ia_gov_sa · guide · processed · 3 chunks
Obstructive Sleep Apnea (OSA) flowchart الجميع السعودي لطب الشراه والمجاز Saudi Society of Family and Community Medicine Definition Risk Factors High Risk Individual's Clinical presentation Physical examination Erowth Sleepiness Scale (ESS) sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. This leads to partial reductions (hypopneas) or complete pauses (apneas) in breathing that last at least 10 seconds during sleep <table><tr><td>•BMI>30 kg/m2•Down Syndrome•Acromegaly•Hypothyroidism•Smokers</td><td>•Middle-aged and older men•post-menopausal women•Family member with OSA•Abnormal nasal morphology•Craniofacial abnormalities</td><td>•Neck sizes ≥17 inches (men) ≥16 inches (women)•Ethnic groups e.g Asian, African American, Native American, and Hispanic•Retrognathic mandible (small lower jaw)•Children with large tonsils and adenoids</td></tr><tr><td colspan="2">•Obesity (BMI >35)•Congestive heart failure•Atrial fibrillation•Resistant hypertension•Type 2 diabetes•Individuals with Retrognathic Maxilla & Mandible</td><td>•Nocturnal dysrhythmias•Stroke•Pulmonary hypertension•High-risk driving populations•Preoperative for bariatric surgery</td></tr></table> <table><tr><td>•Restless non-refreshing sleep•Snoring•Morning headaches•Drowsiness•Sleep fragmentation•Witnessed apneas•Nightmares•Excessive nocturnal sweating•Nocturnal heart burn•Nocturia</td><td>•Excessive daytime sleepiness EDS ( Epworth Sleepiness Scale)•Awakenings (with gasping or paroxysmal nocturnal dyspnea)•Decreased concentration and memory•Motor vehicle accidents•Erectile dysfunction and female sexual dysfunction•Dry mouth and throat on awakening•Increased BP during sleep and in the early morning upon awakening•Excessive salivation during sleep•Mood disorders</td></tr></table> - Neck sizes ≥17 inches (men) ≥16 inches (women •BMI> 30 kg/m2, - Modified Mallampati score of 3 or 4 •Craniofacial abnormalities; retrognathia, micrognathia, lateral peritonsillar narrowing, macroglossia, tonsillar hypertrophy, elongated/enlarged uvula, high arched/narrow hard palate - Nasal abnormalities (polyps, deviation, valve abnormalities, turbinate hypertrophy) and/or overjet •Signs of complications:right sided heart failure,pulmonary hypertension - Resistant hypertension How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. <table><tr><td rowspan="2">No chance</td><td colspan="2">1</td><td colspan="4">2</td><td rowspan="2">3</td></tr><tr><td>Slight chance</td><td></td><td colspan="3">Moderate chance</td><td>High chance</td></tr><tr><td>Sitting and reading</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr><tr><td>Watching TV</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr><tr><td>Sitting, inactive, in a public place</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr><tr><td>As a passenger in a car for an hour without stopping for a break</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr><tr><td>Lying down to rest when circumstances permit</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr><tr><td>Sitting and talking to someone</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr><tr><td>Sitting quietly after a meal without alcohol</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr><tr><td>In a car, while stopped for a few minutes in traffic or a light</td><td></td><td></td><td>0</td><td>1</td><td>2</td><td>3</td><td></td></tr></table> A score ≥10 raises concern Total Score= Class I: Complete visualization of the soft Palate Class II: Complete visualization of the Uvula Class III: visualization of only the base of the Uvula Class IV: Soft Palate is not visible at all STOP-BANG Questionnaire Risk stratification Snoring Tired, fatigued, or sleepy Observed apnea Pressure (hx of high blood pressure) BMI >35 Age>50 Neck size > 16 inches Gender: male Each 1 point Low risk 0-2 Intermediate risk 3-4 High risk 5-8 Differential diagnosis Box1 conditions associated with non-obstructive sleep-disordered breathing: • GOLD stage 2,3,4 COPD • NYHA class 3 or 4 heart failure • Neuromuscular weakness - Opioid Use • History of Stroke* * Majority will have obstructive sleep apnea Box2 Non-respiratory sleep disorders • Narcolepsy or other hypersomnia disorders - Severe insomnia - Parasomnia • Movement disorders References:1. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014. 2. Adult Obstructive Sleep Apoea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine. 2009 Jun 15,5(3):263-76.