OSAHS

بسم الله الرحمن الرحيم

14/2/202
رجب الاصب 1442

Sleep-disordered breathing

A variety of respiratory disorders affect sleep or are affected by sleep

Abnormal lung

Asthma Cough and wheeze disturbing sleep
hypoventilation that accompanies normal sleep can precipitate respiratory failure in patients with disordered ventilation due to kyphoscoliosis, diaphragmatic palsy or muscle disease (e.g. muscular dystrophy).

Normal lung

Patients with these may have normal daytime respiratory function,
but during sleep
1-abnormalities of ventilatory drive (central sleep apnoea)
2-upper airway obstruction (obstructive sleep apnoea). Of these, the
obstructive sleep apnoea/hypopnoea syndrome


The sleep apnoea/hypopnoea syndrome
2–4% of the middle-aged population suffer from
recurrent upper airway obstruction during sleep.
sleep fragmentation.
daytime sleepiness.
risk of road traffic accidents.

Apnoea

(10 secs
Desaturation)

Hypnoea

MALLAMPATI CLASSIFICATION

Clinical Features

Somnolence

Normal subjects average 5.9 (SD 2.2) and patients with

severe obstructive sleep apnoea average 16.0 (SD 4.4).
≥ 9/24

Epworth sleepiness scale

How likely are you to doze off or fall asleep :
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
• Sitting and reading
• Watching TV
• Sitting inactive in a public place (e.g. a theatre or a meeting)
Sitting and talking to someone

• Lying down to rest in the afternoon when circumstances permit

• Sitting quietly after a lunch without alcohol

• As a passenger in a car for an hour without a break

• In a car, while stopped for a few minutes in the traffic

Clinical Features

Somnolence
Snoring
Gasping (Apnoea/Hypopnoea)
Nocturia
Headache/Cognitive Impairment
Sexual Dysfunction


Differential diagnosis ofpersistent sleepiness
Lack of sleep
Sleep disruption
Sleepiness with relatively normal sleep
Psychological/psychiatric

Associated Medical Conditions

Pregnancy
CHF ,ESRD
Chronic Respiratory Disease
CVD
Acromegaly ,Hypothyroid
PCOS
.Metabolic syndrome and T2DM

Risk Factors

Smoking
Male Gender
Obesity
Micrognathia.


Diagnosis

Sleep apnoea/hypopnoea syndrome: overnight oxygensaturation trace. The left-hand panel shows the trace of a patient whohad 53 apnoeas plus hypopnoeas/hour, 55 brief awakenings/hour andmarked oxygen desaturation. The right-hand panel shows the effect ofcontinuous positive airway pressure (CPAP) of 10 cm H2O deliveredthrough a tight-fitting nasal mask: it abolished his breathing irregularity andawakenings, and improved oxygenation.

Diagnosis

Nocturnal Pulse Oximetry
Limited (Ambulatory PSG)
95% sensitivity
Full PSG (EEG)

RDI >10/Min

RESPIRATORY DISTURBANCE INDEX

Management

Treatment
Weight Loss
CPAP
Mandibular Advancement Device
Upper airway surgery
Nasal Devices.
Others

Prognosis

Thank you