Sle e p Apne a T he No t so Sile nt Kille r Dominic A. Munafo, - - PowerPoint PPT Presentation

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Sle e p Apne a T he No t so Sile nt Kille r Dominic A. Munafo, - - PowerPoint PPT Presentation

Apr 23, 2023 343 likes •601 views

Sle e p Apne a T he No t so Sile nt Kille r Dominic A. Munafo, Jr., M.D., F.ABSM Chief Medical Officer T odays Goals Wha t is o b struc tive sle e p a pne a (OSA) Unde rsta nd dia g no sis a nd tre a tme nt Unde rsta nd

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SLIDE 1

Sle e p Apne a…

T he No t so Sile nt Kille r

Dominic A. Munafo, Jr., M.D., F.ABSM Chief Medical Officer

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SLIDE 2

 Wha t is o b struc tive sle e p a pne a (OSA)  Unde rsta nd dia g no sis a nd tre a tme nt  Unde rsta nd the b a sic pa tho physio lo g y  K

no w thre e c o nditio ns hig hly a sso c ia te d with OSA

T

  • day’s Goals
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SLIDE 3

I nsidio us c o nditio n o f re pe titive pa rtia l o r c o mple te a irwa y c o lla pse during sle e p

F re que ntly a ssoc ia te d with:

  • b e sity
  • dia b e te s
  • he a rt dise a se

What is Obstr uc tive Sle e p Apne a (OSA)

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SLIDE 4

T he Obstr uc te d Air way

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SLIDE 5

Spe c tr um o f Dise a se

  • Sno ring
  • Uppe r Airwa y Re sista nc e Syndro me -

(UARS)

  • Sle e p Apne a

– Ob struc tive – Ce ntra l

  • Ob e sity Hypo ve ntila tio n Syndro me -

(OHS)

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SLIDE 6

Pulmo na ry Dise a se a nd Obe sity

Obesity Simple Obesity Obesity Hypoventilation

Exercise intolerance Dyspnea on exertion Increased post-op risk

  • 1. pneumonia
  • 2. atelectasis

Eucapnic Frequent OSA Likely increased respiratory drive Hypercapnic Frequent OSA Abnormal respiratory drive

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SLIDE 7

Sc ope o f the Pro b le m

  • 20 - 30 millio n Ame ric a ns
  • Wisc o nsin sle e p c o ho rt study

– 626 sub je c ts a g e 30-60 – AHI

> 5 in 9% o f wo me n

– AHI

> 5 in 24% o f me n

Yo ung T , N E ng l J Me d 1993;328

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SLIDE 8

Sc ope o f the Pro b le m

  • OSA Pr

e vale nc e in othe r dise ase state s – Ob e sity – 75% – T

ype I I DM – 72% (mo de ra te & se ve re – 66%)

– Hype rte nsio n – 50 to 75% – CAD & A. F

ib . – 50%

– CHF

– 50 to 75%

– De pre ssio n – 40 to 45%

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SLIDE 9
  • Most c ommon symptoms

– L

  • ud sno ring

– Witne sse d a pne a – E

xc e ssive da ytime sle e pine ss

– Wa king up c ho king & g a sping – Co g nitive impa irme nt

Obstr uc tive Sle e p Apne a

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SLIDE 10
  • Most c ommon signs

– Ob e sity – Ne c k size ≥ 17 men ≥ 16 women – Na so pha ryng e a l na rro wing – Ma xillo -ma ndib ula r a no ma lie s – Hype rte nsio n – Stro ke – He a rt fa ilure

Obstr uc tive Sle e p Apne a

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SLIDE 11
  • Clinic a l suspic io n
  • Co nsiste nt sig ns a nd sympto ms
  • Ove rnig ht sle e p study lo o king

fo r re spira to ry e ve nts (HST

  • r

PSG) How to Diagnose

Ob struc tive Sle e p Apne a

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SLIDE 12

Apne a – no a irflo w ≥ 10 seconds Hypopne a – reduced airflow ≥ 10

se c o nds, usua lly a sso c ia te d with

  • xyg e n de sa tura tio n o r e vide nc e o f

a ro usa l

Wha t a re Re spir

ator y E ve nts

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SLIDE 13

Diagnosing OSA

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Co nse q ue nc e s o f Untre a te d OSA

Wo lk, R. e t a l. Circ ula tio n 2003;108:9-12

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Co nse q ue nc e s o f Untre a te d OSA

L e ung , e t a l. Am J Re spirCrit Ca re Me d 2001;164:2147-65

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Co nse q ue nc e s o f Untre a te d OSA

200 150

  • 50

150 Baseline Phenylephrine OSA 150 - 0 = 150 200 - 0 = 200 150 - (- 50) = 200 Calculation of LV transmural pressures

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Co nse q ue nc e s o f Untre a te d OSA

200 150

  • 50

150 + 10 CPAP = 10 Phenylephrine – α1 agonist OSA 150 - 10 = 140 200 - 0 = 200 150 - (- 50) = 200 Calculation of LV transmural pressures

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E ffe c ts o f the Supine Position

  • V/ Q misma tc h
  • Shunting
  • L

ung b a se s we ll pe rfuse d b ut po o rly ve ntila te d

  • Re duc e d lung

vo lume s

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SLIDE 19

E ffe c ts o f the Supine Position

  • Pra c tic a l c o nse q ue nc e

during g e ne ra l a ne sthe sia

– Mo re ra pid de c line in

  • xyg e n sa tura tio n during

a pne a , < 2 minute s vs. 6 minute s whe n b re a thing 100%

  • xyg e n
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Se ve r ity Sc ale o f OSA

  • Apne a Hypopne a Inde x - (AHI)

– Mild sle e p a pne a -

5 – 15 e ve nts / ho ur

– Mo de ra te sle e p a pne a - 16 – 30 e ve nts / ho ur – Se ve re sle e p a pne a -

> 30 e ve nts / ho ur

  • Who to T

re a t ? – AHI ≥ 30 – AHI

5 - 29 ⇒ if sympto ma tic o r if c o -mo rb iditie s pre se nt

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OSA is assoc iate d with:

  • No c turna l b lo o d pre ssure e le va tio n
  • I

nde pe nde nt risk fa c to r fo r hype rte nsio n

  • Cha ng e s in L

V g e o me try a nd func tio n

  • Me ta b o lic Syndro me

Co nse q ue nc e s o f Untre a te d OSA

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SLIDE 22

I nc re a sing pre va le nc e o f c hildho o d

  • b e sity a nd it’ s c o mplic a tio ns c o uld

a c tua lly re sult in the c urre nt g e ne ra tio ns

  • f c hildre n living le ss we ll and fo r

a sho r te r time tha n pre vio us g e ne ra tio ns

Ultima te Conse que nc e s

* Da nie ls, F uture Child. 2006 Spring ;16(1):47-67

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T r e atme nt Options fo r OSA

  • Pe rma ne nt we ig ht lo ss
  • Co ntinuo us po sitive a irwa y pre ssure

(CPAP)

  • Ora l a pplia nc e s
  • Ora l a nd/ o r ma xillo -fa c ia l surg e rie s
  • T

ra c he o sto my

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SLIDE 24

CPAP T he r apy for OSA

  • Applie d via na sa l ma sk
  • Ac ts a s pne uma tic splint
  • Co mplia nc e limits utility
  • Ma sk fit c ruc ia l
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SLIDE 25

T ha nk Yo u!

L e ar n Mo r e and Visit Us at Sle e pData.c o m