Download - obstructive sleep apnoea
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OBSTRUCTIVE SLEEP APNOEA
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SLEEP (11)
Sleep is a routine of the daily life. In sleep, there is reduced or lack of conscious state. Voluntary muscles do not work during sleep.
There are 5 stages of sleep. Stage 1 to stage 4 are classified as NON RAPID EYE MOVEMENT (N-REM) stage of sleep. As the stages increase, the sleep gets deeper and consciousness decrease.
The last stage of sleep is the RAPID EYE MOVEMENT (REM) stage where there is paralysis (complete inactivation) of voluntary muscles. However, the eye muscles are still working and the eyes are moving (rolling) rapidly. The obstructive sleep apnoea mainly occurs in this stage when the paralysed muscles collapse onto the airways and cause blockage.
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WHAT IS SLEEP APNOEA? (12)
Sleep apnoea is a disorder of sleep. The underlying cause is mostly stopping of breathing during the sleep, especially in the deep sleep.
When there is not enough oxygen in the body, it wakes up to re-initiate breathing. This results in interruptions to sleep and leads to lack of quality sleep. These episodes of awakening are very short moments and the patient may or may not even realise it.
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SLEEPSLEEP
STOP BREATHING
STOP BREATHING
WAKE UPWAKE UP
RESTOREBREATHING
RESTOREBREATHING
TRIG GE
R
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For managing sleep apnoea, it is very important to find the condition that triggers breathing to stop.
This lack of quality sleep causes SLEEPLESSNESS and TIREDNESS during the day.
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TYPES OF SLEEP APNOEA (2)
Obstructive Sleep Apnoea (OSA):During sleep, mainly in the REM stage, the muscles of upper airway relax and BLOCK the airways. There can be complete blockage (apnoea) which stops breathing or half blockage (hypopnoea) which causes poorer breathing. The blocking can last for more than 10 seconds.
Central Sleep Apnoea (CSA):There is a respiratory centre in the brain which controls breathing during day and night. Central sleep apnoea occurs when this centre does not send appropriate signals to the muscles that facilitate breathing.
Complex Sleep Apnoea:Complex sleep apnoea is the condition when both obstructive sleep apnoea and central sleep apnoea are present.
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OSA - CAUSES (2) (3)
Palate shape and micrognathism (small jaw)
Large tonsils or tongue
Large neck
Being overweight
Narrow upper airway
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OSA - RISK FACTORS (2) (3)
Male gender
Old age
Family history
Smoking
Alcohol or addictive drug consumption
High blood pressure
Obesity
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SIGNSAND
SYMPTOMS
SNORING
GASPS IN SLEEP
FEELING OFSLEEPLESSNESS AND
FALLING ASLEEP DURING DAYTIME
DRY MOUTH IN THE MORNING
SUSPENSION OF BREATHING
WAKING UP FREQUENTLY IN THE NIGHT
FORGETFULLNESS
HEADACHE
OSA - SIGNS AND SYMPTOMS (3)
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CLINICAL EXAMINATION
OVERNIGHT PULSEOXIMETER
ELECTROENCEPHALOGRAM
ELECTROMYOGRAM ELECTRO-OCULOGRAM
ELECTROCARDIOGRAM
NASAL AIRFLOW SENSOR/SNORE MICROPHONE
Pulseoximeter: record pulse and oxygen saturation during sleep
Electroencephalogram: Measure brain activity
Electromyogram: Measure muscle activity
Electro-occulogram: Measure eye movements
Electrocardiogram: Measure heart rhythm
OSA - DIAGNOSING CRITERIA (4)
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OSA - TREATMENT OPTIONS (4) (6) (8)
OSA is a condition which can be treated very successfully. If the symptoms are mild, simple lifestyle changes can help. However, if the condition remains, a sleep specialist must be seen.
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1. Continuous Positive Airflow Pressure (CPAP):
The main treatment for obstructive sleep apnoea is the CPAP treatment. A mask is positioned on the face and secured in a way that it is not very loose to move or it is not very tight to give pain. The mask is connected to a small machine which blows out air with a steady force. This prevents the obstruction of airways and ensures the inflation of lungs with air is satisfactory during inhalation phase of breathing.
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2. Oral Appliance Therapy (OAT):
OAT ARE specially designed mouthpieces such as mandibular repositioning device, mandibular responding splint or tongue retaining device, which are commended by dental specialists. The aim is to bring the jaw (chin) or tongue to front and prevent airway blockage.
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3. Surgery:
Surgery is the last choice of OSA treatment and it is mainly performed in the presence of tonsiliar enlargement, small jaw, or nose injury.
