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Bronchoesophagology Division
Dept. of Otorhinolaryngology-Head and Neck
Surgery
School of Medicine Airlangga University
Surabaya
2015
OBSTRUCTIVE SLEEP APNEA
SYNDROME
(OSAS)
• Is a sleep disorder in which repeated events
of cessation / reduction of airflow
• Caused by partial or complete narrowing of
the upper airway during sleep
~ sleep fragmentation
~ excessive daytime sleepiness
~ cognitive impairment
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DIAGNOSIS
▪ Anamnesis / Symptoms
▪ Physical Examination
▪ Polysomnography (PSG)
▪ Imaging Studies
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Symptoms of sleep
apnea
Day- time Night- time
Excessive sleepiness Snoring
Morning headache Observed choking
Intellectual Arousal from sleep
deterioration Repeated waking
Personality change Impotence
Depression
Xerostomia
Fatique
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scale
0 = would never doze 2 = moderate chance
of dozing
1 = slight chance of dozing 3 = high chance of
dozing
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History from sleep partner
• Body position
• Snoring
• Apnea / choking
• Arousal from sleep
• Alcohol consumption
• Sedative use
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Physical Examination
• BMI
• Tongue size
• Tonsil size
• Uvula & Palatum molle
• Deformity of the lower face
(micro/retrognathia)
• Site of airway obstruction
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OBESE
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TONGUE SIZE
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TONSIL SIZE
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UVULA & PALATUM MOLLE
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Polysomnography
• Gold-standard
• Parameters :
EEG sleep stadium
EOG REM and non-REM
ECG cardiac monitor
Oxygen saturation
Nasal-oral airflow
Chest and abdominal movement detector
Sleeping position detector
Tracheal microphone
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OSAS …..
of sleep
≥ 5 episode apnea / 1-hour period of
sleep
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BREAS SC20
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DIAGNOSIS OSA
--------------------------------------------------------------------------------------------------
AHI Arousals / h Snoring Daytime
Alertness
------------------------------------------------------------------------------------------------------------
Snoring <5 < 10 + Normal
OSA
- Mild 5 – 15 5 – 20 + Mild
impairment
- Moderate 15 – 30 10 – 30 + Moderate
impairment
- Severe > 30 > 30 ++ Severe
impairment
------------------------------------------------------------------------------------------------------------------------------------------------------------------
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STADIUM OSA
CRITERIA FUJITA & AHI
Stadium Tongue position Tonsil BMI AHI
ESS
Stadium 2 1, 2 0, 1, 2 < 30 15 – 30
>15-30
3, 4 3, 4 < 30
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Site of airway obstruction
• Obstruction :
▫ nasal cavity & nasopharynx
▫ oral cavity & oropharynx
▫ hypopharynx & larynx
• Müller's maneuver
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Site of obstruction .....
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Nasal Obstruction
Polyp
Tumor
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Hipertrophy adenoid
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Hypopharynx & Larynx
Laryngeal papilloma
Omega shaped epiglottis
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Müller's maneuver
• Introduced flexible endoscope via nasal
identifies weakened sections of airway
at levels of soft palate & tongue base,
during this maneuver
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Müller's maneuver …..
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Retropalatal airway during Müller's maneuver (A) and during passive inspiration
(B). Retroglossal airway during Müller's maneuver (C) and during passive
inspiration (D).
.
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Imaging studies
• Controversial
not routinely obtained :
- cost
- do not add to the airway
assessment
• Cephalometry
• CT Scan
• MRI
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Imaging .....
Cephalometry
- evaluate postnasal space
- evaluate tongue position & size
in correlation with mandibula
used for: - surgical planning
- predicting
outcome
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Cephalometry …..
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Imaging .....
CT Scan :
– excellent resolution for soft tissue,
airway & bone
– evaluate the efficacy of dental
appliances & mandibular
advancement
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Imaging .....
MRI :
- superior soft tissue resolution
- multiplane imaging
- 3-dimensional reconstruction
- lack of radiation exposure
- useful in evaluate the efficacy of soft
tissue
surgery but not predicting surgical
outcome
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General Investigations
• Complete blood count: anemia,
polycythemia
• Arterial blood gas analysis
• Chest x-ray: cardiomegaly,
pulmonary disorder
• Lung function: spirometry
• ECG: arrhytmia
• Thyroid function tests: hypothyroidism
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Thank You
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