Snoring and Obstructive Sleep Apnea

Snoring and Obstructive Sleep Apnea

Q. 1 A 45 year old male patient complains that he is often tired and has a headache almost every morning His wife says that her sleep is disturbed because of the patient’s loud snoring. Physical examination reveals leg edema. Hypertension, and cardiac arrhythmia. From which disorder is this patient most likely suffering?

 A Sleep wake schedule disorder
 B Obstructive sleep apnea
 C Narcolepsy
 D Delayed sleep phase syndrome
Q. 1 A 45 year old male patient complains that he is often tired and has a headache almost every morning His wife says that her sleep is disturbed because of the patient’s loud snoring. Physical examination reveals leg edema. Hypertension, and cardiac arrhythmia. From which disorder is this patient most likely suffering?

 A Sleep wake schedule disorder
 B Obstructive sleep apnea
 C Narcolepsy
 D Delayed sleep phase syndrome
Ans. B

Explanation:

In obstructive sleep apnea, airway obstruction results in snoring as well as failure to breathe during the night. The resulting anoxia causes frequent awakenings during the night so that the patient feels tired in the morning. Decreased oxygen availability may result in leg edema, hypertension, morning headaches, cardiac arrhythmias, and stroke in patients with obstructive sleep apnea. myocardial infarction by 50% to 75% within 5 years of cessation. The reduced risk for the other therapies are as follows:
•Postmenopausal estrogen replacement has a 44% decreased risk
• Mild to moderate alcohol consumption has a 25% to 45% decreased risk
• Exercise has a 45% decreased risk.
•Prophylactic low dose aspirin has a 33% decreased risk, particularly in the incidenc of the first acute myocardial infarction in middle aged men and women; however, there is no reduction in overall total cardiovascular mortality. Patients over 50 years of age with risk factors for coronary artery disease are the group most likely to benefit, it is not good for prophylaxis if the patient has poorly controlled
hypertension, because there is a danger for a hemorrhagic stroke.


Q. 2

Modafinil is approved by FDA for treatment of all, except:

 A

Narcolepsy

 B

Shift work syndrome (SWS)

 C

Obstructive sleep apnea syndrome (OSAS)

 D

Lethargy in depression

Q. 2

Modafinil is approved by FDA for treatment of all, except:

 A

Narcolepsy

 B

Shift work syndrome (SWS)

 C

Obstructive sleep apnea syndrome (OSAS)

 D

Lethargy in depression

Ans. D

Explanation:

Modafinil is an FDA approved drug in the treatment of obstructive sleep apnea, shift work disorder and narcolepsy.

It is not FDA approved in the treatment of lethargy in major depression.

Ref: Sleepiness: Causes, Consequences and Treatment By Michael J. Thorpy, Pages 415-6


Q. 3

Which of the following condition is treated by laser-assisted uvulopalatoplasty?

 A

Snoring

 B

Pharyngotonsillitis

 C

Cleft palate

 D

Stammering

Q. 3

Which of the following condition is treated by laser-assisted uvulopalatoplasty?

 A

Snoring

 B

Pharyngotonsillitis

 C

Cleft palate

 D

Stammering

Ans. A

Explanation:

Laser uvulopalatoplasty (LAUP) is the treatment for snoring.

In LAUP, the redundant soft tissue is either excised or ablated.

It helps to avoid most of the postoperative morbidity, as well as providing a good hemostatic benefit during surgery.

The CO2 laser is the laser most commonly used by otolaryngologists for this operation.


Q. 4

Modafinil is approved by FDA for treatment of all except:

 A

Obstructive sleep apnea syndrome (OSAS)

 B

Shift work syndrome (SWS)

 C

Narcolepsy

 D

Lethargy in depression

Q. 4

Modafinil is approved by FDA for treatment of all except:

 A

Obstructive sleep apnea syndrome (OSAS)

 B

Shift work syndrome (SWS)

 C

Narcolepsy

 D

Lethargy in depression

Ans. D

Explanation:

D i.e. Lethargy in major depression

Modafinil is not approved by FDA for treatment of lethargy in depression.

Modafinil is a novel wake promoting agent that has FDA approval for narcolepsy, shift work sleep disorder and as adjunctive treatment of obstructive sleep apnea/hypopnea syndrome.

  • Modafinil is a schedule IV medication, FDA approved for treating the excessive day time fatigue of narcolepsyQ.
  • (CMDT). Modafinil is now the drug of choice, principally because it is associated with fewer side effects than older stimulants and has a long half life (Harrison).
  • Modafinil (200 mg, taken 30-60 min before the stant of each night shift) is approved by US-FDA for excessive sleepiness during night work in patients with shift work disorder (SWD). Although treatment with modafinil significantly increases sleep latency & reduces the risk of lapses of attention during night work in patients with SWD (Harrison).
  • Pharmacological therapy for obstructive sleep apnea syndrome (OSAS) is disappointing (CMDT). Unfortunately, no drugs are clinically useful in the prevention or reduction of apneas & hyponeas. A marginal improvement in sleepiness in patients who remain sleepy despite continuous positive airway pressure (CPAP) can be produced by modafinil, but the clinical value is debatable and the financial cost significant (Harrison). CPAP and MRS (mandibular repositioning split) are the two most widely used and best endence based therapies.
  • Modafinil (provigil / aleretec / modavigil) is a stimulant drug by cephalon & is approved US-Food & drug administration (US – FDA) for the treatment of narcolepsy, shift work disorder, and excessive day time sleepiness (idiopathic hypersomnia) associated with obstructive sleep apneaQ.
  • Although modafinil is thought to be effective in t/t of attention defecit hyperactinity disorder (ADHD), it was rejected by FDA for use by children for that purpose. It is also used off label to treat sedation & fatigue in depression, fibrmyalgia, chronic fatigue syndrome, myotonic dystrophy, opioid induced sleepiness, spastic cerebral palsy, parkihson’s disease, Schizophrenia and cocaine addiction.

