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Obstructive Sleep Apnea Syndrome PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Obstructive Sleep Apnea Syndrome" by Dr. Amir Bar.
This medical PowerPoint presentation talks about Obstructive Sleep Apnea Syndrome (OSAS).
Obstructive Sleep Apnea Syndrome (OSAS) is a sleep disorder characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep. This results in a decrease or cessation of airflow, which can lead to a reduction in oxygen levels in the blood and disruption of sleep.
OSAS is typically caused by the relaxation of the muscles in the throat during sleep, which can cause the airway to narrow or close completely. This can lead to loud snoring, gasping or choking during sleep, and daytime sleepiness or fatigue.
Risk factors for OSAS include obesity, smoking, alcohol use, and certain medical conditions such as diabetes and hypertension. Treatment options for OSAS may include lifestyle changes, such as weight loss and quitting smoking, as well as the use of continuous positive airway pressure (CPAP) therapy, which involves wearing a mask that delivers air pressure to keep the airway open during sleep. In some cases, surgery may be recommended to correct anatomical abnormalities in the upper airway.

Tags : Obstructive Sleep Apnea Syndrome, OSAS, sleep disorder, continuous positive airway pressure (CPAP) therapy, Child Neurology PowerPoint presentation, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 1770 | Downloads : 2

