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Obstructive sleep apnoea

Overview
  • Definition: A condition characterised by repetitive episodes of upper airway obstruction during sleep, leading to reduced or absent airflow despite ongoing respiratory effort.
Etiology/ Risk Factors
  • Obesity, particularly central obesity.
  • Male gender.
  • Neck circumference: larger necks may have more soft tissue that can obstruct the airway.
  • Enlarged tonsils or adenoids.
  • Family history of OSA.
  • Use of alcohol or sedatives which relax the airway muscles.
  • Smoking: potential to increase inflammation and fluid retention in the airway.
  • Endocrine disorders such as hypothyroidism or acromegaly.
  • Structural features: recessed chin, deviated nasal septum, and craniofacial abnormalities.
Clinical Features
  • Snoring: Often loud and disruptive.
  • Witnessed apnoeic episodes during sleep.
  • Chronic daytime fatigue and sleepiness.
  • Difficulty concentrating.
  • Morning headaches.
  • Restless sleep or insomnia.
  • Nocturia.
  • Mood changes: depression, irritability.
Investigations
  • Polysomnography (PSG): Gold standard. A sleep study that monitors various body functions during sleep, including brain electrical activity, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.
  • Oximetry: May be used as a screening tool but less accurate than PSG.
  • Epworth Sleepiness Scale: Subjective measure of daytime sleepiness.
Management
  • Continuous Positive Airway Pressure (CPAP): Delivers air pressure through a mask placed over your nose while you sleep, keeping the airway passages open.
  • Dental devices: Especially for mild cases; reposition the lower jaw and tongue.
  • Lifestyle changes:
    • Weight loss if overweight.
    • Positional therapy if apnoeas occur mostly when lying on the back.
    • Avoiding alcohol and sedatives before bedtime.
  • Surgical options:
    • Tonsillectomy or adenoidectomy.
    • Uvulopalatopharyngoplasty (removal of excess tissue from the throat).
    • Maxillomandibular advancement (repositioning of the upper and lower jaw).
    • Inspire therapy (implantable device that stimulates the hypoglossal nerve).
    • Tracheostomy: For severe, life-threatening OSA.
Complications
  • Cardiovascular problems: hypertension, coronary artery disease, abnormal heart rhythms.
  • Type 2 diabetes.
  • Metabolic syndrome.
  • Complications with medications and surgery due to decreased oxygen levels.
  • Liver function abnormalities.
  • Daytime fatigue leading to accidents.
Key Points
  • OSA is a serious condition that can have a wide range of cardiovascular, metabolic, and neurocognitive complications.
  • Early recognition and appropriate management can significantly reduce morbidity and improve quality of life.

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