Obstructive Sleep Apnea (OSA)

Dr.dr.Fajrinur,M.Ked(Paru)Sp.P(K)

DEPARTEMEN PULMONOLOGI & ILMU

KEDOKTERAN RESPIRASI
FK USU
Obstructive Sleep Apnea (OSA)

Sleep Apnea berarti tidak bernapas secara

berulang sewaktu tidur. Henti tidur terjadi
sekurang kurangnya 10 detik, dapat
sampai 1 menit atau lebih lama dan dapat
terjadi hingga ratusan kali dalam satu
malam.
 Jenis Sleep Apnea
 Obstructive Sleep Apnea (OSA)
• Paling sering dijumpai
• Obstruksi jalan napas di hidung dan mulut

 Central Sleep Apnea (CSA)

• Jarang dijumpai
• Otak terlambat memberi perintah untuk bernapas
• Penyakit atau cidera yang melibatkan sistem saraf mis : stroke,
tumor, infeksi virus di otak, atau penyakit kronik pernapasan

 Combined Sleep Apnea

Etiologi / Faktor Resiko Sleep Apnea
• Bentuk kepala dan leher membuat jalan
napas lebih kecil daripada normal
• Tonsil dan adenoid yang besar
• Septum deviasi, lidah yang besar atau
dagu ke belakang
• Obesitas
• Otot-otot tenggorokan dan lidah relaksasi
berlebihan saat tidur
 Pembesaran uvula pada lidah Soft palate memanjang
(panah besar) dengan (panah)
hipertrofi tonsil (panah kecil).
Eritema pada faring terjadi
trauma dari mendengkur
 Saluran pernafasan yang
normal.
Ukuran soft palate dan uvula
normal. Saluran nafas atas
dari nasofaring, orofaring dan
hypofaring ukurannya normal
Saluran pernafasan yang tidak
normal selama tidur . Banyak
tempat terjadi obstruksi pada
penderita OSA. Pembesaran soft
palate menempati posterior di
nasofaring dan oral faring.
 Gejala OSA
• Mengantuk berlebihan pada siang hari
• Sakit kepala pagi hari
• Daya ingat berkurang
• Berat badan meningkat
• Lelah
• Gastric Reflux, mulut kering, sakit tenggorokan
• Sulit menurunkan berat badan
• Depresi, cemas berat, kesulitan mengingat dan
konsentrasi
• Gangguan intelektual, temperamental
• Napas melalui mulut, gelisah waktu tidur
• Impotensi, penurunan gairah
• Sulit bernapas melalui hidung
• Rasa tercekik waktu bangun
• Insomnia
• Hipertensi
• Mendengkur kuat
 Snoring (Mendengkur)
• Terjadi pada saat tidur, udara melalui jalan
napas yang menyempit dan menyebabkan
vibrasi
• Penyempitan jalan napas karena tonsil
yang besar, palatum molle dan uvula yang
panjang serta deposit lemak yang
berlebihan
 Snoring (Mendengkur)
• Snoring dan Sleep Apnea berbeda
• Snoring dapat menyertai Sleep Apnea,
tetapi Snoring tidak berarti bahwa
pernapasan berhenti.
Tingkatan derajat keparahan dibagi tiga secara klinis
yaitu :
1. Kategori I, atau mild sleepiness penderita tidur
ketika sedang membaca buku, menonton tv, atau
mendengar kuliah; adapun rasa mengantuk lebih
berat jika penderita kecapekan.

2. Kategori II atau moderate sleepiness rasa

mengantuk berat ; pasien bukan hanya mengantuk
pada saat sedang rileks tetapi sedang beraktivitas
seperti menyetir.

3. Kategori III atau severe sleepiness merasa amat

sangat mengantuk , penderita tidur pada saat
berbicara, makan, dan tidak bisa bekerja atau
mengendarai mobil.
 DIAGNOSIS OSA
1. FAKTOR RESIKO OSA

2. POLISOMNOGRAFI

3. INDEKS HIPOPNEA-APNEA
 DIAGNOSA

• POLISOMNOGRAFI
 The Sleep Center is
designed to make a
patient’s stay as
comfortable as
possible.
Each private room is
decorated and
furnished with many
of the comforts of
home. All rooms
include a television,
DVD player, private
bathroom with
shower, and an
individually-
controlled heat/AC
unit. 
 Sistem Sleep study (atas)
mencatat pergerakan tubuh ,
oksimetri (SaO2), denyut jantung
(nadi), dan mendengkur (desibel)
dimana menunjukkan OSA, (tengah)
hasil oksimetri mengalami
desaturasi pada malam hari, severe
OSA, (bawah) Oksimetri selama 4
jam setelah pemakaian CPAP
(selama 1 jam dilakukan observasi)
dengan kontrol komplit dari OSA
 PEMERIKSAAN
POLISOMNOGRAFI
• Dapat diketahui :
Stadium tidur
Indeks henti napas saat tidur
Saturasi Oksigen dalam tubuh
Central atau Obtructive apnea
Apnea ringan,sedang dan berat
Gerakan kaki secara periodik
Gangguan tidur yang lain
 INDEKS HIPOPNEA-APNEA
 Indeks hipopnea-apnea adalah jumlah
rata-rata apnea dan hipopnea per jam
tidur
 Derajat berat OSA :
- Ringan ( IHA 5-15)
- Sedang ( IHA 15-30)
- Berat ( IHA lebih dari 30 )
 PENATALAKSANAAN OSA
• PERUBAHAN GAYA HIDUP/PERILAKU

