1. step 11
1.1. Review and evaluate
1.2. Group members
1.3. Chairman
1.4. Scribe
1.5. Tutor
1.6. Material
1.7. 10 minutes
2. Step 9
2.1. Review session 2
2.2. visualize the data and theory
2.3. mechanism flow chart
2.4. 20 minutes
3. Step 10
3.1. Management (for the individual)
3.1.1. behaivorl modification
3.1.1.1. patient education
3.1.1.2. wieght loss
3.1.1.3. sleep position, non supine position
3.1.1.4. stop smoking and alcohol and medication like benzo and antidepressent (mirtazapine)
3.1.1.5. exersice
3.1.1.6. avoiding heavy meal which compresses diphragm
3.1.2. pharmacological therapy
3.1.2.1. donepezil
3.1.2.2. nasal spray for nasal obstruction , anti histamine,
3.1.2.2.1. for acute infection
3.1.2.3. ace inhibitor for heart failure (captoprel), dirutics like furozamide, beta blockers for hypertention, acetazolamide increases ventaltory drive, modafinil for day time sleepiness,
3.1.3. OSA therapy
3.1.3.1. positive airway pressure
3.1.3.1.1. CPAP, constant pressure in respiratory cycle, fixed during night and auto-titrin has sensor that messure oxygen
3.1.3.1.2. EPAP, constant pressure at end of expiratory cycle
3.1.3.1.3. BPAP, different pressure during inspiration and expiration
3.1.3.1.4. adaptive servo-ventilation
3.1.3.2. oral appliance
3.1.3.2.1. mandible advancment for mandible protrution which prevent mm relaxation
3.1.3.2.2. tounge retaining device
3.1.3.3. surgery
3.1.3.3.1. failed to improve with previous interventions
3.1.3.3.2. UPPP
3.1.3.3.3. jaw surgery
3.1.3.3.4. if obstruction was anatomical deformity then surgery is initial treatment
3.1.4. ongoing
3.1.4.1. occupational therapist
3.1.4.2. sleep study
3.1.4.3. follow up with used devices
3.2. Prevention (for the population)
3.2.1. risk factor avoidance
3.2.2. educate public about causes of OSA
3.2.3. educate about sleep comfort
3.2.4. educate about alcohol, smoking, drugs
3.2.5. screening
3.2.6. educate family members about signs