Obstructive sleep apnoea, a common disorder in ENT clinic practise

At our ENT clinic in Trivandrum, one of the common conditions encountered in Obstructive sleep apnoea. Reutrakul S., and Van Cauter E in their ENT journal article mentions that Obstructive sleep apneoa (commonly misunderstood as snoring) is the most common sleep disorder. This must be accurate, since of the number of patients who visit our ENT clinic at Trivandrum, most patients admit to be suffering from one of the daytime indicators of poor sleep.

Obstructive sleep apnea (OSA) is repetitive airway obstruction while sleeping. Symptoms include snoring and vigorous respiratory efforts while asleep. Diagnosis is made by polysomnography. OSA contributes to the severity of metabolic syndrome. In patients who are obese , OSA sometimes resolves with weight loss.

 

 

Continuous positive airway pressure (CPAP) is the first-line treatment of moderate to severe OSA. Nocturnal oxygen also may be used
OSA in which apneic periods result in arrhythmias requires immediate attention with oxygen or nasal CPAP.

ENT Causes of obstructive sleep apnoea commonly seen in Trivandrum:

• Increased body weight ( obesity )
• Enlargement of Adenoids and tonsills
• Craniofacial anomalies like Pierre Robin, Treacher Collins etc
• Congenital conditions and anatomic anomalies, such as cerebral palsy , Down syndrome , hemifacial microsomia, and Pierre Robin syndrome
• Growth hormone excess like Acromegaly (rare)

Contributory or predisposing ENT factors:

• Age older than 40 years
• Males
• Patients suffering from Diabetes mellitus
• Abuse of Alcohol or sedative
• Smoking
• Nasal block and conditions causing it
• Enlarged tongue which falls back into the oral cavity during sleep
• Retrognathia
• Menopause

Screening Methods to detect OSA:

OSA is associated with significant long-term morbidity and mortality, and it is infrequently recognized in clinical practice despite its prevalence
Specific patient populations may benefit from screening, including those who work in hazardous environments or jobs or those in whom daytime somnolence might pose significant risks to others
There are no guidelines for screening for ENT; physicians can obtain a history and physical examination with or without sleep questionnaires and order diagnostic tests in patients with suspected OSA

Who are at risk of developing OSA?

Patients with craniofacial abnormalities
Patients with unexplained daytime somnolence

Screening modalities

The Epworth Sleepiness Scale is used but has not been validated as a screening tool or a diagnostic tool for OSA
Obtain a thorough history and physical examination that includes such factors as snoring, sleepiness, somnolence, and obesity
Screening tests used in small studies include home pulse oximetry and cardiac monitoring
Compared with polysomnography, all tests have problems with sensitivity, specificity, and predictive value

For any queries regarding OSA, please contact our ENT clinic in Trivandrum. For details about our ENT clinic in Trivandrum. To book an appointment for our expert Ear, Nose, Throat doctors, click here.