《耳鼻喉科学 Otolaryngology》课程教学课件（PPT讲稿）pharynx and larynx_Obstructive Sleep Apnoea Syndrome

Obstructive Sleep ApnoeaSyndrome

Obstructive Sleep Apnoea Syndrome

What is Sleep Apnoea9Apnoea :a period of no airflow at the nose ormouthforatleast10s.Apnoea index(Al):thenumberofperiods ofapnoea per hourHypopnea:50%orgreaterreduction innormaltidal volumeSleep apnoea syndrome :≥30 apnoeicepisodes in 7 h of sleep or if the Al > 5.MildSAS-AI5-20Modeate - Al20-40Severe - Al > 40

What is Sleep Apnoea ? • Apnoea : a period of no airflow at the nose or mouth for atleast 10 s. • Apnoea index (AI) : the number of periods of apnoea per hour • Hypopnea : 50% or greater reduction in normal tidal volume • Sleep apnoea syndrome : > 30 apnoeic episodes in 7 h of sleep or if the AI > 5. Mild SAS – AI 5 – 20 Modeate - AI 20-40 Severe - AI > 40

TypesofSleepApnoea3 types :1.Obstructive-completeairwayobstructionbut patientmakesefforttoovercomethis,peripheralcauses2. Central - respiratory effort and airflowceases for a time being, CNS causes3.Mixed

Types of Sleep Apnoea 3 types : 1. Obstructive – complete airway obstruction but patient makes effort to overcome this, peripheral causes 2. Central - respiratory effort and airflow ceases for a time being, CNS causes 3. Mixed

ConsequencesofSleepApnoea·Hypoxia -cardiac arrhythmias, pulmonary&systemichypertension,corpulmonaleIncreasednegativeintrathoracicpressureIncreasedcardiovascularstrainPoorsleepqualityIncreasedriskofmortalityduetocardiovasculardisease

Consequences of Sleep Apnoea • Hypoxia – cardiac arrhythmias, pulmonary & systemic hypertension, cor pulmonale • Increased negative intra thoracic pressure Increased cardiovascular strain • Poor sleep quality • Increased risk of mortality due to cardiovascular disease

ClinicalfeaturesofOSAS.In adults OSA more common in increasing ageobese,alcoholIn children -most common around 5Excessive day time somnolence,morningheadaches,personality change, intellectualdeterioration, impotence, increased risk of RTA.Find out any excerbating factors (drugsendocrine disorders,anatomical).ldentify the site andlevel of obstruction

Clinical features of OSAS • In adults OSA more common in increasing age, obese, alcohol • In children – most common around 5 • Excessive day time somnolence, morning headaches, personality change, intellectual deterioration, impotence, increased risk of RTA • Find out any excerbating factors (drugs, endocrine disorders, anatomical) • Identify the site and level of obstruction

InvestigationsBody mass index (BMl):kg /m2,calculates degree ofobesityNormalBMl=19-25Overweight=26-30Obese=31-40Very obese= >402General investigations :FBC,TFT,CXR,ECG3.To identify sleep apnoea : polysomnography-goldstandard,EEG,EMG,ECG,airflow,abd&chestmovements,O2 saturation,body positionmonitor,recordingof snoringSite of obstruction:palatal /tongue base/multipleLateral cephalometry,sleepnasoendoscopymanometry,cineCT,somnoflueroscopy

Investigations 1. Body mass index (BMI) : kg /m2, calculates degree of obesity Normal BMI = 19-25 Overweight =26-30 Obese =31-40 Very obese= >40 2. General investigations : FBC, TFT, CXR, ECG 3. To identify sleep apnoea : polysomnography – gold standard, EEG, EMG,ECG,airflow,abd & chest movements,O2 saturation,body position monitor,recording of snoring 4. Site of obstruction : palatal / tongue base / multiple. Lateral cephalometry, sleep nasoendoscopy, manometry,cine CT,somnoflueroscopy

TreatmentMultifactorial condition-so no single RxGeneral :Reassurance, weight loss, abstainfromalcohol,sedativesTreat nasal obstruction : Rhinitis, DNS, hypturbinates,polypsOropharyngeal obstruction:UPPP(uvulopalatopharyngoplasty)LAUP (laser assisted uvuloplasty)SomnoplastyAdeonotonsillectomy - treatment of choice inchildren

Treatment • Multifactorial condition – so no single Rx • General : Reassurance, weight loss, abstain from alcohol, sedatives • Treat nasal obstruction : Rhinitis, DNS, hyp turbinates,polyps, • Oropharyngeal obstruction : UPPP (uvulopalatopharyngoplasty) LAUP (laser assisted uvuloplasty) Somnoplasty Adeonotonsillectomy – treatment of choice in children

RxofOSAS·Tongue base /multisegmental :NasalCPAP(continuous positive airwaypressure) gold standard treatment. Air underpressure is given via tight fitting nasal maskMaxillofacial:Mandibular Positioning DevicesHyoid Suspension Techniques.Tracheostomy:100% effective.Should beperformed only when othermeasures fail

Rx of OSAS • Tongue base /multisegmental : Nasal CPAP (continuous positive airway pressure) gold standard treatment. Air under pressure is given via tight fitting nasal mask. • Maxillofacial : Mandibular Positioning Devices Hyoid Suspension Techniques • Tracheostomy : 100% effective. Should be performed only when other measures fail