sleep apnea…€¦ · associated with obesity* odds ratio = 4.59, (95% ci – 1.58-13.33) for...
TRANSCRIPT
Sleep Apnea… The Not so Silent Killer
Dominic A. Munafo, M.D., F.ABSM Medical Director
Your Lucky Day
Insidious condition of repetitive partial or complete airway collapse during sleep Frequently associated with: • intermittent hypoxemia • sleep fragmentation • sympathetic activation
What is Obstructive Sleep Apnea (OSA)
The Obstructed Airway
Spectrum of Disease
• Snoring
• Upper Airway Resistance Syndrome
• Sleep Apnea – Obstructive – Central
• Obesity Hypoventilation Syndrome -
(OHS)
Scope of the Problem
• 20 - 30 million Americans
• Wisconsin sleep cohort study
– 626 subjects age 30-60
– AHI > 5 in 9% of women
– AHI > 5 in 24% of men
Scope of the Problem
• OSA Prevalence in other disease states – Obesity – 75%
– Type II DM – 72% (moderate & severe – 66%)
– Hypertension – 50 to 75%
– CAD & A. Fib. – 50%
– CHF – 50 to 75%
– Depression – 40 to 45%
• Most common symptoms
– Loud snoring
– Witnessed apnea
– Excessive daytime sleepiness
– Waking up choking & gasping
– Cognitive impairment
Obstructive Sleep Apnea
• Most common signs – Obesity – Neck size ≥ 17 men ≥ 16 women – Nasopharyngeal narrowing – Maxillo-mandibular anomalies – Hypertension – Stroke – Heart failure
Obstructive Sleep Apnea
True prevalence of OSA in the general obese population difficult to ascertain…
However; Moderate OSA found to be significantly
associated with obesity* Odds ratio = 4.59, (95% CI – 1.58-13.33) For every increment in BMI of 1 over the mean
BMI the risk of OSA increased by 12%
Obesity as a Risk Factor for OSA
* Redline, AJRCCM 1999;159:1527-32
• Clinical suspicion
• Consistent signs and symptoms
• Overnight sleep study looking
for respiratory events (HST vs.
PSG)
How to Diagnose Obstructive Sleep Apnea
Apnea – no airflow ≥ 10 seconds Hypopnea – reduced airflow ≥ 10
seconds, usually associated with oxygen desaturation or evidence of arousal
What are Respiratory Events
Diagnosing OSA
Severity Scale of OSA
• Apnea Hypopnea Index = Apneas + Hypopneas /
hr – Mild sleep apnea - 5 – 15 events / hour – Moderate sleep apnea - 16 – 30 events / hour – Severe sleep apnea - > 30 events / hour
• Who to Treat ? – AHI ≥ 30 – AHI 5 - 29 ⇒ if symptomatic or if co-morbidities
present
OSA is associated with: • Nocturnal blood pressure elevation • Independent risk factor for hypertension • Changes in LV geometry and function • Sustained sympathetic activation
Consequences of Untreated OSA
OSA is associated with: Metabolic syndrome Asthma severity Endothelial dysfunction – synergistic
with risk from obesity ADHD – as many as 25%?
Consequences of Untreated OSA
Increasing prevalence of childhood obesity and it’s complications could actually result in the current generations of children living less well and for a shorter time than previous generations
Ultimate Consequences
* Daniels, The Future of Children 2006;16:47-67
Treatment Options for OSA
• Permanent weight loss
• Continuous positive airway pressure (CPAP)
• Oral appliances
• Oral and/or maxillo-facial surgeries
• Tracheostomy
CPAP Therapy for OSA
• Applied via nasal mask
• Acts as pneumatic splint
• Compliance limits utility
• Mask fit crucial
Why Bother?
• Improves overall care of patients
• Identify patients at increased operative risk
• Effective treatment may help reduce peri-op complications
Thank You!
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