Prof. Dr. ABDUL HAMEED AL QASEER Sleep Apnea Syndrome Prof. Dr. ABDUL HAMEED AL QASEER

OSAS is now recognized that 2-4% of middle - aged population have OSAS . The male : female ratio = 2 : 1 . Snoring is very common ( ~ 40% of middle – aged male & ~ 20% of female) . Accurate diagnosis is the best way of management . Excessive daytime sleepiness is the principle symptom ,& snoring is virtually universal .

Epidemiological data suggest that OSAS may : 1. increase the risk of MI ~ 20% . 2. increase the risk of stroke by ~ 40% . 3. recent data suggest that OSAS associated with insulin resistant & it can aggravate DM & even with metabolic syndrome . 4. hepatic dysfunction . * Also OSAS has been associated with an increased risk of : 1. HT 2. HF 3. CAD 4. pul. hypertension 5. risk of sudden death 6. 3-7 fold increase in vehicle accident .

Predisposing Factors

Risk Factors for OSA

Clinical Features Excessive daytime sleepiness is the principal symptom and snoring is virtually universal. Snoring is in all p0sitions and often with multiple breathing pauses. Other features including , difficulty in concentration , impaired cognitive function and work performance. Depression and nocturia may be present.

Epworth Sleepiness Score

Clinical Presentation of OSA

Conditions should be considered in OSA evaluation

Definition of adult OSA

Differential Diagnosis of sleepiness

Pathophysiology & consequences of OSA

OSAS AND Respiratory diseases When OSAS, coexists with COPD , severe respiratory failure can result even if COPD is mild. OSAS if coexists with asthma , it become more difficult to control. Pulmonary hypertension and cor pulmonale

MANAGEMENT OF OSAS Treatment & correction of predisposing factors ( if feasible): 1. Nasal obstruction . 2. Avoidance of alcohol . 3. Avoidance of sedatives . 4. Weight reduction . 5. Treatment of hypothyroidism . 6. Quit smoking .

Continuous positive airway pressure ( CPAP) When CPAP is tolerated the effect is often dramatic ( 30-40% of pat. do not tolerate it). Other centers experienced that CPAP is well tolerated & effective in > 80% of patients . Delivered by a nasal mask ( nCPAP) . Nasal CPAP prevents upper airway occlusion. CPAP is of choice in moderately severe & severe OSAS . In pats. with mild- moderate OSAS , nasal CPAC is superior to more conservative therapy , but is often less well tolerated .

The benefit of CPAP Improvement in sleep quality . Reduced daytime sleepiness & driving accidents Decreased nocturnal hypertension . In pats. With IHD or CHF , CPAP have a beneficial effect on cardiac status . It is improving left ventricular ejection fraction & diastolic function also improved .

COMPLICATIONS ASSOCIATED WITH CPAP : Nocturnal arousals . Rhinitis , nasal irritation , & dryness . Aerophagia . Mask & mouth leaks ( dry mouth in the morning). Facial skin discomfort . Difficulty with exhalation . Claustrophobia . Chest & back pain .

Complications associated with CPAP

COMPLICATIONS ASSOCIATED WITH CPAP : Nocturnal arousals . Rhinitis , nasal irritation , & dryness . Aerophagia . Mask & mouth leaks ( dry mouth in the morning). Facial skin discomfort . Difficulty with exhalation . Claustrophobia . Chest & back pain .

Surgery for OSA

Thank You For full attention