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Obstructive Sleep Apnea

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Forms of Sleep Apnea:

  1. Obstructive sleep apnea

  • More common

  • Soft tissue in throat back collapses

  • Caused from a blockage in the airway

  1. Central sleep apnea

  • No blocked airway

  • Muscles do not get a signal from the brain to move → no breathing

  • Respiratory system is not stable

 

Diagnosis: both measure oxygen levels during sleep  

Nocturnal polysomnography 

  • Equipment monitors:

    • Heart 

    • Lung

    • Brain activity

    • Breathing patterns

    • Arm and leg movements

    • Blood oxygen levels

Technologists place sensors on scalps, temples, chest, and legs.

A small clip is placed on fingers to monitor oxygen levels

Home sleep test 

  • Measures:

    • Heart rate

    • Blood oxygen levels

    • Airflow 

    • Breathing patterns

Mild 5-15 breathing pauses per hour; Moderate/severe 15-30 breathing pauses per hour

Treatment options: 

  • Continuous Positive Airway Pressure (CPAP)

    • Delivers air pressure through a mask during sleep 

    • Air pressure is higher than surrounding air → keeps upper airway open 

    • Can be uncomfortable

    • Most common and reliable option

    • Pressure setting could be adjusted

    • Auto-CPAP

  • Oral Appliances

    • Keep throat open 

    • Easier to use than CPAP

    • Open throat with jaw moving forward

    • Stop snoring and mild OSA

    • Mandibular advancement device and tongue retaining device

    • Can cause soreness, saliva buildup, change in jaw position, teeth, and mouth

  • Sleep apnea implants

    • Inserting a pacemaker system which stimulates muscles to keep airways open

  • Expiratory Positive Airway Pressure

    • Creates pressure when exhaling to prevent closure of throat until next inhale

    • Does not need electricity

  • BPAP or BiPAP

    • Bilevel positive airway pressure

    • More pressure when inhaling compared to exhaling 

    • Automatically adjusts the pressure when sleeping

    • Opens lungs to allow more air to enter

    • Pushes air into lungs

  • Uvulopalatopharyngoplasty

    • Removal of tissue from back of mouth and top of throat

    • Tonsils and adenoids usually are removed too

    • Stops throat structures from vibrating 

    • Less effective than CPAP

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60-80% people do not comply with the treatment

Correlation to patients with Down Syndrome 

Risk Factors:

Specific to patients with Down Syndrome

  • Flat face 

  • Short neck 

  • Poor muscle tone 

  • Upper airway is smaller 

  • Larger tongue 

  • Enlarged tonsils 

  • Obesity 

Statistics of Patients with Down Syndrome: 

  • 94% of Down syndrome patients have OSA

  • 88% of the 94% have moderate OSA with more than 15 breathing pauses per house

  • Can lead to daytime sleepiness and impaired cognitive functions in adults

  • 42% of children have mild with more than 5 breathing occurrences each hour

  • 12% have moderate with 15 or more

  • Untreated sleep apnea can lead to early mortality in Down syndrome patients

Compliance solutions:

  • Best treatment options for patients with down syndrome include sleep apnea implants

    • Implanted while patient is not awake, so no interruptions during the procedure. ​

    • No care needed.

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