Sleep Apnea and Traffic Accidents: By Dr.K.O.Paulose. FRCS DLO Consultant ENT Surgeon Jubilee Hospital, Trivandrum,South India. www.drpaulose.com www.snorefreesleep.com

1. SLEEP APNEA AND DRIVING
ACCIDENTS
Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon
Jubilee Hospital, Trivandrum
South India
www.drpaulose.com,www.snorefreesleep.com

2. Avoid Falling Asleep
While Driving
Every year, over 100,000 accident
deaths
2,500 deaths are caused by driver
fatigue

3. RTA related Sleep debt

4. Sleep Apnea and Sleep Debt

5. Accidents more in early morning

6. Sleep Apnea can kill others too

7. Funeral Driving

8. Lack of sleep affects
driver fatigue
reaction time
judgment and ability
to concentrate

9. When Is It Most Likely To Happen?
1 pm and 4 pm
and 2 am and 6
am.

10. Warning Signs of Drowsy Driving
Yawning
Inability to keep eyes open
Drifting out of the lane
Hitting rumble strips

11. What Can Be Done?
Caffeine, stimulants and other tricks, loud music,
washing face-temporary
Avoid sleep debt- sleep 7-9 hrs/day
Take Breaks-will allow you to stretch, move and
wake up
Pull over in a safe area to nap
Awareness among patients, relatives, and Traffic
police-DL
The only long-lasting solution is to get adequate
sleep.

12. Definition of Sleep Apnea
Apnea is defined as a cessation of oronasal
airflow of at least 10-30 seconds in duration
When it occurs 30 or more times during a 7-
hour period of nocturnal sleep.
>10 episodes per night

13. Types of Sleep Apnea
CSA- brain stem -bulbar polio stroke, a
brain tumor, a viral brain infection
OSA- upper airway obstruction
Mixed- with chronic respiratory disease

14. Description of OSA
Upper airway narrowing
Loud snoring
Wake up
Gasping for air
Fall back to sleep

15. Snoring and OSA can lead to divorce
The spouse cannot
sleep
Separate bed room
Marital discord
Lack of sex drive
EJD
Infertility
Lack of libido

16. Causes of OSA

17. Mechanism of Snoring and OSA

18. Symptoms of OSA
Loud snoring
Frequent cessation of breathing (apnea) during sleep.
Choking sensation, Sudden awakenings
Snorting or gasping for breath during sleeping
Obese
Extreme daytime sleepiness
Problems concentrating
Memory loss
Poor judgment
Personality changes such as irritation, depression
lowest oxygen saturation
(LSAT)>Hypoxia>Hypercarbia
Pickwickian syndrome

19. Obesity OSA Diabetes

20. Snoring is not funny

21. Complications
Social-relationship, accidents
Pulmonary hypertension
Hypertension, arrhythmias
Type 2 Diabetes
CVA

22. Diagnosis
Good History: Talking to the patient
and the spouse
Questionnaire. Epworth Scale

23. Sleep Study or Polysomnogram (PSG)
Home Sleep Study or Lab
Diagnostic Overnight PSG
EEG or electroencephalogram,
EMG or electromyogram,
EOG or electro-oculogram
ECG or electrocardiogram
Nasal Airflow Sensor
Oximeter
Snore Microphone and video recording

24. Sleep Lab Study

25. Treatment of Sleep Apnea
Weight reduction, Diet, Exercise
Avoiding sleep on one's back.
Avoid alcoholic beverages, smoking , hypnotic or
sedative drugs.
Dental appliances, oral devices, and lower jaw
adjustment devices
Medical- Nasal decongestants, physostigmine,
provilgil (increase daytime alertness)
CSA-Mechanical ventilator
CPAP -CPAP is not a cure, but a support measure

26. CPAP

27. CPAP in Children?

28. Surgical Treatment
Hyoid Advancement
Lingualoplasty-tongue reduction
Mandibular osteotomy
Nasal Surgery
TS ADS in Children
Somnoplasty( RF soft palate)
Uvulopalatopharyngoplasty (UPPP)
Tracheostomy- *last option

29. LASER ASSISTED UVULOPLASTY
LAUP and LAPT: to cure snoring and
sleep apnea
Started doing Laser since 1996
More than 1000 cases since then

30. Laser Surgery as OPD Procedure
Laser Surgery was
done in OPD
Patient discomfort
Vasovagal Syncope
Bad smell of burning
tissue
Complaints from
neighboring clinics

31. OPD Set Up of Laser

32. Laser surgery Started in SUT Hospital 2007

33. Laser Team

34. Laser Surgeon

35. Anatomy of Throat

36. Anatomy of Nose

37. Elongated Uvula and Soft palate

38. LAUP in OPD

39. LAUP Procedure under LA

40. After LAUP

41. Snoring in Women

42. LAUP in Women

43. Laser surgery of Nose

44. Before LAUP

45. After LAUP

46. Laser Surgery Nose:LAPT

47. Laser Surgery Nose

48. Laser Surgery of Nose:polyps

49. Laser Septoplasty:LA

50. Laser cautery of Nose

51. Laser surgery Throat

52. Laser Surgery Tongue

53. Pre Op Endoscopy

54. Narrow Retro palatal Area

55. www.drpaulose.com
www.snorefreesleep.com