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Slide 1-

Obstructive Sleep Apnea Syndrome Dr. Amir Bar, Bnei-Zion Medical Center, Haifa
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A “new syndrome” “PubMed” search (Sleep Apnea; 0-18y): 1960’ 11 1970’ 82 1980’ 689 1990’ 1012 A common syndrome Has significant complications w/o Tx Can be efficiently treated in the majority of cases >>Awareness and early diagnosis and Tx
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EEG Non-REM Sleep Stages
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EEGREM sleep
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Sleep physiology REM
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Classification Apnea: a Greek word - “want of breath” Obstructive Central Mixed m/p the Greeks describe obstructive type
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Classification Respiratory Disturbance Index (RDI) Normal value <1-2 per hour of sleep Apnea: complete airflow cessation (2 respiratory cycles) Hypopnea: airflow reduction (2 respiratory cycles) Respiratory Effort Related Arousal (RERA): prolonged flow limitation with associated arousal (Upper Airways Resistance Syndrome) Normal oxygen saturation
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Epidemiology Prevalence: OSAS: 1-3% Primary snoring (PS): 3-12% Gender: M/F ratio 1:1 (Adults: male predominance) Age: From neonates to adolescents Commonest in preschool children (2-5y) (Peak incidence of adenotonsillar hypertrophy) Race: More common in African-American children ??
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Nocturnal presentation Apnea Dyspnea Snoring Mouth breathing Restless sleep
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Pathophysiology Closed AW Opened AW Insp. Neg. pressure Anatomical factors Pharyngeal dilators Muscle relaxation (Sleep) Muscle atonia (REM) Neuromuscular dis
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Upper Airways
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Anatomical Factors
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Anatomical Factors
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Neuromuscular Factors
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Pathophysiology Vast majority of cases are associated with adeno-tonsillar hypertrophy (AT-Ht) Obesity in children is a risk factor for OSAS, and the severity of OSAS is proportional to the degree of obesity In contrast to adults, most OSAS children are not obese (may have FTT)
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Pathophysiology Although strongly associated with AT-Ht, childhood OSAS is not caused by AT-Ht alone: No obstruction during wakefulness Adenotonsillar size and OSAS are not correlated Deficit in arousal mechanisms Elevated arousal thresholds in response to hypercapnia and increased UA resistance Abnormal centrally mediated activation of UA muscles
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Complications CVS – systemic and pulmonary HTN Neurocognitive/behavioral problems FTT Enuresis
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OSAS: PSG screen Chin EMG ECG Airflow Peripheral Pulse Volume BP Leg Mt. Oximetry EEG
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Complications: CVS Cor-pulmonale - used to be a common presentation, but is currently rare When it does develop-can be reversed by Tx Tal, Pediatr Pulmonol, 1988: Ventriculography in children who had abnormal questionnaire for OSAS: 37% had Rt. ventricular EF  67% had abnormal wall motion All of the 11 pt who had a repeat evaluation after T&A showed improvement
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Complications: CVS Shiomi, Chest, 1993: Pulsus-paradoxus and leftward shift of the inter-ventricular septum in 3/6 children with OSAS Correlated with negative esophageal pressures but not with oxygen desaturation, reversed with CPAP
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Complications: CVS Am J Respir Crit Care Med. 2004 Apr 24 h ambulatory BP in children with sleep-disordered breathing Background: OSAS causes intermittent elevation of systemic BP during sleep Objective: to determine whether obstructive apnea in children has a tonic effect on diurnal BP Conclusion: OSA in children is associated with 24 h BP dysregulation
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Complications: CVS AAP The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents PEDIATRICS Vol. 114 No. 2 August 2004
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Complications: CVS
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Complications: Neurocognitive & Behavioral Guilleminault, Lung, 1981: 50 children with OSAS (PSG) 84% - excessive daytime sleepiness 76% - behavior disturbance 42% - hyperactive 16% - school performance 
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Complications: Neurocognitive & Behavioral Gozal, Pediatrics, 1998: 297 first graders who were in the lowest 10th academically were evaluated for OSAS by questionnaire combined with home oximetry 54/297 (18.1%) had positive results (recommended T&A) 24/54 underwent T&A and improved their grading significantly, with no change in the untreated OSAS group or the non-OSAS group
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Complications: Neurocognitive & Behavioral Gozal D, Sleep, 2004 Health-related Quality of Life and Depressive Symptoms in Children with Suspected Sleep-Disordered Breathing Conclusions: Children with suspected OSAS, regardless of the severity of RDI or the presence of obesity, had more impairments in quality of life and depressive symptoms than did children who did not snore
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Complications: Neurocognitive & Behavioral Pillar, Sleep, 2004 Sleep Disorders and Daytime Sleepiness in Children with ADHD Of the children with ADHD, 17 (50%) had signs of OSAS, compared with 7 of the control group (22%, P < .05) Children with ADHD demonstrate objective daytime somnolence (by MSLT), which may explain the beneficial effects of Tx with stimulants Primary sleep disorders, especially sleep-disordered breathing and PLMS, should be looked for
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Complications:FTT FTT in OSAS children and reports of growth spurt following T&A Proposed mechanisms: Low caloric intake Dysphagia High caloric expenditure Work of breathing  Abnormal GH secretion Interrupted SWS, post T&A - IGF 
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Complications: Enuresis Brooks, J Pediatr, 2003: Children 4 y and older who had suspected OSAS were asked about enuresis 160 pt (90/70; M:F) 41% had enuresis (primary/secondary - 3:1) RDI <1: significantly lower prevalence of enuresis (17 vs. 47%) The prevalence of enuresis is associated to the OSAS severity (1-5, 5-15, or >15 events per hour)
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Complications: Enuresis Weider, Otolaryngol Head Neck Surg, 1991: 115 enuretic children undergoing T&A 66% and 77% reduction in enuretic nights 1m and 6 m Post-T&A In the group with secondary enuresis, 100% were dry 6 m Post-T&A
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Evaluation: Polysomnography (PSG) PSG is the gold STD for diagnosis Establishment of diagnosis and severity Prediction of complications, particularly in the immediate Post-Op period Pre-Op baseline for Post-Op further evaluation High costs and shortage of sleep labs >> screening techniques
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Evaluation: Screening Questionnaires Snoring audiotapes ENT exam low sensitivity and specificity Nocturnal Videotapes Oximetry Nap-PSG High false-negative rate, indicative if positive
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Evaluation: Pulse Oximetry Brouillette, Pediatrics, 2000: 349 children, pulse oximetry during PSG OSAS prevalence – 60.2% PPV - 97% NPV - 53%
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Treatment: T&A Tonsillectomy with or w/o adenoidectomy is efficient Tx for OSAS Clinical improvement of symptoms and post-Op complications: CVS, neurocognitive, enuresis, growth Suen, Arch Otolaryngol Head Neck Surg, 1995: 69 with susp OSAS had PSG, 35/69 had RDI > 5 and referred for T&A, 30/35 had T&A, 26/30 had follow-up PSG Cure rate 85% Post-Op snoring: NPV - 100%, and PPV - 57% A high Pre-Op RDI (>19) was a strong predictor of abnormal Post-Op residual abnormality
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Treatment: T&A Nieminen, Arch Otolaryngol Head Neck Surg. 2000: 95% cure rate for a group of 21 children after T&A or tonsillectomy Postoperative snoring NPV 100%, PPV 20% 73% of this group had a previous adenoidectomy, indicating the lack of efficacy of adenoidectomy alone
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Treatment: T&A Post-Op respiratory compromise (16-27%) Causes: Upper airway edema Increased secretions Respiratory depression – 2nd to analgesic/anesthetic agents Risk factors Age <3 yr severe OSAS Children with additional medical conditions
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Treatment: T&A Follow-up PSG (6–8 wk Post-Op) , to ensure that additional Tx is not required Children with additional risk factors Children with a Pre-Op high RDI
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Other Tx alternatives Uvulopharyngopalatoplasty (UPPP): in CP pt and hypotonic upper airway muscles; it has not been studied in the uncomplicated pediatric pt Oral appliances has not been reported in children (it may adversely affect the facial configuration of the growing child) In children, CPAP is usually used when T&A is unsuccessful or contraindicated rather than as a primary treatment Young infants Medical conditions
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Treatment: Oxygen Improved oxygenation during sleep, w/o obstruction worsening PCO2 : Few individuals show marked increase in PCO2 With no apparent predictive factors for which pt would develop hypercapnia Oxygen should never be administered w/o 1st measuring PCO2 response Oxygen does not address many of the associated pathophysiological features
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The end !