Dr.

Ali Sattar
Bronchiectasis

variety bronchiectasis

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 Extensive dilation of the bronchi, with
thickend walls

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 Cystic fibrosis

respiratory epithelium .

in ammation
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 The obstructive sleep apnea [OSA]
Recurrent upper airway obstruction during sleep, suf cient to cause sleep
fragmentation and daytime sleepiness, is thought to affect 2% of women and 4%
of men aged 30-60 in populations of predominantly European descent.
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General Characteristics
1. Intermittent obstruction of the air ow (typically at the level of the oropharynx)
produces periods of apnea during sleep.
2. Each apneic period is usually 20 to 30 seconds long (but may be longer) and
results in hypoxia, which arouses the patient from sleep. This occurs multiple
(sometimes hundreds of) times overight.
Risk Factors
1. Obesity (especially around the neck)- although nonobese patients can also
have OSA
2. Structural abnormalities- enlarged tonsils, uvula, soft palate, nasal polyps,
hypertrophy of muscles in the pharynx, deviated septum, deep overbite with small
chin
3. Family history
4. Alcohol and sedatives worsen the condition
5. Hypothyroidism (multifactorial)

Clinical Features
1. Snoring
2. Daytime sleepiness due to disrupted nocturnal sleep
3. Personality changes, decreased intellectual function, decreased libido
4. Repeated oxygen desaturation and hypoxemila can lead to systemic and
pulmonary HTN as well as cardiac arrhythmias
5. Other features: morning headaches, polycythemia
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Diagnosis
Polysomnography (overnight sleep study in a sleep laboratory) con rms the
diagnosis.

Complications of OSA
❖ Increased pulmonary vascular resistance (due to hypoxemia): over time, can
lead to pulmonary HTN and eventually cor pulmonale (more likely if the patient is
obese).
❖ Systemic HTN (due to increase in sympathetic tone).
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Treatment
1. All patients should undergo behavior modi cation, which includes weight loss
and exercise, avoiding alcohol and sedatives, and sleeping in a nonsupine
position.

2. Mild to moderate OSA :

a. Should be offered positive airway pressure therapy.
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b. If patient refuses or there are issues with compliance, an oral appliance can be
offered.

3. Severe OSA :
a. Continuous positive airway pressure provides positive pressure, thus
preventing occlusion of the upper pharynx. This is the preferred therapy for the
majority of patients because it is noninvasive and has proven ef cacy. It is
poorly tolerated by some due to noise and discomfort.
b. Uvulopalatopharyngoplasty _ removal of redundant tissue in oropharynx to
allow for more air ow.
c. Tracheostomy is a last resort for those in whom all other therapies have failed or
who have life-threatening OSA (severe hypoxemia or arrhythmias).
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15 November 2023
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