Tonsillectomy: Removal of tonsils
Adenoidectomy: Removal of adenoids
Uvulopalatopharyngoplasty: Removal of surplus neck tissue
Soft palate implants: Adding a tool into the mouth to prevent airway obstruction
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OSA - LIFESTYLE CHANGES (6)
Certain lifestyle changes are beneficial in treatment of OSA. Little changes to daily routines and habits can noticeably improve the quality of life. These changes can result in the prevention of airway blockage, and help to restore normal breathing in due course.
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SMOKING CESSATION
WEIGHT LOSS
NO ALCOHOL BEFORE BEDTIME
NO ADDICTIVE DRUG USE
DECREASED CAFFEINE BEFORE BEDTIME
MAINTAINING REGULAR SLEEP ROUTINE
AVOID SLEEPING ON THE BACK
USING A PILLOW IN BED - KEEP HEAD ELEVATED
* AFTER BEING DIAGNOSED WITH SLEEP * APNOEA, DVLA NEEDS TO BE INFORMED
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OSA - OUTCOME (9)
OSA is mainly seen in middle aged and elderly people.
Middle Aged Men
4 in 100
Elderly Over 65
6 in 10
Middle Aged
Women2 in 100
OSA is a treatable condition with good prognosis. With appropriate treatment, patients can continue their daily lives with no obvious problems. However, untreated OSA can lead to serious complications.
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OSA - COMPLICATIONS (9)
Complications are mainly caused by the increase of CO2 and decrease of O2 during apnoea.
UNTREATEDOBSTRUCTIVE
SLEEPAPNOEA
HYPERTENSION
HEART ATTACK/ STROKE HEART FAILURE
TYPE 2 DIABETES
Hypertension: Blood pressure above 140/90
Heart failure: Condition when heart cannot pump enough blood
Heart attack: Damaging of a vessel in heart
Stroke: Damaging of a vessel in brain
Type 2 diabetes: Condition when body cannot produce enough insulin
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OSA - RESEARCH & FUTURE MANAGEMENT (10)
-There are various research programs going on in order to improve diagnosis and treatment of OSA.
-Exercises for throat and tongue to decrease OSA are developed.
-A study in New York is working on developing new technology chips to be placed in the chest for OSA treatment.
-American thoracic society is working on portable monitor testing.
-Da Vinci Surgical System is being implanted into medicine for robotic surgery operations. It will also be used in surgeries for OSA.
-Cognitive behavioural therapy for psychologically accepting CPAP usage is in clinical trials.
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BIBLIOGRAPHY
(1): Welcome to the Sleep Apnoea Trust Association, the Sleep Apnoea Trust, Online resource, Last accessed: 26 March 2011, http://www.sleep-apnoea-trust.org/(2): Obstructive sleep apnea, Pubmed health, Online resource, Last accessed: 26 March 2011, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001814/(3): Sleep apnea, Mayoclinic, Online resource, Last accessed: 26 March 2011, http://www.mayoclinic.com/health/sleep-apnea/DS00148/METHOD=print(4): Sleep Disorders Guide, WebMD, Online resource, Last accessed: 27 March 2011, http://www.webmd.boots.com/sleep-disorders/guide/diagnosing-sleep-apnoea(5): Welcome, Pure sleep cycle, Online resource, Last accessed: 26 March 2011, http://puresleepcycle.com/(6): Sleep apnea, healthguide.org, Online Resource, Last accessed: 27 March 2011, http://www.helpguide.org/life/sleep_apnea.htm(7): Sleep apnoea machines, Sleep apnoea, Online Resource, Last accessd: 27 March 2011, http://mysleepapneasite.com/news/(8): Treating sleep apnoea, NHS Choices, Online Resource, Last accessed: 28 March 2011, http://www.nhs.uk/Conditions/Sleep-apnoea/Pages/Treatment.aspx(9): Sleep Apnoea, NHS Choices, Online Resource, Last accessed: 28 March 2011, http://www.nhs.uk/Conditions/Sleep-apnoea/Pages/Introduction.aspx(10): Sleep HealthCare of Connecticut Offers Treatments of Sleep Apnea,Insomnia,and Sleep Disorders, Sleep Apnea Disorder, Online Resource, Last accessed: 28 March 2011, http://sleepapneadisorder.info/(11): Stages of Sleep, Online Resource, Last accessed: 28 March 2011, http://www.sleepdex.org/stages.htm(12): What is sleep apnoea, British snoring&sleep apnoea association, Online resource, Last accessed: 26 March 2011, http://www.britishsnoring.co.uk/snoring_&_sleep_apnoea/what_is_sleep_apnoea.php-Obstructive sleep apnea, Pubmed health, Online resource, Last accessed: 26 March 2011, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001814/-Obstructive sleep apnoea syndrome, Patient.co.uk, Online resource, Last accessed: 26 March 2011, http://www.patient.co.uk/health/Sleep-Apnoea.htm