower pharyngeal airway (by posterior rotation, vertical opening, and inferior displacement of the hyoid)
hyoid muscles-hyoid posi-> geniohyoid), tongue position (e.g. genioglossus) and palate position (e.g. tensor palatini), stiffen the upper airway and oppose the negative airway pressure generated by contraction of the diaphragm, delay between the upper airway muscle activity and diaphragmatic activity during inspiration->neg intraluminal pressure when upper airway muscl inactive
Supin-tongue projects posteriorly
Changes in tissue mass, lung volume, tracheal tug, and vascular volume from nonsupine to supine, as mass increases, gravity effects will increase.
Balance of Forc: Dilating forces include upper airway muscle tone, mechanical force of the airway wall structure, and positive intraluminal airway pressure. Collapsing forces include tissue mass,surface adhesive forces, and negative intraluminal pressures.
ideal Starling resistor is depicted for differing conditions of upstream pressure (Pus) in B–D. The pressure difference (ie, transmural pressure Pin -Pout =Ptm) across the airway determines airway size. In (B), fluid fills the basin and the pressure outside the tube (Pout) is greater than pressure inside (Pout >Pin), the tube collapses and no flow occurs. In (C), upstream pressure is increased. When dilating pressures are greater than collapsing pressures (Pin > Pout), the tube is patent and flow occurs. In (D) flow increases with increased positive upstream pressures and unchanged downstream pressures.
Flow is determined by upstream pressure.
overnight oximetry may miss subjects with OSA who do not desaturate, young, less obese subjects may not have oxygen desaturations in the presence of apnoeas and hypopnoeas and therefore will not be identified by oximetry. ODI: number of times the oxygen saturation falls by 4 percent averaged out per hour) of over 15 per hour may be suggestive of OSA. ODI > 15 per hour can only be used if the resting saturation of oxygen is above 90 percent
Adv: patient comfort, cost savings, prevention of hospital admission and speed of analysis data. Disadv: include sensor failure at home and loss of signal
(which may lead to repeat studies)r
refers to the recording of multiple sleep-related signals. allows qualitative and quantitative documentation of abnormalities of sleep and wakefulness, sleep-wake transition, and of physiological function of other organ systems that are influenced by sleep. Quistionnare, consent
depending upon the number of physiologica variables, Level I-technician is in constant attendance
Technician is not in constant attendance.
Ventilation: at least two channels of respiratory movement and airflow
Belt movement by piezoelectric sensors
(A) Displaying the trends in 10-second range increases the resolution of EEG waveforms. Alpha waves are clearly recognized in the EEG (C3, C4, O1, and O2) tracings. Frequency is determined by counting the ‘‘peaks’’ in one-second interval. (B) Displaying the data in a compressed format (display range 480 seconds) accentuates the classical pattern of Cheyne-Stokes breathing.
Narcol: excessive daytime sleep & cataplexy. Periodic limb: movement simulates triple flexion with leg flexion, ankle dorsiflexion, and great toe extension; it lasts approximately 2 seconds, REM Behavir dis: physically move limbs or even get up and engage in activities associated with waking. Some sleep talking, shouting, screaming, hittting or punching
Normal <5
Hypoxia-> sympa output->periphe vasocon-incre pulse and bp– marker of subcort arousal , more sensitive measure of obstructive events than visible electroencephalogram (EEG) arousals found on full polysomnography
In children, sleep nasendoscopy can be performed with the child breathing spontaneously a mixture of halothane and oxygen. level 1- adenoid pad and velopharyngeal obstruction, level 2 tonsillar obstruction; level 3 tongue base obstruction; level 4 supraglottic obstruction.
subglottic stenosis, tracheomalacia, innominate artery compression, bronchomalacia or vascular rings
Children-Long-standing sleep apnoea can result in irreversible pulmonary hypertension, failure to thrive or a decrease in growth rate.
