How to Diagnose Sleep Disorders Obstructive Sleep Apnea Treatment
The first step in treating OSA is, of course,to diagnose it properly. This happens using a sleep study. An overnight polysomnogramwould be a more formal term. And in this a patient is going to go to an accredited sleeplab where a sleep technician will attach a series of electrodes and wires to the bodythat monitor things like respiration, abdominal force, eye movement, so we can track whatsleep stage you are in. And, of course, a breathing monitor and a camera. The most importantof the camera is it actually physically records somebody having an apnea. It's not uncommonfor patients to know that they have awoken themselves by not breathing or to wake upand actually not be able to breathe and take
a second to catch their breath But for somepatients they have no concept of sleep apnea. They think they sleep just fine. It's theirbed partner who can't handle the snoring and the sounds of the apneas and the wakeningwho forces them to reach treatment. After the sleep study is executed, the andsleep technicians will review the results, review the results with you. And at that point,it might warrant another sleep study which we would call a CPAP titration. CPAP standsfor continuous positive airway pressure, and it's basically one of the most naturalistictreatments you find in sleep disorder medicine. It involves taking a mask or nasal unit ofsome kind which is connected to an air hose
to a compressor. And, essentially, this compressorwhich is set at a pressure prescribed by the physician is used to force air into the oralcavity and into the throat to expand the airway and prevent it from collapsing. There's anynumber of different masks and face units that can be used. It used to be in the early daysof sleep medicine that CPAP choices were limited, and the discomfort of CPAP keeps people fromseeking it as treatment. So in this day and age we have so many more options. So manymore people will stay treatment compliant and actually use their CPAP machine whichwill lead to better sleep, better health. Their's other treatments that can be usedfor some people. An oral mandibular advancement
device which is a sort of dental appliancemay be an option. Although that is not indicated for everybody it would be due to certain conditionsin the mouth that lead to sleep apnea. There's also a type of surgery called a UPPP whichinvolves surgery on the uvula and soft palate on the throat. That's usually performed byan ear, nose, throat and, again, that's not always an option for everybody. But thosecould be part of a treatment plan for OSA in particular patients.
Tonsillectomy and Adenoidectomy for OSA Anesthetic Considerations by Denise Chan MD
Tonsillectomy and Adenoidectomy for ObstructiveSleep Apnea: Anesthetic Considerations, by Denise Chan. Hello, my name is Denise Chan, and I'm a pediatricanesthesiologist at Boston Children's . Today, I'll be discussing important aspectsof taking care of children with obstructive sleep apnea syndrome in the perioperativesetting. Introduction. Now, first let's define what is obstructivesleep apnea syndrome. Well, it's a disorder of breathing during sleep, and it's characterizedby a few different things, according to the
American Thoracic Society. First of all, these patients have either prolongedupper airway obstruction, which is known as obstructive hypopnea, or intermittent completeobstruction, known as obstructive sleep apnea. And this occurs with or without snoring. Second, the patient exhibits moderate to severeoxygen desaturation. Third, normal ventilation is disrupted. And fourth, normal sleep patternsare disrupted. So these are the components of obstructive sleep apnea syndrome. Now, in children, obstructive sleep apneasyndrome is oftentimes caused by enlarged
adenoid or tonsillar tissue. And you can seein this illustration that the hypertrophied tonsils really do get in the way of normalairflow. So what do you expect to see in a patientwith this syndromeé First of all, you'll probably see snoring. They'll have difficulty breathingduring sleep, restless sleep, or even nightmares or night terrors. You may see excessive sweating.They may have nocturnal enuresis, or bedwetting, mouth breathing, pauses in breathing, or chronicrhinorrhea. More importantly, though, what is the significanceof having obstructive sleep apnea, and what are the consequences for the patienté Well,there are a number of problems that can occur.
Daytime somnolence patients have fallenasleep while driving older patients, of course and this can lead to motor vehicleaccidents; cognitive dysfunction, which leads to behavioral problems or problems with workor school performance; metabolic effects, such as insulin resistance, type 2 diabetesmellitus, or metabolic syndrome; or other metabolic effects, such as failure to thriveor stunted growth. Or if obstructive sleep apnea is more severeor left untreated, this could lead to cardiovascular morbidity, such as pulmonary or systemic hypertension,cor pulmonale, or stroke. Obstructive sleep apnea syndrome can even lead to death. Andit's been hypothesized to be a factor contributing
to SIDS, or Sudden Infant Death Syndrome.Diagnosis and al Features. In order to diagnose whether or not someonehas obstructive sleep apnea, you must first and foremost perform a thorough history andphysical exam. A sleep history screening for snoring should be a part of every child'sroutine health care visits. It's really unlikely that someone's goingto have obstructive sleep apnea if they don't snore. So if a child does snore, ask the parentsmore details about the sleep history. Does your child have difficulty breathing or stopbreathing during sleepé Or are you worried about their breathing at nighté Does yourchild sweat during sleepé Does your child
have restless sleepé Does he or she breathethrough his mouth while awakeé Has anyone in the family had obstructive sleep apneaor sudden infant death syndromeé Or does your child have behavioral problemsé When you examine the patient, you may noticecertain features that are suggestive of obstructive sleep apnea, such as a small, triangular chin,retrognathia, a high arched palate or a long soft palate, a long oval face, or, of course,large tonsils. There are also certain patients who are athigh risk for having obstructive sleep apnea. And these are patients with obesity; Downsyndrome; PraderWilli syndrome; certain neuromuscular