Obstructive sleep apnea - Revision history

ClaireLewis at 17:24, 25 October 2020

2020-10-25T17:24:58Z

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	==References==		==References==
	<references/>		<references/>
			[[Category:Pulmonary]]

ClaireLewis at 00:59, 22 October 2020

2020-10-22T00:59:26Z

← Revisión anterior		Revisión del 00:59 22 oct 2020
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	==Background==		==Background==
	'''Obstructive sleep apnea (OSA)''' is a common, potentially serious sleep disorder~~. It is characterized~~ by repetitive collapse of the upper airway leading to intermittent pauses in breathing during sleep~~. It is most~~ common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities. Complications include drowsy driving ~~and~~ motor vehicle accidents, neuropsychiatric dysfunction, cardiovascular morbidity, pulmonary hypertension, and right heart failure.		*'''Obstructive sleep apnea (OSA)''' is a common, potentially serious sleep disorder
			*Characterized by repetitive collapse of the upper airway leading to intermittent pauses in breathing during sleep
			*Most common in adult males and postmenopausal women
			*Risk factors include older age, male gender, obesity, and upper airway abnormalities
			*Complications include drowsy driving/motor vehicle accidents, neuropsychiatric dysfunction, cardiovascular morbidity, [[pulmonary hypertension]], and right [[heart failure]].

	==Clinical Features==		==Clinical Features==
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	** May be underestimated due to chronic nature, insidious onset		** May be underestimated due to chronic nature, insidious onset
	* Loud snoring, gasping, interruptions in breathing while sleeping		* Loud snoring, gasping, interruptions in breathing while sleeping
	** Usually history obtained from patient's ~~bed partner~~		* Morning [[headache]]s
	* Morning headaches
	** Usually bifrontal, squeezing		** Usually bifrontal, squeezing
	** Possibly secondary to hypercapnia, vasodilation, increased intracranial pressure, and impaired sleep quality		** Possibly secondary to [[hypercapnia]], vasodilation, [[increased ICP\|increased intracranial pressure]], and impaired sleep quality

	==Differential Diagnosis==		==Differential Diagnosis==
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	* Abrupt awakening or abnormal sounds during sleep		* Abrupt awakening or abnormal sounds during sleep
	**Primary snoring - Most patients who have OSA snore, but most patients who snore do not have OSA.		**Primary snoring - Most patients who have OSA snore, but most patients who snore do not have OSA.
	**~~Gastroesophageal reflux disease~~ - ~~Can~~ produce a choking sensation and dyspnea at night		**[[GERD]]- can produce a choking sensation and dyspnea at night
	**Nocturnal asthma		**Nocturnal [[asthma]]
	**Nocturnal seizure		**Nocturnal [[seizure]]
	*Early morning headaches		*Early morning headaches
	**Space occupying lesions of the brain ~~- consider brain imaging~~		**[[intracranial mass\|Space occupying lesions]] of the brain
	**Obesity hypoventilation - would potentially show hypercapnia/hypercarbia on venous blood gas		**Obesity hypoventilation - would potentially show hypercapnia/hypercarbia on venous blood gas

	==Evaluation==		==Evaluation==
	~~OSA is not~~ a clinical diagnosis and objective testing must be performed for diagnosis. Consider diagnostic testing with patients with excessive day time sleepiness (EDS) on most days '''and''' two of the following clinical features: habitual loud snoring, witnessed apnea or gasping or choking during sleep, and diagnosed systemic hypertension.		''Not typically an ED diagnosis''
			*Evaluate for alternative, emergent etiology of symptoms
			*Not a clinical diagnosis and objective testing must be performed for diagnosis
			*Consider diagnostic testing with patients with excessive day time sleepiness (EDS) on most days '''and''' two of the following clinical features: habitual loud snoring, witnessed apnea or gasping or choking during sleep, and diagnosed systemic hypertension.
	* Evaluation tool parameters: No evaluation tools have been shown to be superior to history and physical examination and their poor accuracy make them imperfect diagnostic tools, but are often used in preoperative evaluation to assess risk of undiagnosed OSA		* Evaluation tool parameters: No evaluation tools have been shown to be superior to history and physical examination and their poor accuracy make them imperfect diagnostic tools, but are often used in preoperative evaluation to assess risk of undiagnosed OSA
	**STOP-Bang questionnaire		**STOP-Bang questionnaire
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	==Disposition==		==Disposition==
	~~Home with primary provider follow up for~~ sleep medicine ~~study as appropriate. If patient arrived as victim of motor vehicle accident, consider reporting lapse of consciousness while driving to your Department of Motor Vehicles~~		*Discharge- consider sleep medicine referral

