🎯 Pathology

• episodes of partial or complete collapse of the upper airway during sleep which result in hypoxia and arousal from sleep

​

💡 Risk factors

• anatomic factors

• micrognathia, retrognathia

• adenoid and tonsillar hypertrophy

• obesity

• endocrine conditions: hypothyroidism, acromegaly, Cushing’s syndrome

• Down’s syndrome

​

🩺 Clinical features

• typical presentation: an obese patient who presents with a history of snoring or breathing cessation witnessed by a bed partner, and daytime excessive sleepiness

• consequences of poor sleep:

  • ​excessive day time somnelence (increases risk of road traffic accidents)

  • poor concentration and cognitive performance

  • fatigue

​

😢 Complications

• pulmonary hypertension (due to hypoxia)

• cardiovascular disease and stroke (due to increased oxidative stress as a result of hypoxia)

• type 2 respiratory failure (due to hypoventilation)

​

🕵️‍♂️ Investigations

• initial

  • Epworth Sleepiness Scale (questionnaire)

• best

  • polysomnography based on the apnoea-hypopnoea index (AHI)

    • AHI = (apnoeas + hypopnoeas) / total hours of sleep

    • diagnosis confirmed if:

      • AHI ≥ 5 with symptoms, or

      • AHI ≥ regardless of symptoms

​

💆‍♂️ Management​

• weight loss

• ​1st line: continuous positive airway pressure (CPAP)

• oral devices if unable to use CPAP

  • surgery

  • uvulopalatopharyngoplasty (UPPP) - removal of the uvula and tissue from the soft palate

  • maxillomandibular advancement (MMA)

  • hypoglossal nerve stimulation