Evaluation and management of obstructive sleep apnea:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2009
|
| Schriftenreihe: | Oral and maxillofacial surgery clinics of North America
21,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | X S., S. 370 - 481 zahlr. Ill. |
| ISBN: | 9781437712513 |
Internformat
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Datensatz im Suchindex
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| adam_text | Titel: Evaluation and management of obstructive sleep apnea
Autor: Boyd, Scott B.
Jahr: 2009
Evaluation and Management of Obstructive Sleep Apnea
Contents
Preface jx
Scott B. Boyd
Epidemiology Pathophysiology, and Clinical Features of Obstructive Sleep Apnea 369
Mansoor Madani and Farideh Madani
The normal cycle of respiration includes a unique balancing force between many up-
per airway structures that control its dilation and closure. Alteration of this delicate
equilibrium, possibly by an increased airflow resistance, can cause various degrees
of obstructive sleep apnea (OSA). OSA is now recognized as a major illness, an im-
portant cause of medical morbidity and mortality affecting millions of people world-
wide, and a major predisposing factor for several systemic conditions, such as
hypertension, cardiovascular disease, stroke, diabetes, and even sexual dysfunc-
tion. Initial evaluation for possible OSA may be done by dental professionals who
can provide guidance for its comprehensive evaluation and management. Because
of the complexity of the disease, factors contributing to its development must be
identified. Some factors caused by the patient s anatomic structures are slightly
easier to rectify, whereas others may relate to the patient s age, sex, habits, or as-
sociated illnesses, including obesity. In this article, various epidemiologic, patho-
physiologic, and clinical features of OSA are discussed.
Evaluation of the Obstructive Sleep Apnea Patient and Management of Snoring 377
N. Ray Lee
This article provides a practical strategy for the systematic evaluation of the obstruc-
tive sleep apnea patient. The management of snoring is also discussed. The pre-
sented strategy is based upon review of the current literature, the principles set
forth in the American Academy of Sleep Medicine clinical guideline publication,
and the author s personal experience.
Imaging the Upper Airway in Patients with Sleep Disordered Breathing 389
Somsak Sittitavornwong and Peter D.Waite
Obstructive sleep apnea syndrome is an increasingly common disorder, but the eti-
ology and site of obstruction often remain unknown. The obstruction seldom is im-
aged or identified. All surgical procedures must be directed toward the anatomic site
of obstruction. Currently, it is very difficult to identify the site of obstruction in the
awake, nonsupine patient. Therefore, better diagnostic methods must be developed
to help direct treatment options and improve surgical outcomes. This article will help
surgeons identify possible sites of obstruction and direct surgical intervention.
Management of Obstructive Sleep Apnea by Continuous Positive Airway Pressure 403
Terri E.Weaverand Amy Sawyer
Obstructive sleep apnea (OSA) is a common problem, with 9% to 28% of women
and 24% to 26% of males having apneic events at a treatable level, making this syn-
drome a serious public health issue. This article describes the outcomes associated
with continuous positive airway pressure treatment, significance of the issue of poor
Contents
adherence in OSA, discusses evidence regarding the optimal duration of nightly use,
describes the nature and predictors of nonadherence, and reviews interventions that
have been tested to increase nightly use and suggests management strategies.
Principles of Oral Appliance Therapy for the Management of Snoring and Sleep
Disordered Breathing 413
Fernanda R. Almeida and Alan A. Lowe
Oral appliance (OA) therapy for snoring, obstructive sleep apnea, or both is simple,
reversible, quiet, and cost-effective and may be indicated in patients who are unable
to tolerate nasal continuous positive airway pressure (nCPAP) or are poor surgical
risks. OAs are effective in varying degrees and seem to work because of an increase
in airway space, the provision of a stable anterior position of the mandible, advance-
ment of the tongue or soft palate, and possibly a change in genioglossus muscle ac-
tivity. This article provides a detailed clinical protocol and titration sequence for OAs,
because this clinical procedure is often not well understood by practitioners new to
the field. Prediction of treatment success is addressed, OA treatment is compared
with surgery and nCPAP, OA compliance is described, and the possible adverse ef-
fects associated with this type of therapy are discussed.
Sleep Apnea Surgery: Putting It All Together 421
Kasey K. Li
Since the first description of uvulopalatopharyngoplasty (UPPP) in 1972, the surgical
management of obstructive sleep apnea syndrome (OSA) has become increasingly
popular. This popularity is caused by several reasons. The psychomotor sequelae of
OSA, such as excessive daytime sleepiness, daytime fatigue, and poor sleep quality
caused by sleep fragmentation, have major deleterious impact on patients well be-
ing, which behooves them to seek treatment. The risk of hypertension, heart attack,
and stroke also prompts patients to seek treatment. Further, despite the potential
success of nasal continuous positive airway pressure (CPAP), patients compliance
represents a clear problem, thus causing patients to seek treatment alternatives,
namely surgery. All surgeons treating patients who have OSA must realize that the
management of OSA crosses specialty lines and no single specialty can adequately
take care of patients alone.
