Obstructive sleep apnea
Patient (condition)
 
Aliases:
OSA
Obstructive sleep apnoea

Topic aliases are alternate phrasings for a particular topic.


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STOP Bang-questionnaire can be used to quickly distinguish "high risk" vs "low risk" of OSA refl.in/44 refl.in/43. STOPBANG

Snoring,
Tiredness (daytime),
Observed apnoea,
Pressure (hypertension),

BMI>35,
Age >50,
Neck circumference >44cm male, >40cm female,
Gender = Male.

Score of equal or greater than 3 places patient at high risk of OSA.

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Nov 26, 2012
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Polysomnography may be used to assess severity of OSA.
AHI - Apnea Hypopnea Index. The number of apneas and hypopneas per hour.
Mild 5-15,
Moderate 15-30,
Severe >30
refl.in/45

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Mar 04, 2012
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Polysomnography. Apnoea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI). Mild 5-15, mod 15-30, severe >30 refl.in/45

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May 18, 2011
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Example sleep study with severe obstructive sleep apnoea

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Mar 12, 2012
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Polysomnography may be used to assess the severity of OSA. RDI - Adult Respiratory Disturbance Index adds Respiratory Effort Related Arousals (RERs) to AHI.
Mild 5-15,
Moderate 15-30,
Severe >30
refl.in/45

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Mar 04, 2012
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Instruct patient to bring CPAP machine from home if they have one.

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May 18, 2011
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Minimise opiods to reduce risk of postoperative respiratory depression

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Regional anaesthesia where possible to minimise dose of sedating drugs that may precipitate upper airway obstruction

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Extubate in lateral or sitting up position rather than supine, to reduce risk of airway obstruction.

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Aug 11, 2011
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If nasal ETT, consider using it as a nasal airway at end of case. Withdraw tip to oropharynx, cut ETT & place safety pin through to prevent losing it into the airway.

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Mar 03, 2012
PS #RCH
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At elevated risk of difficult bag mask ventilation

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May 18, 2011
If additionally concerned about difficult laryngoscopy, consider awake fibreoptic intubation (nasal or oral)
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Ensure full reversal of neuromuscular blockade at emergence to minimise risk of upper airway obstruction on extubation

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May 18, 2011
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Extubate awake to minimise risk of obstruction on emergence

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May 18, 2011
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Book a HDU bed for postoperative respiratory monitoring for patients with severe sleep apnoea (eg AHI or RDI >30)

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Sep 28, 2011
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Risk of opiod induced respiratory depression. If general anaesthesic performed, consider monitoring in HDU/oximetry in bed near nurses in ward

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Aug 11, 2011
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Supplemental oxygen in ward may prolong apnoeas, delaying alert if oximetry is used as apnoea monitor

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