OBSTRUCTIVE SLEEP APNOEA  (OSA)—is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort during sleep.. It is characterized by recurrent episodes of upper airway collapse during sleep.These episodes are associated with recurrent oxygen desaturations and arousals from sleep. Signs and symptoms…… NOCTURNAL SYMPTOMS :-- Snoring, usually loud, habitual, and bothersome to others Gasping and choking sensations that arouse the patient from sleep Nocturia Insomnia; restless sleep DAYTIME SYMPTOMS :-- Nonrestorative sleep… ie waking up as tired Morning headache Excessive daytime sleepiness Daytime fatigue memory and intellectual impairment Personality and mood changes Sexual dysfunction Gastroesophageal reflux Resistant Hypertension DIAGNOSIS Evaluate the upper airway in all patients, particularly in nonobese adults with symptoms consistent with OSA. Examination findings may include the following: Abnormal (increased) Mallampati score Abnormally enlarged tonsils & /or Adenoids in children Systemic arterial hypertension: Present in about 50% of cases Congestive heart failure Pulmonary hypertension Stroke Metabolic syndrome Type 2 diabetes mellitus DIAGNOSIS :- An overnight sleep study, or polysomnography, is required to diagnose OSA. MANAGEMENT of OSA Conservative therapy and prevention,...... (1)Avoid supine position during sleep or Sleeping in an upright position for markedly obese patients (2) Avoiding alcohol and other sedatives. Standard treatment option :- (1)Nasal CPAP (2)Bilevel positive airway pressure (3)Oral appliance therapy Pharmacotherapy Medications such as modafinil have been used adjunctively in the management. Surgery (1)Uvulopalatopharyngoplasty (2)Craniofacial reconstruction with advancement of tongue or maxillomandibular bones (3)Tracheostomy Most of the patients remain undiagnosed until progressed to an advanced stage.. Multiple cases of road traffic accident is reported while driving a vehicle.. We must keep the diagnosis of OSA in mind while getting cases with similar symptoms.. Epworth Sleepiness Scale is also available to assess these patients clinically.. I hope this information will be HELPFUL in your clinical practice…

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Thanks again dear Poddar, Again a wonderful and tough topic made easy, Poddar is a Pulmonary Magician who makes very tough topics very simple and easily understandable. When I was doing my Medicine, before appearing for ENT examination, I read in journals about Surgical procedure for Snoring called U3P Surgery in BMJ some where around in 1985 or 1986, Uvulo Palato Pharyngo Plasty. I felt extremely happy to see the same surgery mentioned by you. The incidence of OSA has drastically Increased in Patients with DM & Metabolic Syndrome. Any way thanks a lot dear Poddar for highlighting a tough Burning topic made so simple to understand for all the doctors. You are a practical Pulmonologist.

Many thanks Dr Mohan
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I accept that both Diagnosis and treatment of OSA is beyond the reach of most of our patients.. But we must not miss the diagnosis of OSA & ask the patient to get the sleep study done if he can afford.. In my practice I found most of the treated patient had drastically improved quality of life..

Sir is modafinil safe in CKD ESRD patients on CAPD
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Thank you so much sir for this wonderful update on a very important topic. OSA is very common specially in pts with METABOLIC SYNDROME. it affects all parameters BP SUGAR LIPIDS and increases CVD Mortality and morbidity. Thank you once again.

Thanks Dr Zuber for your valuable added comments
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Thanks Dr Poddar....very informative...clears many doubts.As we all know polysomnography costing 8000/approx n every second pt complains snoring may be the reason that psychiatric medication causing somewhat metabolic disturbance any comments or cheaper method?

pt's with no daytime complaint
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informative

Thanks Dr Sharma for the appreciation
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Thank you Sir worth sharing

Thanks Dr Lele
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thankyou for valuable info ,Sir.

Thank you sir useful information in nutshell.

Dr poddar it is risky for this patient during restlessness and choking observe the patient if chocking starts kindly admit him immediately

obstructiv we sleep apnea oh GCB

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