The severity of obstructive sleep apnea (OSA) based on the apnea hypopnoea index (AHI).
| OSA severity | |
|---|---|
| AHI < 5 | Normal or primary snoring |
| 5 < AHI < 20 | Mild |
| 20 < AHI < 40 | Moderate |
| AHI > 40 | Severe |
Most common symptoms associated with obstructive sleep apnea.
| Nocturnal | Diurnal |
|---|---|
| Snoring | Excessive sleepiness |
| Witnessed apnoeas | Morning headaches |
| Choking at night | Depression/irritability |
| Nicturia | Memory loss |
| Insomnia | Decreased libido |
many patients can develop cognitive and neurobehavioral dysfunction, inability to concentrate, memory impairment and mood changes such as irritability and depression.
Insulin resistance, type II diabetes and altered serum lipid profile, widely described in patients with OSA,
Positive airway pressure (PAP), available since the beginning of the 1980s, provides the most effective and commonly used treatment. Alternative options include weight control, mandibular advancement devices and a number of upper airway surgical approaches.
CPAP is highly effective in controlling symptoms, improving quality of life and reducing the clinical consequences of sleep apnoea and we must consider it as a first-line option. Bilevel PAP and Auto-CPAP can be used in those patients intolerant to CPAP or when high treatment pressures are necessary. Mandibular advancement devices can be offered as a viable alternative to patients with mild to moderate OSA, intolerant to PAP. The role of surgery remains controversial. Tonsillectomy and adenoidectomy are useful in children and in adults with enlarged tonsils. Uvulopalatopharyngoplasty is a well established procedure to be considered as a second-line option when PAP has failed. Maxillar mandibular surgery is extremely effective and can be suggested to patients with craniofacial malformations. All patients with obesity should be encouraged to lose weight and bariatric surgery can be considered in patients with BMI over 40. A multidisciplinary approach and the implementation of educational programs will significantly improve the management of the disease.
Positive airway pressure (PAP), available since the beginning of the 1980s, provides the most effective and commonly used treatment. Alternative options include weight control, mandibular advancement devices and a number of upper airway surgical approaches.
CPAP is highly effective in controlling symptoms, improving quality of life and reducing the clinical consequences of sleep apnoea and we must consider it as a first-line option. Bilevel PAP and Auto-CPAP can be used in those patients intolerant to CPAP or when high treatment pressures are necessary. Mandibular advancement devices can be offered as a viable alternative to patients with mild to moderate OSA, intolerant to PAP. The role of surgery remains controversial. Tonsillectomy and adenoidectomy are useful in children and in adults with enlarged tonsils. Uvulopalatopharyngoplasty is a well established procedure to be considered as a second-line option when PAP has failed. Maxillar mandibular surgery is extremely effective and can be suggested to patients with craniofacial malformations. All patients with obesity should be encouraged to lose weight and bariatric surgery can be considered in patients with BMI over 40. A multidisciplinary approach and the implementation of educational programs will significantly improve the management of the disease.
没有评论:
发表评论