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SLEEP APNEA
SLEEP APNEA
PRESENTER,
DR. SUMAIYA BANU,
MPT (CARDIO)
What is sleep apnea???
Sleep apnea is a disorder in
which breathing is interrupted
or paused during sleep.
What may be the cause??
When there is not enough space
to accommodate sufficient
airflow in a portion of the upper
airway during sleep.
When muscle tone is decreased,
When there is imbalance in
transmitting the signals between
the brain and respiratory
muscles
In adults, it is most commonly
associated with obesity, male
sex, and advancing age
Types??
Clinical Presentation…
Contributing Factors!!!
Factors that contribute to airway obstruction are
• Obesity
• Large neck circumference
• Large tongue or tonsils
• Narrow airway due to bony structures of head and neck
• Taking sedative medication
• Drinking alcohol
• Smoking
• Nasal congestion
Medical disorders associated with OSA include
• Stroke
• Hypothyroidism
• Metabolic syndrome
• Acromegaly
• Neurological disorders (eg myasthenia gravis)
Associated Factors…
OSA induced biological changes
• Intermittent hypoxia,
• Intermittent hypercapnia,
• Intrathoracic pressure changes,
• Sympathetic activation and
• Sleep fragmentation
OSA can cause
• Metabolic dysregulation,
• Endothelial dysfunction,
• Systemic inflammation,
• Oxidative stress and
• Hypercoagulation.
OSA has been shown to increase the risk for
• Systemic hypertension,
• Pulmonary vascular disease,
• Ischemic heart disease,
• Cerebral vascular disease,
• Congestive heart failure and
• Arrhythmias
History
•Possible risk factors,
•Co-morbidities,
•Snoring, and
•What a normal night of sleep is like
to him/her.
Indices
•AHI (apnea-hypopnea index),
•RDI (respiratory disturbance index)
Clinical Examination:
•Nose,
•Tonsils,
•Palate,
•Tongue,
•Neck circumference,
•Upper airways.
Questionnaires
• Epworth Sleepiness Score (ESS) for
daytime sleepiness;
• Berlin questionnaire for common
OSA risk factors and symptoms
Oximetry
• Analyse oxygen saturation of
haemoglobin to help identify individuals
unlikely to have OSA.
Tests
• Nocturnal polysomnography, and
• Home sleep tests.
Differential Diagnosis!
•Asthma
•Central sleep apnea
•Chronic Obstructive Pulmonary Disease
•Depression
•Gastroesophageal reflux
•Hypothyroidism
•Narcolepsy
•Periodic limb movement disorder
Medical Management
• Acetazolamide,
• Opioids.
Surgical Management
•Tissue removal,
•Tissue shrinkage,
•Jaw repositioning,
•Implants,
•Nerve stimulation, and
•Tracheostomy.
Physical Therapy
•Aerobic Exercise,
•Upper airway muscle training,
•Oropharangeal Muscle Training,
•Tongue Exercise,
•Breathing Exercise, and
•Inspiratory resistance training.
Therapies
•Continuous positive airway pressure (CPAP),
•Bilevel positive airway pressure (BPAP),
•Adaptive servo-ventilation (ASV)
SLEEP APNEA PHYSIOTHERAPY-DEMOCLASS.pptx

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SLEEP APNEA PHYSIOTHERAPY-DEMOCLASS.pptx