Q. 5

Modafinil is used as an adjunct in the treatment of?

 A

Sleep apnea syndrome

 B

Narcolepsy

 C

AMID

 D

Imsomnia

Q. 5

Modafinil is used as an adjunct in the treatment of?

 A

Sleep apnea syndrome

 B

Narcolepsy

 C

AMID

 D

Imsomnia

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sleep apnea syndrome

Modatinil is approved for treatment of : (i) narcolepsy, (ii) multiple sclerosis (to relieve fatigue), (iii) shift workers and, (iv) obstructive sleep apnea.


Q. 6

Laser uvulopharyngopalatoplasty is the surgery done for which of the following?

 A

Snoring

 B

Recurrent pharyngotonsilitis

 C

Cleft palate

 D

Stammering

Q. 6

Laser uvulopharyngopalatoplasty is the surgery done for which of the following?

 A

Snoring

 B

Recurrent pharyngotonsilitis

 C

Cleft palate

 D

Stammering

Ans. A

Explanation:

Snoring : Noisy breathing, a rough, rattling inspiratory noise produced by vibration of pendulous soft palate or occasionally of vocal cords, during sleep.

  • Snoring indicates some obstruction in upper airway and represents a continum of the similar pathology as of Obstructive Sleep Apnea (OSA), where snoring is on one end and OSA on the other.
  • Management of snoring without Obstructive Sleep Apnea.
  • Uvulopalatoplasty-Laser Assisted Uvulopalatoplasty (LAUP) or Bovie-Assisted Uvulopalatoplasty (BAUP). It can be performed under Local A naesthesia in OPD. In this procedure uvula is amputated and 1 cm trenches are created in the soft palate on either side of uvula. The soft palate elevates and stiffens after healing.
  • Uvulopalatopharyngoplasty- It is the M/C surgery performed for Obstructive Sleep Apnea. It is also very effective in treating snoring.

Q. 7

All of the following are true about obstructive sleep apnea syndrome except:

 A

Females affected more than males

 B

Commonly associated with hypertension

 C

Day time sleepiness is seen

 D

>5 episodes of apnea per hour

Q. 7

All of the following are true about obstructive sleep apnea syndrome except:

 A

Females affected more than males

 B

Commonly associated with hypertension

 C

Day time sleepiness is seen

 D

>5 episodes of apnea per hour

Ans. A

Explanation:

 

OSAHS occurs in around 1-4% of middle-aged males and is about half as common in women.


Q. 8

A 36 years old obese man was suffering from hyperten­sion and snoring. Patient was a known smoker. In Sleep test, there were 5 apnea/hyperapneas episodes per hour. He was given antihypertensives and advised to quit smoking. Next line of management:

 A

Uvulopalatopharyngeoplasty

 B

Weight reduction and diet plan

 C

Nasal CPAP

 D

Mandibular repositioning sling

Q. 8

A 36 years old obese man was suffering from hyperten­sion and snoring. Patient was a known smoker. In Sleep test, there were 5 apnea/hyperapneas episodes per hour. He was given antihypertensives and advised to quit smoking. Next line of management:

 A

Uvulopalatopharyngeoplasty

 B

Weight reduction and diet plan

 C

Nasal CPAP

 D

Mandibular repositioning sling

Ans. B

Explanation:

 

 

The primary treatments of obstructive sleep apnea are: weight loss in those who are overweight, continuous positive airway pressure, and mandibular advancement devices. There is little evidence to support the use of medications or surgery.

Continuous positive airway pressure (CPAP) is effective for both moderate and severe disease. It is the most common treatment for obstructive sleep apnea.

Adherence to CPAP is generally better than that to an MRS, and there is evidence that CPAP improves driving, whereas there are no such data on MRSs. Thus, CPAP is the current treatment of choice (for both moderate and severe disease). However, MRSs are evidence-based second-line therapy in those who fail CPAP.- Harrison 18/p2189

There is no proven evidence that pharyngel surgery, including uvulopalatopharyngoplasty (whether by scalpel, laser or thermal techniques) helps OSAHS patients.


Q. 9

Associated with obstructive sleep apnea are all of the following except:   

March 2011

 A

Acromegaly

 B

Obese

 C

Males

 D

Protruding jaw

Q. 9

Associated with obstructive sleep apnea are all of the following except:   

March 2011

 A

Acromegaly

 B

Obese

 C

Males

 D

Protruding jaw

Ans. D

Explanation:

Ans. D: Protruding jaw

Predisposing factors to the sleep apnea/ hypoapnea syndrome include being male, which doubles the risk probably due to a testosterone effect on the upper airway, and obesity, found in about half of the patients, because parapharyngeal fat deposits tend to narrow the pharynx.

Nasal obstruction or a recessed mandible can further exacerbate the problem

Acromegaly and hypothyroidism also predispose by causing submucosal infiltration and narrowing of the upper airway



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