SLEEP APNEA AND DRIVING SLEEP APNEA AND DRIVING ACCIDENTSACCIDENTS

Dr.K.O.Paulose FRCS DLODr.K.O.Paulose FRCS DLOConsultant ENT SurgeonConsultant ENT Surgeon

Jubilee Hospital, TrivandrumJubilee Hospital, TrivandrumSouth IndiaSouth India

www.drpaulose.com,www.snorefreesleep.comwww.drpaulose.com,www.snorefreesleep.com

Avoid Falling Asleep While Driving

Every year, over 100,000 accident Every year, over 100,000 accident deaths deaths 2,500 deaths are caused by driver 2,500 deaths are caused by driver fatiguefatigue

RTA related Sleep debtRTA related Sleep debt

Sleep Apnea and Sleep DebtSleep Apnea and Sleep Debt

Accidents more in early morningAccidents more in early morning

Sleep Apnea can kill others tooSleep Apnea can kill others too

Funeral DrivingFuneral Driving

Lack of sleep affects

driver fatiguedriver fatigue

reaction timereaction time

judgment and ability judgment and ability to concentrateto concentrate

When Is It Most Likely To Happen?

1 pm and 4 pm 1 pm and 4 pm and 2 am and 6 and 2 am and 6 am.am.

Warning Signs of Drowsy DrivingWarning Signs of Drowsy Driving

YawningYawning

Inability to keep eyes open Inability to keep eyes open

Drifting out of the laneDrifting out of the lane

Hitting rumble strips Hitting rumble strips

What Can Be Done?What Can Be Done?Caffeine, stimulants and other tricks, loud music, Caffeine, stimulants and other tricks, loud music, washing face-temporarywashing face-temporary

Avoid sleep debt- sleep 7-9 hrs/dayAvoid sleep debt- sleep 7-9 hrs/day

Take Breaks-will allow you to stretch, move and Take Breaks-will allow you to stretch, move and wake up wake up

Pull over in a safe area to nap Pull over in a safe area to nap

Awareness among patients, relatives, and Traffic Awareness among patients, relatives, and Traffic police-DLpolice-DL

The only long-lasting solution is to get adequate The only long-lasting solution is to get adequate sleep.sleep.

Definition of Sleep Apnea

Apnea is defined as a cessation of oronasal Apnea is defined as a cessation of oronasal airflow of at least 10-30 seconds in durationairflow of at least 10-30 seconds in duration

When it occurs 30 or more times during a 7-When it occurs 30 or more times during a 7-hour period of nocturnal sleep.hour period of nocturnal sleep.

>10 episodes per night>10 episodes per night

Types of Sleep Apnea

CSA- brain stem -bulbar polio stroke, a CSA- brain stem -bulbar polio stroke, a brain tumor, a viral brain infectionbrain tumor, a viral brain infection

OSA- upper airway obstructionOSA- upper airway obstruction

Mixed- with chronic respiratory diseaseMixed- with chronic respiratory disease

Description of OSADescription of OSA

Upper airway narrowingUpper airway narrowing

Loud snoringLoud snoring

Wake upWake up

Gasping for airGasping for air

Fall back to sleepFall back to sleep

Snoring and OSA can lead to divorceSnoring and OSA can lead to divorce

The spouse cannot The spouse cannot sleepsleep

Separate bed roomSeparate bed room

Marital discordMarital discord

Lack of sex driveLack of sex drive

EJDEJD

InfertilityInfertility

Lack of libidoLack of libido

Causes of OSACauses of OSA

Mechanism of Snoring and OSAMechanism of Snoring and OSA

Symptoms of OSASymptoms of OSALoud snoringLoud snoringFrequent cessation of breathing (apnea) during sleep.Frequent cessation of breathing (apnea) during sleep.Choking sensation, Sudden awakeningsChoking sensation, Sudden awakeningsSnorting or gasping for breath during sleepingSnorting or gasping for breath during sleepingObeseObeseExtreme daytime sleepiness Extreme daytime sleepiness Problems concentrating Problems concentrating Memory loss Memory loss Poor judgment Poor judgment Personality changes such as irritation, depressionPersonality changes such as irritation, depressionlowest oxygen saturation lowest oxygen saturation (LSAT)>Hypoxia>Hypercarbia(LSAT)>Hypoxia>HypercarbiaPickwickian syndrome Pickwickian syndrome

