Describe the pathophysiology of the Obstructive Sleep Apnoea Syndrome.
What are the potential long-term complications of this syndrome?
(a) Patency of the oropharyngeal airway is due to activity of paired sets of upper airway muscles.
The presence of respiratory activity in the muscles of the soft palate, pharyngeal walls and tongue prevents otherwise floppy strictures from being sucked into the airway. Obstruction during sleep may be due to a combination of factors:
1) reduced airways size -enlarged tonsils/adenoids, macroglossia myxoedema, acromegaly, malignancy. A large percentage of OSA patients have a structurally small airway.
2) neuromuscular tone- reduced tone occurs in REM sleep, particularly in postural muscles of the pharynx, palate etc.
3) neuromuscular coordination – the normal coordination of increased upper airway tone withinspiration is lost.
(b) Potential long-term complications include:
Cardiac- hypertension, nocturnal angina/arrhythmias
Pulmonary- respiratory failure, cor pulmonale
Neurological- headache, somnolence, dementia
Psychiatric – depression, personality changes
Other - impotence, polycythaemia, glaucoma
Pathophysiology of sleep apnoea:
Consequences of sleep apnoea
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