+ P 52. OBSTRUCTIVE SLEEP APNEA STOP BANG questionnaire-Used to tell non-medicos the medical issues a/w sleep Snoring, excessive daytime sleepiness Tired all the time Observed apnea episodes Apinta Hypoxio Hypertension Age> 50 years, M BMI>35 st keedu sleeping custant Chemssensors ↑ neck circumference Gender-male catecholamines محدود Thin people small mardi ble can abo have cond snoring But it does not become apreic PATHOPHYSIOLOGY Normal - With deep sleep, neuromuscular Input, but pharyngeal dilator muscles keep airway patent In OSA-More severe in REM sleep mstone! Transient episodes of collapse /near collapse of airway Chain of events Loud snoring OSA M/c site of collapse soft palate, tongue base, lateral pharyngeal wall Flow Smitation Apneic episodes/severe airflow limitation Grunting that causes forcible opening of airway Cortical arousal and repeated sleep interruption Apnea 2 nyposcia 1 HR. Cyclical changes in sympathetic tone with bradycardia during apneic episode and tachycardia after episode After Ppnee 7 Cortico 00:08:22 Sensors on face and scalp ur eye movement and brain activity لم سهلة EEG ECO ENG around symp drive Tachycard DIAGNOSIS Normal Ema Sena chin Sensor on finger measures amount of oxygen in blood Spo2 Polysomnography IOC skep study IOC-Polysomnography 1 sensor checks Sa02 (saturation shows cyclical pattern) EEG (checks cortical arousal) EOG (checks phase of sleep) when ofres occurs ECG (checks fluctuations in heart rate) EMG (checks vibrations in the neck during snoring) @Sensor at nose (measures air flow) 800 Belt sensors (checks chest and abdomen movements) Both moves upwards paradoxical chest abdominal movement PREVALENCE 5-15%: Middle-aged adults Adnads 20%: Elderly (n) Peak age in children: 3-8 years, corresponding to peak lymphoid growth APNEA T Obstructive Absent breathing effort > 10 sec during sleep with Persistent respiratory effort - OSA or Absence of respiratory effort-Central sleep apnea حمار →Cheyne Stoke's breathing seen in Ict DEFINITION Sean in cuf DEFINITION HYPOPNEA 00:11:35 > 30% decrease in airflow for > 10 sec during sleep with A/w 3% dip in Sa02 or Cortical arousal 00:14:16 Symptoms of nocturnal breathing difficulty/excessive daytime sleepiness with adequate opportunity to sleep And Apnea-hypopnea index > 15 episodes per hour in absence of symptoms On polysomnography ≥ 5 episodes of apnea/hypopnea per hour of sleep SEVERITY OF OBSTRUCTIVE SLEEP APNEA - HYPOPNEA SYNDROME (OSAHS) APNEA HYPOPNEA INDEX (AHI) 00:15:26 Number of apnea/hypopnea per hour of sleep OSAHS MildAHI 5-14/hr Moderate AHI 14-29/hr Severe- AHI >30/hr 25 RISK FACTORS Centripetal Obesity ↑ neck circumference Micrognathia/retrognathia