Obstructive Sleep Apnoea

Normal Sleep

November, 2011, Brown University researchers reported:

“In adolescents and younger college students,…sleep is a neurologically important process during which the fast-growing brain becomes better organized. Many neural connections forged earlier in life during rapid growth are pruned away if they are no longer needed, and new pathways are established to parts of the brain that are responsible for planning, organizing, and abstract thinking.

“Sleep is food for the brain. When teens do not get enough sleep, they fall asleep in class, struggle to concentrate, look and feel stressed, get sick more often, and do not meet their obligations due to tiredness,”. “Teens who sleep fewer than eight hours may also consume more calories than those who sleep > than eight hours. Therefore, they have a higher risk for obesity and associated health problems, including high blood pressure, heart disease and stroke,”

Any aerobic physical activity that raises the heart rate and increases the body’s need for oxygen may reduce the risk for dementia and slow cognitive decline once it starts, “exercise sufficient to elevate the heart rate to about 60% of maximum, and done for about 150 minutes a week [divided], would be a good starting recommendation. This is similar to the American Heart Association recommendation.”

…significant effects of aerobic exercise in humans have been well documented and include: reduced subsequent risks for dementia and mild cognitive impairment, improved scores on cognitive testing in both normal seniors and those with cognitive impairment, better maintained brain connectivity, measured by functional magnetic resonance imaging, and increased volumes of both brain cortex and hippocampus (a crucial memory area).

Treatment Schedules:

Throat Exercises

• Three months daily 10 minute helps mild OSA
• Weight Loss
• YAWNING
• SINGING
• RELAXATION –Yoga
• Tongue & Soft Palate

Apnoea & Hypopnea

Apnea is defined by the American Academy of Sleep Medicine (AASM) as the cessation of airflow for at least 10 seconds.

Hypopnea is defined as a recognizable transient reduction (but not complete cessation) of breathing for 10 seconds or longer, a decrease of greater than 50% in the amplitude of a validated measure of breathing, or a reduction in amplitude of less than 50% associated with oxygen desaturation of 4% or more

Diagnosis of Sleep Apnoea

Individuals must fulfill criterion 1 or 2, + criterion 3

1. Excessive daytime sleepiness that is not explained by other factors
2. Two or more of following not explained by other factors:-
   1. Choking or gasping during sleep
   2. Recurrent awakenings from sleep
   3. Unrefreshing sleep
   4. Daytime fatigue
   5. Impaired concentration
3. Overnight monitoring demonstrates 5 to 10 or more obstructed breathing events per hour during sleep or greater than 30 events per 6 hours of sleep. These events may include any combination of obstructive apnea, hypopnea, or respiratory effort–related arousals.

Evaluating severity of OSA

Apnea Hypopnea Index (AHI):
The AHI is the number of apneas or hypo-apneas recorded during the study per hour of sleep. It is generally expressed as the number of events per hour. Based on the AHI, the severity of OSA is classified as follows:

• None/Minimal: AHI < 5 per hour
• Mild: AHI 6 to 15 per hour; PaO2 90%
• Moderate: AHI 16 to 30 per hourPaO2 80 to 89%
• Severe: AHI > 31 per hour PaO2 < 80%

Obstructive apnoea is cessation of airflow for at least 10 seconds with persistent respiratory effort

Sleep Apnoea

• Characterised by respiration pauses or instances of shallow or sporadic respiration throughout sleep. Three types: Obstructive – Central – Mixed or Complex Sleep Apnoea

Patients with High Risk Factors

• Obesity, especially BMI > 35 kg/ m2
• Sleep Apnoea in family
• Short thick neck, Narrow throat
• Adenoid, Alcoholics, sedatives high dose
• Large Tongue, Retrognathia
• Resistant Hypertension, CHF, Atrial Fibrilla, Stroke, Type 2 Diabetes, Hypothyroidism, Muscle Dystrophy, Shy Dragger Syndrome, Gastro-oesophageal Reflex

Symptoms:

• Long pauses in breathing
• Loud, chronic snoring
• Choking, gasping in sleep
• Morning headaches
• Insomnia or night-time awakenings
• Moody, irritability, depression
• Waking up feeling out of breath
• Excessive sweating
• Forgetful, lack focus &  concentration
• Excessive day time sleepiness

Mimickers Narcolpesy:

• Excessive daytime sleepiness
• Abnormal REM sleep
• Sleep paralysis, cataplexy and hypnagogichallucinations
• Fragmented nighttime sleep with frequent awakenings

Examination findings may include following:

• Abnormal (increased) Mallampati score: Identifies risk for difficult tracheal intubation
• Narrowing of the lateral airway walls: Independent predictor of the presence of obstructtive sleep apnea in men but not women
• Enlarged (ie, “kissing”) tonsils (3+ to 4+)
  Retrognathia or micrognathia
• Large degree of overjet
  High-arched hard palate
• Systemic arterial hypertension: Present in
  about 50% of obstructive sleep apnea cases
• Congestive heart failure
• Pulmonary hypertension
• Stroke
• Metabolic syndrome

A number of different tests will be carried out during polysomnography, including

• electroencephalography (EEG) – this monitors brain waves
• electromyography (EMG) – monitors muscle tone
• recordings of movements in your chest and abdomen
• recordings of airflow through your mouth and nose
• pulse oximetry – this measures your heart rate and blood oxygen levels
• electrocardiography (ECG) – this monitors your heart