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Slide OSA
Slide OSA
Overview
Physiology of Sleep
Evaluation of Sleep
Definition of Obstructive Sleep
Apnea (OSA)
Prevalence of OSA
Pathophysiology of OSA
Medical Treatment of OSA
Surgical Treatment of OSA
Physiology of Sleep
Woodson, Tucker Obstructive Sleep Apnea Syndrome, Diagnosis and Treatment SIPAC 1996
REM
Sleep Latency, REM Latency
Arousal
Evaluation of Sleep
Polysomnography
EMG
Airflow
EEG, EOG
Oxygen Saturation
Cardiac Rhythm
Leg Movements
AI, HI, AHI, RDI
Evaluation of Sleep
Polysomnography
Woodson, Tucker Obstructive Sleep Apnea Syndrome, Diagnosis and Treatment SIPAC 1996
Evaluation of Sleep
Split-Night Polysomnography
Epworth Sleepiness Scale
Multiple Sleep Latency Test
Definition of OSA
RDI>5
RDI > 20 increases risk of mortality
RDI 20-40=moderate, >40=severe
Upper Airway Resistance Syndrome
Snoring
Prevalence of OSA
Study
Location
Age
Prevalence of
Range AHI>5 (95%CI)
Prevalence of
AHI15 (95%CI)
Men
Women
Men
Women
Wisconsin
626
30-60
24
(19-28)
9
(6-12)
9
(6-11)
4
(2-7)
Penn
1741 20-99
17
(15-20)
Not given
7
(6-9)
2
(2-3)
Spain
400
26
(20-32)
28
(20-35)
14
(10-18)
7
(3-11)
30-70
Pathophysiology of OSA
Airway size:
Pathophysiology of OSA
Sites of
Obstruction:
Obstruction
tends to
propagate
Pathophysiology of OSA
Sites of Obstruction:
Pathophysiology of OSA
Symptoms of OSA
Pathophysiology of OSA
Findings in Obstruction:
Nasal Obstruction
Long, thick soft palate
Retrodisplaced Mandible
Narrowed oropharynx
Redundant pharyngeal tissues
Large lingual tonsil
Large tongue
Large or floppy Epiglottis
Retro-displaced hyoid complex
Pathophysiology of OSA
Mullers Maneuver
Sleep endoscopy
Fluoroscopy
Manometry
Cephalometrics
Dynamic CT scanning and MRI
scanning
Medical Management
Weight Loss
Nasal Obstruction
Sedative Avoidance
Smoking cessation
Medical Management
CPAP
Pressure must be
individually titrated
Compliance is as
low as 50%
Air leakage,
eustachian tube
dysfunction,
noise, mask
discomfort,
claustrophobia
Medical Management
BiPAP
Nonsurgical Management
Oral appliance
Mandibular
advancement
device
Tongue retaining
device
Nonsurgical Management
Oral Appliances
Surgical Management
Measures of success
Surgical Management
Perioperative Issues
Surgical Management
Tracheostomy
Surgical Management
Nasal Surgery
Adenoidectomy
Surgical Management
Uvulopalatopharyngoplasty
Surgical Management
Uvulopalatopharyngoplasty
Surgical Management
UP3
Complications
Minor
Transient
VPI
Hemorrhage
<1%
Major
NP stenosis
VPI
Surgical Management
Cahali, 2003
proposed the
Lateral
Pharyngoplasty for
patients with
significant lateral
narrowing:
Cahali MB. Lateral pharyngoplasty: a
new treatment for obstructive sleep
apnea hypopnea syndrome.
Laryngoscope. 113(11):1961-8, 2003
Nov.
Surgical Management
Lateral Pharyngoplasty
Surgical Managment
Lateral Pharyngoplasty
Surgical Management
Laser Assisted
Uvulopalatoplasty
Surgical Management
Radiofrequency
Ablation Fischer
et al 2003
Radiofrequency device is
inserted into various parts of
palate, tonsils and tongue base
at various thermal energies
Surgical Management
Fischer et al 2003
Surgical Management
Lingual Tonsillectomy
Surgical Management
Tongue Base
Procedures
Lingualplasty
Chabolle, et al
success rate of
77% (RDI<20,
50% reduction) in
22 patients in
conjunction with
UPPP
Complication rate
of 25% - bleeding,
altered taste,
odynophagia,
edema
Can be combined
with
epiglottectomy
Surgical Management
Mandibular
Procedures
Genioglossus
Advancement
Rarely performed
alone
Increases rate of
efficacy of other
procedures
Transient incisor
paresthesia
Surgical Management
Lingual
Suspension:
Surgical Management
Lingual
Suspension:
Surgical Management
Advances hyoid
bone anteriorly and
inferiorly
Advances epiglottis
and base of tongue
Performed in
conjunction with
other procedures
Dysphagia may
result
Surgical Management
Maxillary-Mandibular Advancement
Severe disease
Failure with more conservative
measures
Midface, palate, and mandible
advanced anteriorly
Limited by ability to stabilize the
segments and aesthetic facial changes
Surgical Management
MaxillaryMandibular
Advancement
Performed in
conjunction with
oral surgeons
Surgical Management
Algorithms
Surgical Management
Algorithms
Riley et al 1992
Surgical Management
Algorithms
Friedman et al
developed a
staging system for
type of operation:
Surgical Management
Algorithms:
Friedman
et al:
Surgical Management
Algorithms:
Friedman et al:
Success =
RDI<20 and
RDI reduced
50%
Conclusions
Physiology of Sleep
Evaluation of Sleep
Definition of Obstructive Sleep Apnea
(OSA)
Prevalence of OSA
Pathophysiology of OSA
Medical Treatment of OSA
Surgical Treatment of OSA
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