Obstructive Sleep Apnea.ppt

Obstructive Sleep Apnea SS Visser Lung Unit PAH and UP Contents Definition Pathogenesis Pathophysiology Clinical Features Treatment Introduction Sleep apnea is the intermittent cessation of airflow at the nose and mouth during sleep. Apneas of at least 10 s duration are important but in most cases the apneas last 20-30 s and can last as long as 2-3 min. Sleep apnea is a leading cause of daytime sleepiness and contributes to CVS disorders. Prevalence: 2% in middle-aged women and 4% in middle-aged men Definition Sleep apneas are divided into: Central sleep apnea: neural drive to all respiratory muscles is abolished Obstructive sleep apnea: airflow ceases despite continuing respiratory drive because of occlusion of the oropharyngeal airway. Pathogenesis Occlusion of the oropharyngeal airway results in progressive asphyxia until there is a brief arousal from sleep, whereupon airway patency is restored and airflow resumes. The patient then returns to sleep and the process is repeated, up to 300-400 x per night – sleep becomes fragmented. The immediated factor leading to collapse of the upper airway is generation of subatmospheric pressure during inspiration and which exceeds ability of airway dilator and abductor muscles to maintain airway stability. During wakefulness upper airway muscle activity is greater than normal to compensate for airway narrowing and high airway resistance Alcohol is a co-factor – has a depressant effect on airway muscles and the arousal response that terminates each apnea Structural abnormalities: Oropharyngeal airway may predispose to closure ( short neck) Structural compromise may be due to anatomic disturbances such as tonsillar hypertrophy, retrognathia and macroglossia. In the majority there is only subtle reduction in airway size which can be described as “crowding” Obesity may contribute to reduction in upper airway size by ? fat deposition in the soft tissues of the pharynx or by compressing the pharynx by superficial fat masses in