WEIGHT: 62 kg
Services: Naturism/Nudism, Role playing, Striptease, Extreme, Tie & Tease
Obstructive sleep apnea OSA is a condition characterised by partial or complete periodic obstruction of the upper airway during sleep. Untreated OSA can cause significant short-term complications, such as impaired neurocognitive function and daytime somnolence. The aetiology of OSA is multifactorial, making effective management of the condition challenging. However, a comprehensive understanding of individual phenotypic characteristics that contribute to OSA can allow for targeted, effective multimodal treatment.
The history should include factors relating to the diagnosis of OSA snoring, witnessed pauses or gasps, positional differences, waking from apnoea , the consequences of OSA daytime somnolence, waking unrefreshed, poor cognitive function, cardiometabolic comorbidities and the existence of concomitant sleep disorders insomnia, sleep architecture. General examination and visualisation of the airway allow assessment of potential contributing anatomy.
Blood pressure and body mass index BMI are important to note, particularly as obesity is a significant contributing factor. Important transoral features to note include a high arched narrow palate, elongated uvula, malocclusion, tongue and tonsil size incorporating the modified Friedman staging system. Dynamic airway assessment via flexible nasendoscopy is performed to determine sites and planes of airway collapse, which may include palatine and lingual tonsil hypertrophy, retrolingual and retropalatal collapse and, rarely, laryngeal pathology.
Otherwise, referral to a sleep physician for assessment prior to a polysomnogram is required. However, there is a progressive shift toward limited and full-channel sleep studies that can be performed at home.
Individualised patient goals and motivations should be taken into consideration. This often includes symptom control, with the usual foci being reduction in snoring and improvement in general wellbeing including tiredness and daytime sleepiness. The treating physician should also aim for reduction in cardiovascular risk factors and seek improvement in polysomnographic indices such as Apnoea—Hypopnea Index AHI and nocturnal oxygen desaturation.