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Snoring and OSA

Snoring and OSA. Snoring – a noise generated as a result of partial upper airway obstruction during sleep Apnoea – a period of no airflow in the nose or mouth for at least 10 seconds. Pathophysiology.

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Snoring and OSA

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  1. Snoring and OSA Snoring – a noise generated as a result of partial upper airway obstruction during sleep Apnoea – a period of no airflow in the nose or mouth for at least 10 seconds

  2. Pathophysiology • Snoring - Partial obstruction of the upper airway leads to vibration of the soft palate and pharyngeal walls • Nose • Soft palate • Tongue base • Apnoea – complete obstruction of the airway due to complete collapse • Both associated with obesity but up to 1/3rd of OSA sufferer’s may have a BMI <25

  3. History • Try to see with the sleep partner – It is usually the partner who has a problem with the snoring and they can describe it • Apnoea episodes described? • Day time somnolence • Alcohol • Smoking • Sedatives • Shift work • Weight gain • Nasal obstruction

  4. Examination and Investigation • BMI • Nose • Oropharynx – crowded ? • Retrognathia • Neck mass • FBC, TFT, FBS – other cause of fatigue • Epworth score < 10 reasurring

  5. Management: • Patient presents with snoring or ?OSA  • GP does Epworth • Epworth <10 - OSA unlikely. If anatomical cause for snoring - nasal polyps, large tonsils – Rx / consider referral to ENT • Treat rhinitis or nasal polyps if found • Nasal expanders from pharmacist • Lifestyle advice – weight loss, reduce alcohol, sleep on side etc • Epworth <10 - OSA unlikely. No anatomical cause found - lifestyle advice - stop smoking, lose weight etc

  6. Epworth <10 - OSA unlikely. No anatomical cause. Lifestyle change not worked. Consider mandibular advancement splint. Patient needs to have a dentist. Dentists can make these but will charge. GPs can refer direct to Simon Littlewood an Orthodontist at St Lukes who will make them on a no charge NHS basis. (We should look at the tariffs for this and if a commissioning group could ask local dentists to make them cheaper than a referral to St lukes. Also a long waiting list at St Lukes.)

  7. Epworth >/= 10 - possible OSA. If anatomical cause for snoring/OSA could refer direct to sleep studies or ENT. Will probably need both anyway as wouldn't usually operate without sleep study results. • Epworth >/= 10 - possible OSA. No anatomical cause for snoring/OSA - refer direct to sleep studies

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