Hypothyroidism and cigarette smoking are additional

factors for obstructive sleep apnea. Before making the diagnosis of obstructive
sleep apnea, a drug history should be obtained and a seizure disorder, narcolepsy,
and depression should be excluded.
- A. Symptoms and Signs

Obese, middle-aged men.

Arterial hypertension is common.

Patients may complain of excessive daytime somnolence, morning
sluggishness and headaches, daytime fatigue, cognitive impairment, recent
weight gain, and impotence.

Bed partners usually report loud cyclical snoring, breath cessation,
witnessed apneas, restlessness, and thrashing movements of the
extremities during sleep. Personality changes, poor judgment, work-
related problems, depression, and intellectual deterioration may also be
observed.

The oropharynx is frequently found to be narrowed by excessive soft
tissue folds, large tonsils, pendulous uvula, or prominent tongue. Nasal
obstruction by a deviated nasal septum, poor nasal airflow, and a nasal
twang to the speech may be observed. A “bull neck” appearance is
common.
- Diagnosis

A complete polysomnography examination includes
electroencephalography, electro-oculography,

Electromyography) ECG, pulse oximetry, and measurement of respiratory
effort and airflow. Polysomnography reveals apneic episodes lasting as
long as 60 seconds. Oxygen saturation falls, often to very low levels.

Bradydysrhythmias, such as sinus bradycardia, sinus arrest, 01
atrioventricular block, may occur. Tachydysrhythmias, including
paroxysmal supraventricular tachycardia, atrial fibrillation, and ventricular
tachycardia, may be seen once airflow is reestablished.
- Treatment

Weight loss and strict avoidance of alcohol and hypnotic medications are
the first steps in management.

Nasal continuous positive airway pressure (nasal CPAP) at night is
curative in many patients.

Polysomnography is frequently necessary to determine the level of CPAP
(usually 5-15 cm H20) necessary to abolish obstructive apneas.

02 may increase length of apneas and can’t be prescribed without
Polysomnography.

Mechanical devices inserted into the mouth at bedtime to hold the jaw
forward and prevent pharyngeal occlusion have modest effectiveness in
relieving apnea; however, patient compliance is not optimal.

Uvulopalatopharyngoplasty (UPPP)> a procedure consisting of resection
of pharyngeal soft tissue and amputation of approximately 15 mm of the
free edge of the soft palate and uvula, is helpful in approximately 5o% of
selected patients.
Chap. 32 :

Pg. 1425-1433: "Common viral respiratory infections: RSV through Avian
Flu"
COMMON VIRAL RESPIRATORY INFECTIONS
- 1. Respiratory Syncytial Virus (RSV) & Other Paramyxoviruses

Is a major cause of morbidity and mortality at extremes of age.