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Obstructive Sleep Apnea - Thinking beyond CPAP

Discussion in 'Pulmonology' started by neo_star, Jan 12, 2013.

  1. neo_star

    neo_star Moderator

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    [TD="class: contentBody"]Obstructive Sleep Apnea - Thinking beyond CPAP

    My Thoughts -
    A lot of people have OSAS (obstructive sleep apnea syndrome ) secondary to jaw architecture ( i.e they could be born with slightly smaller jaws and age related recession, then compounds the problem ), forcing the tongue into the oropharynx and causing OSA. Now although this problem is augmented in the reclining position, there is still a degree of obstruction when the patient is awake and the machine (CPAP) will only help while asleep. Also many patents complain about the noise (of the machine ), the plastic and metallic taste from the tubing.

    I have my conerns about the long - term implications regarding these plastic and metallic fumes / vapor...since a lot of these patients will live long enough ( thanks to improved overall health care )...can they cause Ca or chronic Chemical pneumonitis ? i guess only God knows

    So these are some advices i give to my patients

    - of course lifestyle modification ( exercise, diet etc. )...but exercise is not a practical option for those who are very obese.
    - for those who take the advice about exercise seriously, i ask them to avoid any strenuous physical activity after sundown ( becos the oropharyngeal musclature will have increased relaxation from the fatigue and htat will augment the problem )
    - also early dinner and sleeping on a relatively light stomach.
    - will advice lying on the side as opposed to lying on the back ( for obvious reasons )...lying on the belly can also be problematic for those who have GERD
    - avoid caffeine, cigarretes, mint etc. atleast 2 - 3 hours before bedtime, because that again will precipitate reflux and the irritation can compromise the airway.

    - would ask them to avoid all diary products ( as milk allergy is the most common allergy in the world and can cause chronic congestion in some people ), if the above methods don't help....asking for this right away is impractical

    Medical Mx


    - Rule out GERD and treat appropriately if present ( in addition to lifestyle modification )
    - Rule out nasal congestion and post nasal drip ( treat it if present with nasal decongestants, antihistaminics, antibiotics +/- local steroids )
    - nasal splints ( strips applied externally on the bridge of the nose ) - do help in some patients esp. those who have chronically congested nasal mucosa
    - send the patient to an orthodontist ( dentofacial orthopaedician, is what i lke to call them ), if i think the space within the oral cavity is less than optimum.


    Comments are welcome (-:
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