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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, recentweight 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. -DiagnosisA 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 ventriculartachycardia, 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.