Transcript Obstructive Sleep Apnea: Is it in your Differential?

Obstructive Sleep Apnea:
Is it in your Differential?
Helene Hill
Professor Sam Powdrill
PAS 645
Agenda
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Introduction
Pathophysiology
Risk Factors
Comorbid Conditions
Application
Obstructive Sleep Apnea
“Laugh and the world laughs with
you, snore and you sleep alone.”
~ Anthony Burgess
 AKA the “Spousal
Arousal” syndrome
 Prevention and
early treatment is
essential
 The problem is that
PCP might not
consider OSA in
the nonstereotypical
patients
Obstructive Sleep Apnea
 Epidemiology
 More prevalent than once was believed
 Wisconsin Sleep Cohort Study
 9% women
 24% men
 Estimated that 80-90% are undiagnosed
 Comorbidities
 Awareness
 SES
Pathophysiology
 A sleep breathing disorder due to a
mechanical problem of tissue collapse
 Apnea leads to
 Oxyhemoglobin desaturation
 Fragmentation in sleep cycle
 Variability in BP and HR/Increase in SNS
 Persistent hypoxia manifests with
numerous daytime Sx
Treatment
 Mild 5-15/hr
 Lifestyle modification
 Weight loss
 Elimination of products that suppress
respiration
 No BZDs
 Sleeping position modification
Treatment
 Moderate 15-30/hr
 More in-depth plus
lifestyle changes
 CPAP
 Oral appliances
 Mandible advancing
 Tongue device
Martin Dunitz
Treatment
 Severe > 30/hr
 Surgical procedures in
addition to previous
changes
 Tonsillectomy/adenoidectomy
 Nasal surgery combined with
pharyngeal surgery
 Uvulopalatopharyngoplasty
(UPPP)
Martin Dunitz
Risk Factors
 “Pickwickian Patient”
 Male Sex
 Age 40-70 yr
 Familial Aggregation
 Established risk factors
 Body habitus
 Craniofacial/Upper
Airway Abnormalities
 Suspected risk factors
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Genetics
Smoking
Menopause
Alcohol before sleep
Nighttime nasal
congestion
Martin Dunitz
Comorbid Conditions
 Decreased daytime functioning
 Daytime sleepiness
 Psychosocial problems – STRESS!
 Decreased cognitive function
Comorbid Conditions
 Cardiovascular/Cerebrovascular
Disease
 Stroke, pulmonary HTN, CHF
 Resistant hypertension
 Increased sympathetic activity
 Vasculopathy
 Activation of vasoconstrictors
 Sustained hypertensive effects
 “Non-dipping” phenomenon
Comorbid Conditions
 Diabetes/Metabolic Syndrome
 Vascular disease that lead to endothelial
dysfunction
 OSA is independently associated with
insulin resistance
 Control OSA, see better control of DM
So is it in your Dif Dx?
 Few easy steps
 Consider OSA in patients who snore or
have excessive daytime sleepiness
 Check out risk factors and get detailed
history
 Consider your alternatives
 Consider OSA when evaluating patients
for comorbidities associated with sleep
apnea
Wrapping it up…
 Don’t forget to treat the underlying
condition!
 Don’t forget the non-stereotypicals!
 Know risk factors and what OSA can
do if left untreated!
 Future ideas…
 Hypoglossal nerve stimulation
 Serotonergic medications
References
Available upon request