Wake up dad !

Anatomy of the upper respiratory tract
Sleep apnea
1. What it it?
  1. Disorder in which breathing repeatedly stops and starts.
2. Signs and symptoms:
  1. Snoring
    1. Mechanism
      1. 1 - Airway is partially obstructed by the uvula, nasal congestion, adenoids.
      2. 2 - Lung will work harder to get the same amount of air (TV) to satisfy the bodies demand of O2
      3. 3 - This causes vibration of the soft palate and uvula which produces the snoring sound
    2. Life risk factors of snoring
  2. Morning headache
  3. Difficulty staying asleep
    1. Sleep cycle
      1. Changes in the sleep cycle with age
      2. Stages
        NREM – Non-Rapid eye movements
        N1 – very light sleep - 5%
        N2 – slightly deeper - 25%
        N3 – deep sleep - 45%
        REM – Rapid eye movements
        Dreams and brain development - 25%
  4. Excessive daytime sleepiness
  5. Attention problems
  6. Irritability
  7. Awakening with a dry mouth or sore throat
  8. Episodes of breathing cessation
  9. Abrupt awakenings accompanied by shortness of breath
3. Types and causes of each type
  1. Obstructive sleep apnea
    1. More common form that occurs when throat muscles relax.
  2. Central sleep apnea
    1. Occurs when your brain doesn't send proper signals to the muscles that control breathing
  3. Complex sleep apnea syndrome
    1. Occurs when someone has both obstructive sleep apnea and central sleep apnea
4. Risk factor
  1. Being older.
  2. Heart disorders.
  3. Using narcotic pain medications.
  4. Stroke.
5. Complication
  1. Daytime fatigue.
  2. High blood pressure or heart problems.
  3. Obstructive sleep apnea may increase the risk of recurrent heart attack, and abnormal heartbeats, such as atrial fibrillation.
  4. You may also feel quick tempered, moody or depressed.
  5. You may have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving.
  6. Type 2 diabetes.
  7. Complications with medications and surgery.
  8. Metabolic syndrome.
  9. Liver problems.
  10. Sleep-deprived partners.
6. History taking
  1. Questions regarding sleep apnea
  2. Background information
    1. Medical History
      1. Childhood sleeping patterns
      2. Surgery
      3. Long standing illnesses --> HTN and Diabetes
      4. Medication
    2. Family History
      1. Long standing illnesses
      2. Genetic sleep apnea - Genes leads to sleep apnea indirectly
    3. Social history
      1. Stress
  3. Differential diagnosis
    1. Asthma
    2. Central Sleep Apnea Syndromes
    3. COPD
    4. Depression
    5. Gastroesophageal Reflux Disease
    6. Hypothyroidism
    7. Narcolepsy
    8. Obstructive Sleep Apnea
    9. Periodic Limb Movement Disorder
7. Physical examination
  1. Breathing pattern
    1. Rate
    2. Depth and mode
    3. Chest expansion
    4. Breathing sounds
8. Investigations
  1. Polysomnogram
    1. What is it?
      1. Records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.
    2. How do you prepare ?
      1. The doctor may advise you to stop drinks that contains caffeine such as alcohol and coffee.
    4. Normal Polysomnograph
9. Treatment
  1. Surgical - Tonsillectomy
    1. What is it?
      1. surgical procedure to remove the palatine tonsils
    2. Complications
      1. Fever
      2. Nasal congestion or drainage
      3. Snoring and mouth breathing may worsen for 10-14 days after surgery
      4. Bad breath
      5. Voice changes
    3. Health problems that can be treated by tonsillectomy
      1. Tonsillitis
      2. Breathing problems related to swollen tonsils
      3. Frequent and loud snoring
      4. Bleeding of the tonsils
      5. Cancer of the tonsils
  2. Non-Surgical - CPAP
    1. Applied to the airways of a spontaneously breathing patient throughout the respiratory cycle.
    2. How does it wokr?
      1. Maintains constant level of airway pressure
      2. Keeps alveoli open (asthma, COPD)
      3. Moves extracellular fluid into vasculature (pulmonary edema)
      4. Improves gas exchange
      5. Buys time for medications to work

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