Obesity OSA DiabetesObesity OSA Diabetes

Snoring is not funnySnoring is not funny

Complications

Social-relationship, accidentsSocial-relationship, accidents

Pulmonary hypertensionPulmonary hypertension

Hypertension, arrhythmias Hypertension, arrhythmias

Type 2 DiabetesType 2 Diabetes

CVACVA

Diagnosis

Good History: Talking to the patient Good History: Talking to the patient and the spouseand the spouse

Questionnaire. Epworth ScaleQuestionnaire. Epworth Scale

Sleep Study or Polysomnogram (PSG)Sleep Study or Polysomnogram (PSG)Home Sleep Study or LabHome Sleep Study or Lab

Diagnostic Overnight PSGDiagnostic Overnight PSGEEG or electroencephalogram,EEG or electroencephalogram,EMG or electromyogram,EMG or electromyogram,EOG or electro-oculogramEOG or electro-oculogramECG or electrocardiogramECG or electrocardiogramNasal Airflow SensorNasal Airflow SensorOximeterOximeterSnore Microphone and video recordingSnore Microphone and video recording

Sleep Lab StudySleep Lab Study

Treatment of Sleep Apnea

Weight reduction, Diet, ExerciseWeight reduction, Diet, Exercise

Avoiding sleep on one's back.Avoiding sleep on one's back.

Avoid alcoholic beverages, smoking , hypnotic or Avoid alcoholic beverages, smoking , hypnotic or sedative drugs.sedative drugs.

Dental appliances, oral devices, and lower jaw Dental appliances, oral devices, and lower jaw adjustment devicesadjustment devices

Medical- Nasal decongestants, physostigmine, Medical- Nasal decongestants, physostigmine, provilgil (increase daytime alertness)provilgil (increase daytime alertness)

CSA-Mechanical ventilatorCSA-Mechanical ventilator

CPAP -CPAP is not a cure, but a support measureCPAP -CPAP is not a cure, but a support measure

CPAPCPAP

CPAP in Children?CPAP in Children?

Surgical TreatmentHyoid Advancement Hyoid Advancement

Lingualoplasty-tongue reductionLingualoplasty-tongue reduction

Mandibular osteotomyMandibular osteotomy

Nasal SurgeryNasal Surgery

TS ADS in ChildrenTS ADS in Children

Somnoplasty( RF soft palate)Somnoplasty( RF soft palate)

Uvulopalatopharyngoplasty (UPPP) Uvulopalatopharyngoplasty (UPPP)

Tracheostomy- *last optionTracheostomy- *last option

LASER ASSISTED UVULOPLASTY

LAUP and LAPT: to cure snoring and LAUP and LAPT: to cure snoring and sleep apneasleep apnea

Started doing Laser since 1996Started doing Laser since 1996

More than 1000 cases since thenMore than 1000 cases since then

Laser Surgery as OPD ProcedureLaser Surgery as OPD Procedure

Laser Surgery was Laser Surgery was done in OPDdone in OPD

Patient discomfortPatient discomfort

Vasovagal SyncopeVasovagal Syncope

Bad smell of burning Bad smell of burning tissuetissue

Complaints from Complaints from neighboring clinicsneighboring clinics

OPD Set Up of Laser OPD Set Up of Laser

Laser surgery Started in SUT Hospital 2007Laser surgery Started in SUT Hospital 2007

Laser TeamLaser Team

Laser SurgeonLaser Surgeon

Anatomy of ThroatAnatomy of Throat

Anatomy of NoseAnatomy of Nose

Elongated Uvula and Soft palateElongated Uvula and Soft palate

LAUP in OPDLAUP in OPD

LAUP Procedure under LA

After LAUPAfter LAUP

Snoring in WomenSnoring in Women

LAUP in Women

Laser surgery of NoseLaser surgery of Nose

Before LAUP

After LAUPAfter LAUP

Laser Surgery Nose:LAPT

Laser Surgery NoseLaser Surgery Nose

Laser Surgery of Nose:polypsLaser Surgery of Nose:polyps

Laser Septoplasty:LALaser Septoplasty:LA

Laser cautery of NoseLaser cautery of Nose

Laser surgery ThroatLaser surgery Throat

Laser Surgery TongueLaser Surgery Tongue

Pre Op EndoscopyPre Op Endoscopy

Narrow Retro palatal AreaNarrow Retro palatal Area

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