Obstructive sleep apnoea

Obstructive sleep apnoea is a very common condition affecting 2-4% of adults to a significant degree. It characterised by repeated episodes of obstruction of the throat during sleep and is usually associated with loud snoring and excessive daytime sleepiness. OSA is an independent risk factor for the development of hypertension and insulin resistance, and is associated with heart attack, cardiac arrhythmia, and stroke. Treatment includes lifestyle changes, continuous positive airway pressure (CPAP), mandibular advancement spints and surgery.

History

Loud and chronic snoring, Chocking or grasping, day time sleepiness, morning head ache

Time to time wake up night , difficult to control , mood

Risk-  over weight  , FH , > 65 , Smoker, ----

Examination

Thick neck, enlarge tonsils, nasal congestion , allergy , polycythemia

Management

·          Sleep disorder center - Sleep study Polysongrapic ( Observe patients sleep pattern when the patient sleep  involve a camera noisy breathing duration frequency )  , FBC, BSL LP ECG Cx ray,  X ray neck SE, UFR , ESR ( Cheep ) CRP ( Change rapid so monitor )

    2^nd Iron study if FBC , Na Ca , blood film, B12 folic HBV Etc

·         SNAPS (lifestyle modification )

·         Avoid caffeine , sleeping tablets, heavy meal

·         Elevate head end

·         Commercial standard  not met for DL

·         Regular health check

·         4 R

·         Breathing devises – O2 RX , CPAP delivered by nasal or facial masks , Dental devises ( The mandibular advancement splint )

·         ENT for Corrective Surgery  ( tonsillectomy , nasal obstruction )

·         Medicating ( Amitriptyline ) , If nasal – nasal decongestion and topical steroid 

Sleep apnea refers to brief interruption  of ventilation resulting hypoxemia and biochemical effects . That is nott recognized by the patients. OSA which involves intermittent narrowing and occlusion of pharyngeal area of the upper airway. that you feel difficult to breath time to time at night  as a result of an obstruction at throat

4 Main DD for fatigue are depression , sleep apnea , stress and anxiety , post viral illness

Airway size- Obesity, tonsiller adenoidal hypertrophy.    U/ Airway muscle hypotonia –alcohol , neuron .   Nasal obstruction

Sleepiness  Day  ( Day time somnolence ) , Depression,  personality changes , Family meeting ,  ( family problem ? Why wife sleep separately , Sexual dysfunction )

Ass  obesity  ( sleep  hygiene not good ) ,  alcohol drugs , hypothyroidism

Sleep on the side , 8 hour sleep enough quantities but check for the quality . commercial driving but can private car .

Stiff 

dermatology

Author & Editor

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