Page 24 - Waterfall Issue 6 2021

Waterfall News

• Drowsiness while driving • Insomnia (especially difficulty staying It delivers a positive pressure
and an increased risk of asleep, with frequent awakenings). via a flexible hose to ‘splint’
motor vehicle accidents. the airway open, preventing
Who Is MosT AT RIsK oF the airway from collapsing.
The following cognitive functions have oSA? • Oromandibular devices, which
been shown to be affected in OSA: Risk factors for OSA include: bring the jaw (mandible) or
• Attention • Male gender the tongue forward, helping to
• Memory • Obesity relieve the airway obstruction,
• Executive functioning (higher-level • Increasing age are useful in mild OSA.
thinking and decision-making) • Craniofacial and airway • Positional therapy is advised in
• Speed of processing information abnormalities. purely positional sleep apnoea
• Visuospatial and where the airway blockage occurs
constructional abilities. HoW IS oSA DIAGNoSeD? only whilst sleeping in a particular
The treating specialist’s diagnosis position, for example, on one’s back.
Rapid eye movement (REM) and of OSA is made by taking a • Surgery can be done to remove
stage three sleep play a vital role history, conducting a physical obstructive lesions such as enlarged
in cognitive functions, especially in examination and doing a sleep tonsils or adenoids. Specific
consolidating new memories and test (polysomnography). surgical approaches to advance
converting them into long-term the mandible or procedures to
memories. Sleep fragmentation The decision of whether to do decrease the soft tissue in the
disrupts REM and stage three sleep, a full polysomnography or a airway and reshape the airway are
causing cognitive dysfunction. home sleep test will be made reserved for patients who cannot
Hypoxia or shortage of oxygen to by the treating specialist. tolerate or fail CPAP therapy. The
the brain, decreased blood supply to risks and benefits of any individual
the brain, and the presence of other The polysomnogram measures surgery require discussion between
comorbidities like hypertension and the following parameters: the surgeon and patient.
diabetes, further promote cognitive • Sleep (by placing recording • Hypoglossal nerve stimulation is
dysfunction by increasing oxidative electrodes over the scalp) a method where an implantable
stress and inflammation in the brain. • Breathing (by placing belts over device in the chest can stimulate
the chest and abdomen) the hypoglossal nerve to
Imaging studies of the brain can • Airflow (via a nasal cannula) restore the tone in the tongue
help in understanding which • Oxygen saturation, and muscles, hence relieving airway
cognitive functions are affected • Muscle activity. obstruction. This treatment, like
by matching them to the brain surgery, is reserved for patients
regions seen to be affected in OSA. The number of complete airflow who fail CPAP therapy and it has
They can also show the negative blockages (apnoeas) and partial a specific set of indications.
effects of OSA by identifying brain airflow blockages (hypopnoeas) are • Pharmacological therapies to
volume decrease in these regions. scored. The Apnoea-Hypopnoea reduce upper airway collapse or
Index (AHI) is the number of apnoeas stimulate the respiratory drive
The positive effects of treatment and hypopnoeas per hour of sleep. as the primary treatment of
with continuous positive airway The AHI is used to diagnose sleep OSA are still being explored.
pressure (CPAP) has also been apnoea and grade its severity.
shown to increase the brain ConCLUsIon
region size affected by OSA. hoW CAn osA bE A strong emphasis on a multimodal
tReAteD? approach to the treatment of
WhAT ARE ThE syMPToMs Treatment of sleep apnoea OSA cannot be overemphasised.
oF oSA? includes the following: Combining lifestyle modification
Symptoms that should alert you • Lifestyle modification focusing with individual therapy such
to see your doctor include: on weight loss, diet and exercise as CPAP or an oromandibular
• Snoring, choking and witnessed is the first step for all patients. device, as well as treatment of
pauses in breathing (apnoeic spells) • Avoiding sedative medications comorbidities like hypertension and
• Daytime sleepiness and alcohol at night as they can diabetes, is the best approach.
• Early morning headaches depress breathing and worsen
• Poor memory, attention the airway obstruction. Identifying the symptoms of OSA
and concentration • CPAP (continuous positive and seeking medical advice is the
• Frequent urination at night (nocturia) airway pressure) therapy is still first step on the path to a diagnosis
• Low mood and irritability the first-line treatment for OSA. and treatment of this condition.

22 Waterfall Issue 6 2021
•