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Obstructive Sleep Apnea
Julia Buchfuhrer, PGY-II Updated March 2018
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Objectives Define OSA Recognize Risk Factors for OSA
Know when to refer for PSG Know the available treatments for OSA
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Case 52y/o obese gentleman comes into clinic complaining of being tired everyday. He often falls asleep at work or while driving home. He gets about 8 hours of sleep most nights and falls asleep right away. Vitals signs normal except BP 145/90 Physical exam BMI 40, enlarged neck All other labs normal including EKG
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Case We’ll get back to him later…
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What is OSA? Collapse of the oropharynx during sleep causing decreased airflow Includes spectrum from apneas to hypopneas to breathing related arousals Hypopnea defined as <88% oxygen saturation
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More Pathophys Increased work of breathing against closed airway leads to arousals during sleep Patients often don’t remember these arousals Sleep arousals poor quality sleep daytime sleepiness
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Chief Complaint Most often the patient’s complaint is excessive daytime sleepiness In the setting of 7+ hours of sleep at night If the patient is getting less than 7 hours of sleep at night, daytime sleepiness is likely due to this
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When does OSA occur? REM SUPINE SLEEP most commonly, why?
Pharyngeal airway muscles relaxed during REM sleep Neck habitus while supine physically collapses pharynx
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Epidemiology 20-30% of male Americans 10-15% of female Americans
THAT’S A LOT OF PEOPLE!
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Risk Factors Age Gender: M>F Obesity, especially BMI >40
Small airway Large neck size
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When to screen? Patient with concerning RFs and complaint of excessive daytime sleepiness How to screen? STOP-BANG Questionnaire RFs – risk factors Questionnaire on next slide
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STOP-BANG Scoring <3 is low risk, 3-5 medium, 5+ high risk
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Back to our patient 52y/o obese gentleman comes into clinic complaining of being tired everyday. He often falls asleep at work or while driving home. He gets about 8 hours of sleep most nights and falls asleep right away. Vitals signs normal except BP 145/90 Physical exam BMI 40, enlarged neck
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What’s his STOP-BANG? Tired, BP, BMI, Age, Neck, Gender = 6
This is the key slide here, go through this thoroughly Tired, BP, BMI, Age, Neck, Gender = 6
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So now what? Send for “sleep testing”, what is that?
PSG = Polysomnographic study No need to go over this picture, just here for reference
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Treatment - CPAP CPAP - the mainstay of OSA treatment
Uses PEEP to open posterior oropharynx
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Treatment WEIGHT LOSS! Decreases BMI, neck size, BP – 3 of the STOP-BANG A 2009 Randomized control trial showed 10kg weight loss lead to decrease in AHI by approx 10 (A LOT). P<.001
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Summary Sleep apnea is collapse of the oropharynx during sleep causing reduced airflow Rougly ¼ of Americans have sleep apnea STOP BANG Questionairre > 3 = PSG Treatment = CPAP + weight loss
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THE END! UpToDate.com. Accessed 3/5/ Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. Dixon et. Al. JAMA Sep;308(11): A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Foster et. Al. Arch Intern Med Sep;169(17): Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Araghi et al. Sleep. 2013;36(10):1553. Epub 2013 Oct 1. Continuous positive airways pressure for obstructive sleep apnoea in adults. Giles et al. Cochrane Database Syst Rev
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