<Insert cover image here, follow by right click send to back> SLEEP APNOEA DR TAN KAH LEONG ALVIN CO-DIRECTOR SLEEP LABORATORY SITE CHIEF SDDC (SLEEP) DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD & NECK SURGERY
2 What is Obstructive Sleep Apnoea (OSA)? Cessation of oronasal airflow Upper airway obstruction Presence of respiratory efforts
3 What is Snoring? Sound produced by vibration of the soft tissues of the upper airway during sleep
4 Epidemiology Estimated population prevalence of moderateto-severe Sleep Disordered Breathing (OSA) of 30.5% 91% of subjects with moderate-to-severe OSA were previously undiagnosed Adeline Tan et al. Prevalence of sleep-disordered breathing in a multiethnic Asian population in Singapore: A community-based study. Respirology 2016; 21: 943-950
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6 Clinical Consequences of OSA Increased incidence in : Hypertension Ischaemic heart disease Cerebrovascular accidents
7 Social Consequences of OSA Increased RTA Increased work-related accidents Poor job performance Depression Family discord Decreased quality of life
8 Risk Factors of OSA Obesity Increasing age Male gender Anatomic abnormalities of upper airway Family history Alcohol or sedative use Smoking Associated conditions (Hypothyroidism, acromegaly, amyloidosis, VC paralysis)
9 HISTORY
10 Symptoms in OSA Loud snoring Excessive daytime sleepiness Nocturnal gasping and choking Unrefreshing sleep Personality changes Nocturia Morning headaches Recurrent arousals/insomnia
EPWORTH SLEEPINESS SCALE 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing Sitting and reading Situation Chance of dozing Watching TV Sitting, inactive in a public place (e.g. a theatre or a meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone Sitting quietly after a lunch without alcohol In a car, while stopped for a few minutes in traffic 11 TOTAL
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13 CLINICAL EXAMINATION
Oropharynx Normal 14 Crowded
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18 Tonsillar Hypertrophy
19 Normal Inferior Turbinate Hypertrophy Rt Lt
20 Anatomic Abnormalities Retrognathia Thick neck
21 Flexible Nasopharyngolaryngoscopy
22 Endoscopic Exam - Retrognathia
23 SLEEP STUDY
24 Home Sleep Studies - WatchPat
25 In-Laboratory Polysomnographic Study Overnight sleep study Gold Standard in diagnosing OSA Determines severity of OSA Guides treatment
26 Polysomnographic Study EEG Electroencephalogram EOG Electrooculogram EMG Electromyogram ECG Electrocardiogram Oronasal airflow Chest/Abdominal wall movement Pulse Oximetry Leg movements Video Recording Snore Microphone
27 6 beds Level 1 studies Fully attended 8 Sleep Technologists
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37 5/21/2018 Main presentation title if needed (10 pt) 37
38 What is Obstructive Sleep Apnoea (OSA)? Apnoea: Cessation of oronasal airflow > 10s Hypopnoea: 50% Reduced airflow for > 10s
39 What is Obstructive Sleep Apnoea (OSA)? Apnoea/Hypopnoea Index (AHI) = # apnoeas + hypopnoea per hour of sleep
40 Severity of OSA AHI < 5 Normal AHI 5 to 15 Mild OSA AHI 15 to 30 Moderate OSA AHI >30 Severe OSA
41 TREATMENT
42 Treatment of OSA Risk counselling RTA Job-related hazards Judgment impairment Apnoea and comorbidity treatment Behavioural Non-Surgical Surgical
43 Treatment : Behavioural Weight loss Avoidance of alcohol/sedatives Avoid sleep deprivation Avoid supine sleep position Stop smoking
44 Sleep-Position Training
45 Night Shift Positional Therapy
46 Treatment : Non-Surgical Continuous Positive Airway Pressure (CPAP) Oral appliances (Mandibular advancement devices)
47 CPAP
48 CPAP
49 CPAP Devices
50 Problems with CPAP therapy Cost Compliance Rhinitis Mask discomfort, pressure marks Air leak Throat dryness Aerophagia Claustrophobia
51 Oral Appliances Mandibular Repositioning Appliances (MRA) cover upper and lower teeth, hold mandible in advanced position Tongue Retaining Devices (TRD) Hold only the tongue in a forward position without mandibular repositioning
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55 Treatment : Surgical Office-based: Radiofrequency - Soft palate - Inferior Turbinates - Tongue Base
56 Radiofrequency
57 Treatment (OSA) : Surgical Tracheostomy Tonsillectomy Nasal Operation Relocation Pharyngoplasty Uvulopalatopharyngoplasty (UPPP) Genioglossal advancement Hyoid myotomy/suspension Tongue Base Suspension Suture Midline Glossectomy Transpalatal Advancement Pharyngoplasty (TAP) Maxillomandibular advancement
58 Conclusions Snoring is often a symptom of OSA OSA is common High index of suspicion required Health risk if left untreated Early identification and treatment essential
59 Thank You