Transcript Sleep Apnoea and YOU

Sleep Apnoea and YOU
Pocket Briefing
17th August 2005
Definitions
• Apnoea – cessation of airflow for > 10 secs
Obstructive – persistent effort (OSA)
Central – poor/no effort
Mixed
• Hypopnoea – reduction in airflow/resp. effort > 10 secs + desatn
>3% and/or evidence of arousal
• Apnoea/Hypopnoea Index (AHI) - No. of each per hour of sleep
(5 -15; 15 – 30; >30)
• Obstructive Sleep Apnoea Syndrome (OSAS)
OSA + daytime sequelae
Pathophysiology
• OSA – narrow, floppy
upper airway
Obesity, body fat distribution41 46
Race/genetics6 92
Age13
Male gender139
Alcohol,123 sedatives, analgesics,
anaesthetics
Smoking
Nasal obstruction82
Pharyngeal obstruction47
Cranio-facial abnormality20 39 78 95 118 125
Laryngeal obstruction
Endocrine/Metabolic40
Neuromuscular disorders29 42 44 52 83
Connective tissue disorders19
Storage diseases109
Chronic renal failure63 73
Symptoms
Heavy snoring
Enuresis (uncommon)
Excessive daytime sleepiness
Dry mouth on awakening
Witnessed apnoeas
Nocturnal or morning headache
Sudden awakenings with
‘choking’
Impotence
Accidents related to sleepiness
Nocturnal epilepsy
Poor memory/concentration
Delirium
Gastro-oesophageal reflux
Mood/personality changes
Nocturnal sweating
Restlessness during sleep
Nocturia
Signs
Oedematous soft palate or uvula
Long soft palate and uvula
Decreased oro-pharyngeal dimensions
Nasal obstruction
Maxillary hypoplasia
Retrognathia
Central adiposity/increased neck circumference
Hypertension and other cardiovascular
consequences
Conditions/syndromes associated with sleep
apnoea
Sequelae
Neuropsychological
Sleepiness, impaired memory and cognition,
decreased vigilance, increased accident risk, anxiety
and depression, chronic headache, intracranial
hypertension
Cardiovascular
Hypertension, ischaemic heart disease,
cerebrovascular disease, right heart failure
Pulmonary
Hypoxaemia, hypercapnia, pulmonary hypertension
Endocrine
Decreased growth hormone and testosterone levels,
diabetic instability
GIT
Gastro-oesophageal reflux
Treatment
• Weight loss; decreased alcohol/sedatives;
change of sleep position
• Nasal CPAP (may require BiPAP) and oral
appliances
• Palatal surgery (? Usefulness in OSA)
• Tracheostomy
Anaesthesia & SDB
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• Perioperative risks:
Anaesthetic issues – anaesthetic agents/sedative/analgaesia
↓ pharyngeal tone; decreased responses to
↑CO2 and ↓O2
- duration of anaesthesia
Surgical issues –
Site (airway/abdo/thorax)
Inability to use CPAP
Anaesthesia & SDB
Preop. Suspicion
OR
2
(Heavy snoring; Witnessed apnoeas; Sudden awakenings
with ‘choking’; Morning ‘un-refreshedness’; Excessive
daytime sleepiness )
Confirmed OSA proceed as follows:
Pre-op:
?Severity (sequelae)
Presence of CPAP facilities and trained staff
Sedative premedication (caution – CPAP/antagonists)
Type and likely effect of surgery
Anaesthesia & SDB
Intra-op:
Regional anaesthesia
preferable (+/- GA); NSAIDs
High incidence of difficult
airway
Caution with long-acting
NDMRs/Opiods
PEEP
Post-op:
Lateral recovery position; NP
airway
Caution with Opiods and
sedatives
Use of CPAP immediately postop (expertise)
Impact of NGT/nasal packing
etc.
HDU for 48 hrs (severity of OSA;
length/type of surgery)
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