Obstructive sleep apnoea

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Obstructive sleep apnoea (OSA) is caused by obstruction of the upper airway during sleep. Oxygen saturations drop, causing the patient to waken briefly. This does not happen when awake due to muscles of the upper airway. It is important as sleep is not refreshing, leading to reduction in performance during the day. The majority of cases are obese middle-aged men. It should be distinguished from central sleep apnoea where generally the mechanical interventions possible in obstructive sleep aponea worsen outcome.

Contents

Correctable predisposing factors

  • Obesity
    • A very low energy diet, resulting in weight loss, maintains initial benefit for over a year. You can reduce the need for CPAP by almost 50% by a year in severe disease[1].
  • Tonsilar enlargement
  • Nasal obstruction (by increasing negative pressure within the airway)
  • Respiratory depressants (alcohol, sedatives, opioid analgesics)

Clinical features

  • Snoring (95%)
  • Daytime sleepiness (90%)
  • Morning headache
  • Apnoeic episodes (often presenting feature due to partner's concern)
  • Associated with mortality and morbidity from a wide range of conditions (see below)

Diagnosis

Management

Simple things first: reverse factors above, if possible. If this does not help, CPAP splints the airways open.

Implications

Obstructive sleep apnoea is associated with[2]:

References

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