The Agony or the Ecstasy. Familiar?

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1

2 The Agony or the Ecstasy Familiar?

3 Snoring Related Complaints Drives wife from bedroom Girlfriend won t marry me Shakes entire house Ask me to leave movies and church Has had to leave boat so friends could sleep Fall asleep at traffic lights waiting for red light to change

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5 Snoring and Obstructive Sleep Apnoea

6 Snoring and Obstructive Sleep Apnoea

7 Consequences of Sleep Apnoea 1. Daytime fatigue, especially sleepiness 2. Bed partner sleep disturbance 3. Cardiovascular complications

8 Effects of OSA 1. Excessive daytime sleepiness (EDS). Increased irritability and lower stress tolerance Low motivation ( Can t be bothered ) Faulty judgment Lapses in attention and vigilance Impaired decision making and logical reasonin

9 Effects of OSA 1. Excessive daytime sleepiness (EDS). Slowed reaction time Susceptibility to illness Increased sensitivity to pain Road Accidents

10 Effects of OSA 2. Bed partner disturbance The most common reason for referral Difficulty with sleep onset Disturbance of sleep quality, leading to Daytime fatigue Marital disharmony Hearing impairment

11 Effects of OSA 3. Cardiovascular and medical complications Hypertension Diabetes Obesity Heart Attack Stroke Cancer

12 Effects of OSA 3. Cardiovascular and medical complications Nocturia Depression Gastric reflux Reduced libido

13 Risk Factors for Sleep Apnoea Male: Female 2 : 1 Increasing age Body Mass Index > 30 Neck Circumference > 42cm ( 17ins) Alcohol ( > 2 units) Smoking Post Menopausal Women Sleeping Pills (Benzodiazepines) But 20% of those with OSA are not obese!

14 History Taking (If Possible With Partner) Sleepy vs non-sleepy Smoking / alcohol Recent weight gain Consistency of snoring Every night Every position Periods of apnoea

15 Examination BMI Neck circumference Nasal airway: septum/ valves Tonsil size / soft palate Soft palate oedema Base of tongue

16 Risk Factors for Sleep Apnoea Retrognathia Scalloped tongue

17 Risk Factors for Sleep Apnoea Over Jet Large tongue

18 Risk Factors for Sleep Apnoea c Crowded Teeth Long face

19 Risk Factors for Sleep Apnoea

20 Investigations Polysomnography Level 1 Level 2 Cardio-respiratory Level 3 Overnight Oximetry Level 4

21 Overnight Oximetry

22 Overnight Oximetry (Normal)

23 Overnight Oximetry (Severe Sleep Apnoea)

24 Level 3 sleep study

25 Level 1 & 2 sleep study Polysomnography

26 Level 1 & 2 sleep study Polysomnography

27 Managements Lifestyle Sleep position, i.e. Side Upright Control of Obesity Avoidance of alcohol and drugs (especially BZD s)

28 Conservative Weight loss Alcohol reduction Stop smoking Avoid sleeping tablets Keep off back

29 Managements Surgery Adenotonsilectomy -- especially in children, rarely in adults Uvulopalatopharyngoplasty (UPPP) -- rarely helpful Nasal surgery Palatal surgery generally unhelpful

30 Managements Other surgery Tracheostomy Weight loss surgery

31 Devices Mandibular Advancement Splints SomnoMed/MDSA

32 Devices Aveo TSD Tongue Stabilising Device

33 Devices External nasal splints Internal nasal splints Not helpful

34 Devices Hypoglossal Nerve Stimulation during Sleep

35 Managements Continuous Positive Air Pressure (CPAP) Standard CPAP

36 Managements Continuous Positive Air Pressure (CPAP) Transcend (Travel CPAP)

37 Brief questions: - Do you have any concern about your sleep? - Have you been told that you snore? - Do you wake refreshed in the morning?

38 The Epworth Sleepiness Scale How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation: 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing It is important that you put a number (0 to 3) in each of the eight boxes.

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40 Brief questions: STOP-BANG 1. Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)? 2. Do you often feel TIRED, fatigued, or sleepy during daytime? 3. Has anyone OBSERVED you stop breathing during your sleep? 4. Do you have or are you being treated for high blood PRESSURE? 5. BMI more than 35? 6. AGE over 50 years old? 7. NECK circumference > 42 cms? 8. Male GENDER? 3 yes answers: High-risk for OSA <3 yes answers: Low-risk for OSA

41 Laugh and the world laughs with you snore and you sleep alone.

42 Thank You Dr Alex Bartle The SLEEP WELL CLINICS Throughout New Zealand

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