2. OSA
Anatomic disorder bcoz of etiology lies
in anatomic area e.g upper airway
obstruction,retrognathia,tonsillar
hypertrophy,macroglossia etc
State dependant condition
3. OSA
can be defined as a cessation of
breathing during sleep because of a
mechanical obstruction such as a retro
positioning of the tongue in the airway,
a large amount of tissue in the upper
airway, or even a partially collapsed
trachea.
(Semin Orthod 2009;15:63-69.)
4. History
Obstructive sleep apnea (OSA) was first
described by Charles Dickens in 1837.
He coined the term “Pickwickian syndrome”
but described a similar presentation of a
typical OSA patient; obese, somnolent, and
with an excessive appetite.
It was only in 1956 that Sidney Burwell
carefully documented a case of an OSA patient,
rationalized the signs and symptoms, and made
a distinction between this disease and other
illnesses.
5. OSA
Common respiratory sleep
disorder characterized by
1. snoring
2. episodes of breathing
cessation or absence of
respiratory airflow (10
seconds) during sleep.
6. Characterized by
recurrent interruptions of breathing during sleep
due to temporary obstruction of the airway by lax,
excessively bulky, or malformed pharyngeal tissues
(soft palate, uvula, and sometimes tonsils), with
resultant hypoxemia and chronic lethargy.
(Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ,
Weaver EM, WeinsteinMD. Clinical guideline for the evaluation, management and long-term care of
obstructive sleep apnea in adults. Adult obstructive sleep apnea task force of the American Academy of
Sleep Medicine. J Clin Sleep Med. 2009; 5:263-76)
OSA
7. Upper airway has
three major
functions:
1. ventilation,
2. swallowing
3. speech.
For ventilation, the
upper airway must
remain patent, but
for the other
functions, it must
narrow or close.
In addition,
ventilation must be
maintained when the
nose is occluded or,
alternatively, when
8.
9.
10.
11. The apnea event is
considered when the
air flow is interrupted
during sleep for a
period of 10 s or
more.
Hypopnea is a
reduction of at least
50% of the breathing
capacity combined
with a saturation
decrease of the
oxyhemoglobin in at
least 3%.
16. This disease affects
an average
4% of adult males
2% of adult
females increasing as
of the fifth decade of
life .
The prevalence of the disease
has been found to be
8% in men
2% of women in the United States
(Semin Orthod 2009;15:94-98.)
17. About 80 percent to 90 percent of adults
with OSA remain undiagnosed.
OSA occurs in about two percent of children
and is most common at preschool ages
OSA with resulting daytime sleepiness
occurs in at least four percent of men and
two percent of women
About 24 percent of men and nine percent
of women have the breathing symptoms of
OSA with or without daytime sleepiness
18. Risk factors according to
American academy of sleep
medicine
People who are overweight (Body Mass
Index of 25 to 29.9) and obese (Body Mass
Index of 30 and above)
Men and women with large neck sizes: 17
inches or more for men, 16 inches or more
for women
Middle-aged and older men, and post-
menopausal women
Ethnic minorities
People with abnormalities of the bony and
soft tissue structure of the head and neck
19. Risk factors according to
American academy of sleep
medicine
Adults and children with Down
Syndrome
Children with large tonsils and
adenoids
Anyone who has a family member with
OSA
People with endocrine disorders such as
Acromegaly and Hypothyroidism
Smokers
Those suffering from nocturnal nasal
congestion due to abnormal
morphology, rhinitis or both.
20. Positive risk factor
Neck circumference(Indicate upper body
obesity) greater than43.2 cm
Nasal septal deviation,
Internal or external valve collapse
Turbinate hypertrophy,
Nasal polyps,
chronic sinusitis
Macro glossia
Retro positioning of mandible
Enlargement of upper airway soft tissue
structures
Inferior positioned hyoid bone
21.
22. Obesity
Increase in size of
soft tissue structures
in upper airway
Dec. functional
size of upper
airway
Predispose toOSA
23. Classification of OSA
Fujita et al simply categorized the
upper airway obstruction as
Retro palatal
Retro glossal.
The retro palatal level involves the soft
palate, uvula, and palatine tonsils.
The retroglossal level involves the
tongue base and supraglottic
structures.
24. Fujita et
Type I obstruction is the presence of
restriction only at the retro palatal
level.
Type II obstruction is the presence of
restriction only at the retroglossal
level.
Type III is the presence of both
obstructions at both levels
25. Moore classification of OSA
Considered the airway obstruction as a
spectrum of disease, starting from
primary snoring as the mildest form,to
upper airway resistance syndrome
(UARS) and then to the different
degrees of OSA;
mild, moderate, and severe.
26.
27. Index use for OSA
AHI (A common measurement of sleep
apnea is the apnea-hypopnea index
(AHI). This is an average that
represents the combined number of
apneas and hypopneas that occur per
hour of sleep.)
RDI(respiratory distress index)
Apnea index,
Oxygen desaturation index (ODI)
28. Scales use to measure OSA
Mallampati Scale
Friedman Score
The Epworth sleepiness score,
29. Sleep nasoendoscopy
Identifies the level of and the degree of
obstruction when the patient is asleep.
Obstructions are classified as
palatal, multilevel, or tonguebased with a
grading system:
Grade 1—palatal snoring;
Grade 2—palatal level obstruction;
Grade3—multisegmental involvement with
intermittent oro- and hypopharyngeal
collapse;
Grade4—sustained multilevel collapse
Grade5—tongue base obstruction.
30.
31. Symptoms
1. Loud irregular snoring.
2. Snorts, gasps, and other unusual breathing
sounds during sleep.
3. Long pauses in breathing during sleep
32. Excessive daytime sleepiness
Hall mark of this disease
causes
impaired cognition
increased accident rates
multiple medical and dental disorder
33. 5. Fatigue
6. Obesity
7. Changes in cognitive functions such
as alertness, memory, personality, or
behavior
8. Impotence
9. Morning
headaches19
34. Consequences
Cardiovascular.
1. Systemic hypertension
2. Coronary heart disease
3. Cardiac arrhythmias
4. Sudden nocturnal death
5. Other (stroke, pulmonary hypertension)
Social/behavioral.
1. Drowsy driving/accidents
2. Decreased work performance
3. Poor quality of life19
4. Increased mortality20-22
35. Dentofacial features
Narrow
upper airway
dental arches
Hypoplastic maxilla
Retrognathic mandible
Increased ant.facial height
Increased craniocervical angulation
than normal