Anesthetic and Postoperative Management of the Obstructive Sleep Apnea Patient 425
Samuel A. Mickelson
Sleep apnea patients pose a challenge for surgeons, anesthesiologists, and surgical
facilities as there is increased risk for anesthetic and postoperative complications.
Precautions before and after surgery minimize these risks. Screening for sleep ap-
nea should be done for all surgical patients. Safe perioperative management re-
quires judicious use of narcotics and sedating medications, reducing upper airway
edema, prevention of aspiration and deep vein thrombosis, blood pressure control,
use of positive airway pressure, and proper postoperative monitoring. Although the
literature lacks specific recommendations, the guidelines presented in this article are
based on more than 20 years of experience and supported by peer-reviewed med-
ical literature.
Reconstruction of Airway Soft Tissues in Obstructive Sleep Apnea 435
B.TuckerWoodson and Peter D. O Connor
Surgery for obstructive sleep apnea is multimodal. Procedures and aims of treat-
ment vary. Surgery, medical devices, and medical therapy each may contribute to
Contents
individualized patient care. There is no single procedure or intervention that cures
upper airway obstruction. Treatment varies as the disease varies. In addition, surgi-
cal treatment varies because the level of obstruction and influence on air flow occurs
at multiple levels and from many structures. This article is not intended as a critical
assessment of surgical outcomes but rather focuses on airway structures and the
nature of the procedures applied to influence them.
Management of Obstructive Sleep Apnea by Maxillomandibular Advancement 447
Scott B. Boyd
Obstructive sleep apnea (OSA) is a common primary sleep disorder. It is character-
ized by repetitive partial or complete upper airway collapse during sleep. Maxillo-
mandibular advancement (MMA) is an orthognathic surgical procedure that has
been used to manage OSA. The main objective of this article is to provide practical
guidelines for evaluating and managing OSA patients by MMA. The presentation will
focus on MMA for adults, as this is the most common and clinically effective appli-
cation of MMA to treat OSA.
Management of Obstructive Sleep Apnea: Role of Distraction Osteogenesis 459
Carl Bouchard, Maria J. Troulis, and Leonard B. Kaban
Distraction osteogenesis to expand the facial skeleton is an alternative to standard
orthognathic surgery for selected patients with obstructive sleep apnea. For children
with congenital micrognathia or midface hypoplasia, distraction osteogenesis allows
large advancements without the need for bone grafting and with less risk of relapse.
For later-onset obstructive sleep apnea, distraction osteogenesis may represent an
alternative when acute bone movement is expected to be difficult (scarring from pre-
vious surgery or radiation therapy) or when the risk for inferior alveolar nerve damage
is unacceptable (patients older than 40 years).
Index 477
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| isbn | 9781437712513 |
| language | English |
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| physical | X S., S. 370 - 481 zahlr. Ill. |
| publishDate | 2009 |
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| series | Oral and maxillofacial surgery clinics of North America |
| series2 | Oral and maxillofacial surgery clinics of North America |
| spelling | Evaluation and management of obstructive sleep apnea guest ed. Scott B. Boyd Philadelphia [u.a.] Saunders 2009 X S., S. 370 - 481 zahlr. Ill. txt rdacontent n rdamedia nc rdacarrier Oral and maxillofacial surgery clinics of North America 21,4 Therapie (DE-588)4059798-2 gnd rswk-swf Schlafapnoe (DE-588)4137452-6 gnd rswk-swf Schlafapnoe (DE-588)4137452-6 s Therapie (DE-588)4059798-2 s DE-604 Boyd, Scott B. Sonstige oth Oral and maxillofacial surgery clinics of North America 21,4 (DE-604)BV002758944 21,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=018856979&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Evaluation and management of obstructive sleep apnea Oral and maxillofacial surgery clinics of North America Therapie (DE-588)4059798-2 gnd Schlafapnoe (DE-588)4137452-6 gnd |
| subject_GND | (DE-588)4059798-2 (DE-588)4137452-6 |
| title | Evaluation and management of obstructive sleep apnea |
| title_auth | Evaluation and management of obstructive sleep apnea |
| title_exact_search | Evaluation and management of obstructive sleep apnea |
| title_full | Evaluation and management of obstructive sleep apnea guest ed. Scott B. Boyd |
| title_fullStr | Evaluation and management of obstructive sleep apnea guest ed. Scott B. Boyd |
| title_full_unstemmed | Evaluation and management of obstructive sleep apnea guest ed. Scott B. Boyd |
| title_short | Evaluation and management of obstructive sleep apnea |
| title_sort | evaluation and management of obstructive sleep apnea |
| topic | Therapie (DE-588)4059798-2 gnd Schlafapnoe (DE-588)4137452-6 gnd |
| topic_facet | Therapie Schlafapnoe |
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