00:01
Now, with obstructive sleep apnea,
our discussion continues.
00:04
And then here,
what is it?
What is actual occuring?
Its respiratory obstruction
caused by excess.
00:12
Please know the actual
anatomical structure
parapharyngeal tissue in
obese adults, patient one.
00:20
Patient two,
adenotonsillar hypertrophy
in children who snore loudly.
00:27
So you have the adenotonsillar
in children
and you have the parapharyngeal
in the adult obese individuals.
00:34
This is obstructive sleep apnea
meaning to say that you're having
difficulty with proper respiration.
00:41
Central sleep apnea.
00:43
Well, there's no respiratory effort.
00:45
Why? Because it's actually been
a real CNS injury.
00:49
And when there's CNS injury,
please understand that it's
going to knock out centrally
your sleep center.
00:55
And so therefore
there is no respiratory effort.
00:59
Now we have what's known as
obesity hypoventilation syndrome.
01:03
It's specifically
a type of sleep apnea,
in which we then have to
categorize or label
as being in the
obese individuals.
01:11
First, who is your patient?
Know the BMI.
01:14
The basal metabolic index
is measured
and defined is greater than
30 kilograms per meter squared.
01:23
That's an obese individual,
by definition by BMI.
01:27
Because of the obesity,
there is going to be difficulty with
remember?
If you're gonna have obesity,
what happens to your thoracic cage?
It doesn't open up.
01:37
It causes more shrinkage
of thoracic cage.
01:40
So now we have
restrictive lung disease.
01:43
Now, once such an issue
takes place,
now you're worried about
retention of carbon dioxide
during sleep and during the day.
01:51
And hypoxemia.
01:53
There is no joke.
01:54
The fact that you're actually
retaining a carbon dioxide
continuously
at night and at day
because it's not like
"Oh, well, I feel like I want to be
500 pounds at night.
02:05
And then I'm going to weigh
150 in the morning.
02:08
I'm sorry, but that's
don't work like that.
02:11
So the individuals obese,
I don't care at night or day, right?
So therefore,
what is this going to result in?
This is scary
ladies and gentlemen.
02:20
You're going to have increased
retention of carbon dioxide
it doesn't matter at day
or at night, and hypoxemia.
02:27
Once again,
you're worried about
all those things
that we talked about
including secondary type
of primary hypertension
the class three,
and the fact that you may result in
right ventricle issues.
02:37
And the fact that you might have
secondary polycythemia
obesity,
hypoventilation syndrome.
02:44
Now, sleep apnea.
02:45
Two major categories of sleep apnea.
02:47
Obstructive.
02:48
We talked about how you have an
individual parapharyngeal in adults
and adenotonsillar in children.
02:55
Whereas, if it's central,
then you have issues with
well, heart failure, strokes,
and drugs such as methadone.
03:01
Two major categories.