• TERAPI FISIS ATAU MEKANIS

• INTERVENSI BEDAH
 PERUBAHAN GAYA HIDUP
• MEROKOK

• MENGKONSUMSI ALKOH0L

• MENGKOMSUMSI PIL TIDUR

• OBESITAS
TERAPI FISIS ATAU MEKANIS
• CONTINIOUS POSITIVE AIRWAY
PRESSURE (CPAP)

• BILEVEL POSITIVE AIRWAY

PRESSURE (BiPAP)

• DENTAL APPLIANCES
 CPAP
Metode memberikan tekanan positif konstan
pada jalan napas selama inspirasi dan
ekspirasi

Ventilasi noninvasifteknik pemberian tekanan

positifjalan napas terbukatanpa pipa
trakea

Alat penghubungmasker, nasal,oronasal atau

mouthpiece
 CPAP pada OSA
 Tekanan 10 cmH2O digunakan saat tidur
 membuka jalan nafas

 Pilihan terapi non bedah  paling efektif

 Efektiviti  90 – 95%
 EFEK SAMPING CPAP
1. MASKER :
• Ketidaknyamanan
• Eritema kulit muka
• Claustrophobia (perasaan tidak enak
memakai masker)
• Ulserasi batang hidung
 EFEK SAMPING CPAP
2. TEKANAN / ALIRAN UDARA
• Hidung tersumbat
• Nyeri sinus/ telinga
• Iritasi mata
• Kembung

3. KEBOCORAN UDARA
Gambar.10 Efek dari Continous positive airway pressure (CPAP)
pada penderita OSA. Terapi OSA dengan CPAP akan membuka
saluran nafas dari obstruksi di faring
 INTERVENSI BEDAH
• UVULOPALATOPHARYNGOPLASTY

• TRACHEOSTOMY (OSA berat)

• REKONSTRUKSI MANDIBULA

• GASTRIC STAPLING (terapi obesiti)

 Sleep Organizations
1971 - European Sleep Research Society (ESRS) is founded
1976 - The Association of Sleep Disorders Centers (ASDC) was
founded
1978 - Association of Polysomnographic Technologists (APT) was
founded by Peter McGregor
1978 - The Japanese Society for Sleep Research (JSSR) is founded
1982 - The Belgian Association for the Study of Sleep (BASS) is
founded
1983 - The Association for the Psychophysiology Study of Sleep is
renamed the Sleep Research Society (SRS)
1984 - The Clinical Sleep Society (CSS) is recognized as a branch
of the ASDC
1985 - The Scandinavian Sleep Research Society (SSRS) is founded
1986 - The ASDC, CSS, APT, and SRS becomes the federated
Association of Professional Sleep Societies (APSS)
1986 - The Latin American Sleep Society (LASS) is founded
1986 - The Sleep Society of Canada (SSC) is founded
1987 - The ASDC changes its name to American Sleep
Disorders Association
1989 - The British Sleep Society (BSS) is founded
1990 - The National Sleep Foundation is created
1992 - The United States Congress appoints the National
Commission on Sleep Disorders Research to
determine the extent of sleep disorders on safety
1993 - Legislation is passed to create the National Center for
Sleep Disorders Research in the U.S.
1996 - The American Medical Association recognized sleep
medicine as a specialty
1999 - The American Sleep Disorders Association is
renamed the American Academy of Sleep Medicine
(AASM)
1999 - The formation of TALK ABOUT SLEEP
Publications of sleep disorders
Obstructive Sleep Apnea (OSA) May Contribute to
Blood Clots
From the Journal of the American Medical Association
5/22/2002
Researchers in Europe tested 68 patients undergoing
treatment for pulmonary embolism or deep venous
thrombosis. 63 percent of these patients had moderate-
to-severe Obstructive Sleep Apnea (OSA) compared to
prior estimates that 15% of patients in the same age
range had moderate-to-severe OSA. This suggests that
sleep apnea may be a risk factor for blood clots. Further
studies are being conducted.
Snorers Found to be Twice as Likely to Develop Diabetes
From the America Journal of Epidemiology 3/10/2002

Obesity has long been a known risk factor for developing

diabetes, but now a ten-year study of 70,000 women
found that snorers were twice as likely to develop Type II
diabetes, regardless of their weight. The researchers
believe that when snoring prohibits the intake of oxygen
into the body it produces a compound called
catecholaminea. The catecholaminea causes insulin
resistance, which is a known precursor of diabetes.
Snoring and Stroke Risk
As reported by the American Stroke Association
2/15/2002

There is now more evidence that if you're a daytime

sleepyhead you are more likely to have a stroke.
Snoring, sleeping over eight hours a night, and
daytime sleepiness are all associated with increased
risk of stroke regardless of age, race, gender or health
status. The study was conducted on 1,348 adults. The
researchers are still investigating why sleep patterns
affect stroke risk.
Snoring and Sleep Apnea May be Hereditary
From Reuters 2/6/2002

A recent UK Study suggests that some forms of

sleep apnea and snoring may be hereditary. The
study compared children who had their tonsils
removed with those who still had their tonsils.
Regardless of the tonsillectomies, children born
with narrow throats were more prone to snoring
and sleep apnea as they became adults.
Sleep Apnea Treatment Reduces Stroke Risk
From The Lancet 1/19/2002

Treating obstructive sleep apnea (OSA) can reduce

the risk of stroke and heart attack. The collapse of
the pharynx during sleep causes blocked airways and
higher blood pressure during sleep. But Continuous
Positive Airway Pressure (CPAP) has been proven to
reduce blood pressure in patients with OSA and
reduce the risk of stroke and coronary heart disease.
Sleepless in America:
Snoring is an epidemic. In fact the New England
Journal of Medicine estimated over 90 million people
over the age of 18 are affected by snoring in the
United States.

The American Sleep Association stated that, "sleep is

one of the fundamental conditions for the quality of
life."