Obstructive Sleep Apnea - DOC by hcj


									                                         Obstructive Sleep Apnea
   Brief periods of breathing cessation (apnea) and marked reduction of tidal volume (hypopneas) are
    common during sleep
 OSA is defined by an apnea-hypopnea index (total number of episodes of apnea and hypopneas per
    hour of sleep) of 5 or more with excessive daytime somnolence
 Sleep apnea occurs in 4% men and 2 % of women between 30-60 yo
 Apnea-hypopnea index can exceed 100 in severe cases
 Risk factors:
             o Obesity
             o Elevated neck circumference
             o Craniofacial abnormalities
             o Hypothyroidism
             o Acromegaly
 Differential Dx:
             o Simple snoring
             o Central sleep apnea
             o Sleep disorders (narcolepsy, periodic leg movement)
 Untreated sleep apnea is a risk for the following:
             o ? Increased CV events
             o Increased systemic HTN (benefit of Tx unclear)
             o Three fold increase of MVA
             o Clinical suspicion: Prediction rule:
             o Neck circumference in cm
             o + 4cm for HTN
             o + 3 cm habitual snorer
             o + 3 cm if pt reports choking or gasping at night
             o if < 43 cm low probability
             o 43-48 cm intermediate probability (4-8 times)
             o >48high prob (>20 times)
 Polysomnography: combines EEG, electrooculography, and electromyography as well as monitoring
    breathing and saturations
 Portable monitors ineffective

 CPAP immediate reversal
 Short-term compliance 50-80 % for 3.4-4.5 hours/night
 Compliance better with people with high AHI and symptoms
 Conservative Tx:
           o Lateral sleeping position
           o Avoidance of etoh/sedation
           o Weight loss (10% wgt loss 26% decrease in AHI
 Mandibular/tongue appliances less effective but less invasive; consider in pts who do not tolerate
 Surgery: uvulopalatoplasty vs. laser assisted UPP
           o Little evidence to support

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