	==See Also==		==See Also==

NadavNahumi: /* Disposition */

2020-03-16T21:58:38Z

Disposition

← Revisión anterior		Revisión del 21:58 16 mar 2020
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	==Disposition==		==Disposition==
			Home with primary provider follow up for sleep medicine study as appropriate. If patient arrived as victim of motor vehicle accident, consider reporting lapse of consciousness while driving to your Department of Motor Vehicles

	==See Also==		==See Also==

NadavNahumi: /* Management */

2020-03-16T21:56:15Z

Management

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	==Management==		==Management==
			* Patient education
			* Behavioral modification
			** Losing weight if overweight
			** Exercise
			** Changing sleep position if positional
			** Abstaining from alcohol or certain sedative medications
			* Positive airway pressure during sleep
			* Oral appliance is reasonable second line for mild-moderate OSA
			* Surgical therapy
			** Surgical resection of obstructing lesion
			** Hypoglossal nerve stimulation

	==Disposition==		==Disposition==

NadavNahumi: /* Background */

2020-03-16T21:50:47Z

Background

← Revisión anterior		Revisión del 21:50 16 mar 2020
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	==Background==		==Background==
	'''Obstructive sleep apnea (OSA)''' is a common, potentially serious sleep disorder. It ~~causes~~ breathing ~~to repeatedly stop and start~~ during sleep. It is most common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities. Complications include drowsy driving and motor vehicle accidents, neuropsychiatric dysfunction, cardiovascular morbidity, pulmonary hypertension, and right heart failure.		'''Obstructive sleep apnea (OSA)''' is a common, potentially serious sleep disorder. It is characterized by repetitive collapse of the upper airway leading to intermittent pauses in breathing during sleep. It is most common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities. Complications include drowsy driving and motor vehicle accidents, neuropsychiatric dysfunction, cardiovascular morbidity, pulmonary hypertension, and right heart failure.

	==Clinical Features==		==Clinical Features==

NadavNahumi: /* Background */

2020-03-16T21:48:24Z

Background

← Revisión anterior		Revisión del 21:48 16 mar 2020
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	==Background==		==Background==
	'''Obstructive sleep apnea (OSA)''' is a common, potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. It is most common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities.		'''Obstructive sleep apnea (OSA)''' is a common, potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. It is most common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities. Complications include drowsy driving and motor vehicle accidents, neuropsychiatric dysfunction, cardiovascular morbidity, pulmonary hypertension, and right heart failure.

	==Clinical Features==		==Clinical Features==

NadavNahumi: /* Clinical Features */

2020-03-16T21:44:23Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	* Daytime sleepiness		* Daytime sleepiness
	**May be underestimated due to chronic nature, insidious onset		** May be underestimated due to chronic nature, insidious onset
	* Loud snoring, gasping, interruptions in breathing while sleeping		* Loud snoring, gasping, interruptions in breathing while sleeping
	**Usually history obtained from patient's bed partner		** Usually history obtained from patient's bed partner
			* Morning headaches
			** Usually bifrontal, squeezing
			** Possibly secondary to hypercapnia, vasodilation, increased intracranial pressure, and impaired sleep quality

	==Differential Diagnosis==		==Differential Diagnosis==

NadavNahumi: /* Clinical Features */

2020-03-16T21:42:05Z

Clinical Features

← Revisión anterior		Revisión del 21:42 16 mar 2020
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	==Clinical Features==		==Clinical Features==
			* Daytime sleepiness
			**May be underestimated due to chronic nature, insidious onset
			* Loud snoring, gasping, interruptions in breathing while sleeping
			**Usually history obtained from patient's bed partner

	==Differential Diagnosis==		==Differential Diagnosis==

NadavNahumi: /* Background */

2020-03-16T21:39:19Z

Background

← Revisión anterior		Revisión del 21:39 16 mar 2020
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	==Background==		==Background==
	Obstructive sleep apnea (OSA) is a common, potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. It is most common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities.		'''Obstructive sleep apnea (OSA)''' is a common, potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. It is most common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities.

	==Clinical Features==		==Clinical Features==

NadavNahumi: /* Background */

2020-03-16T21:38:48Z

Background

← Revisión anterior		Revisión del 21:38 16 mar 2020
Línea 1:		Línea 1:
	==Background==		==Background==
			Obstructive sleep apnea (OSA) is a common, potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. It is most common in adult males and postmenopausal women. Risk factors include older age, male gender, obesity, and upper airway abnormalities.

	==Clinical Features==		==Clinical Features==