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Conflict of Interest Statement

Conflict of Interest Statement. I have no conflict of interest related to to this presentation…! Dr. Özen Kaçmaz Başoğlu. 1. SUCCESS CRITERIA IN OBSRUCTIVE SLEEP APNEA SYNDROME TREATMENT. Panel: Different Dimensions in the Diagnosis and Treatment of Sleep Disordered Breathing.

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Conflict of Interest Statement

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  1. Conflict of Interest Statement I have no conflict of interest related to to this presentation…! Dr. Özen Kaçmaz Başoğlu 1

  2. SUCCESS CRITERIA IN OBSRUCTIVE SLEEP APNEA SYNDROME TREATMENT Panel: Different Dimensions in the Diagnosis and Treatment of Sleep Disordered Breathing Dr. Özen KAÇMAZ BAŞOĞLU Ege University School of Medicine Department of Chest Diseases Turkish Thoracic Society 15. Annual Congress April 14, 2012 2

  3. Success Criteria in OSAS Treatment -Outline- • Apnea-hypopnea index, oxygen saturation and sleep quality • Symptoms (daytime sleepiness) and quality of life • Cardiovascular and metabolic comorbidities • Mortality 3

  4. Sleep Apnea Circle Sleep Apnea Hypoxia Negative pleural pressure Sympathetic activation Re-oxygenation Ventilation Arousal Intermittent Hypoxia Bernardo S. Clin Chest Med 2010;31:203-20

  5. Consequences of OSAS OSAS Obesity Intermittent hypoxia - reoxygenation Metabolic dysfunc. Sympathetic excitation Oxidative stress Systemic inflammation Endothelial dysfunc. Atherosclerosis Cardiovascular disease McNicholas WT. Pro Cardio Dis 2009;51:392-9 & Kent BD. ERM 2010;50:340-59

  6. Consequences of OSAS MORTALITY 6 Parish JM. Mayo Clin Proc 2004;79:1036-46

  7. Patients at Risk for OSAS Atrial fibrillation Type II DM Stroke PHT OSAS is a systemic disease… OSAS High-risk driver CHF BMI>35 Nocturnal arrhythmia Refractory HT OSA Task Force (AASM). J Clin Sleep Med 2009;5:263-76

  8. OSAS Treatment • Consertavive treatment • Specific treatment - Oral appliance - Surgery - CPAP 8

  9. CPAP Treatment

  10. Effects of CPAP-Effect on Upper Airway Collapsibility- 10 Montserrat JM. Eur Respir Mon 2010; 50: 244-66

  11. Effect on Upper Airway Collapsibility Spontaneous breathing CPAP application 11 Montserrat JM. Eur Respir Mon 2010; 50: 244-66

  12. Effects on Respiratory Events, Saturation and Sleep Stages Hirshkowitz MP et al. Semin in Respir Crit Care Med 2005; 26: 68-79

  13. Effects on Respiratory Events, Saturation and Sleep Stages 74 sn SpO2 %66 13

  14. Our puppy sleeps very well…

  15. Effect on Subjective Daytime Sleepiness • Epworth sleepiness score (ESS) 2.94 points  (p<0.001) • In pts with AHI≥30/h and ESS≥11 → ESS 4.74 points  (p<0.001) 15 Patel RS. Arch Intern Med 2003;163;565-71

  16. Effect on Objective Sleepiness -MSLT or MWT- • Sleep latancy 0.93 min  (p=0.04) 16 Patel RS. Arch Intern Med 2003; 163; 565-71

  17. Effect on Daytime Sleepiness and Quality of Life n=149 3 months CPAP • < 2 h users 41% ESS, 33%, FOSQ, 13% MSLT improvement • More than 7 h use → no more benefit 17 Weaver TE. Sleep 2007; 30; 711-19

  18. Effect on Motor Vehicle Accidents OSAS Healthy • 210 OSAS with CPAP tx and 210 healthy - 3 yrs follow-up • 3-fold decrease in accidents with CPAP 18 George CFP. Thorax 2001;56:508-12

  19. No sleepiness, better QoL…

  20. Effect on Blood Pressure • 32 moderate-severe OSAS • 9 weeks - CPAP (n=16) and sham CPAP (n=16)[anti-HT (+)] CPAP Sham CPAP Sham CPAP CPAP • 9.9±11.4 mmHg  20 Becker HF. Circulation 2003;107:68-73

  21. Effect on Blood Pressure • HT + OSA → 3 months - CPAP (n=169) ve sham CPAP (n=171) (anti-HT Ø) • Significant decrease in diurnal and nocturnal blood pressures with CPAP 21 Duran-Cantolla J. BMJ 2010;341:c5991

  22. Effect on Blood Pressure • 16 RCT, n=818 • -1.83 mmHg change in diastolic pressure • -2.46 mmHg change in systolic pressure 22 Bazzano LA. Hypertension 2007;50:417-23

  23. Effect on Coronary Artery Disease • Development of CHD in 7 yrs follow-up → In 105 OSA 16.2% and in 203 snorer 5.4% • In OSA with treatment 4%, in OSA with no treatment 25% → CHD (+) OSA Non-OSA 23 Peker Y. ERJ 2006;28:596-602

  24. Effects on Early Signs of Atherosclerosis • 24 severe OSA pts without comorbidity - 4 months follow-up • CPAP (+) (n=12) and CPAP (-) (n=12) • Decrease in carotid intima-media thickness and pulse-wave velocitywithCPAP Drager LF. AJRCCM 2007;176:706-12

  25. Effect on Heart Failure AHI<15/h (n=113) AHI≥15/h (n=37) • CHF and moderate-severe OSA (+) (n=37), CHF and snorer +mild OSA (n=113) - 3 yrs follow-up • No mortality in 14 pts using CPAP 25 Wang H. J Am Coll Cardiol 2007;49:1625–31

  26. Effect on Arrhytmia Control CPAP CPAP (+) (-) • Postcardioversion pts with AF/flutter - 1 yr follow-up • Control (n=79), CPAP (+) (n=12) ve CPAP (-) (n=25) • Recurrence of AF 53%, 42% and 82%, respectively Kanagala R. Circulation 2003;107:2589-94

  27. Effect on Pulmonary Artery Pressure • 23 OSAS (10 with PH), 10 control (no PH) 29.8 mmHg 23.4 mmHg OSAS Control (n=23) (n=10) • 12 weeks CPAP, 12 weeks sham CPAP (cross-over) 28.9 mmHg → 24.0 mmHg 27 Sham CPAP CPAP Arias MA. Eur Heart J 2006;27:1106-13

  28. Effect on Stroke • 166 pts with stroke+OSA - 7 yrs follow-up • 89 deaths during follow-up (52% in pts with no CPAP tx p<0.01 28 Martinez-Garcia MA. ERJ 2012;39:906-12

  29. Effect on Insulin Sensitivity • 61 moderate-severe OSA without comorbidity→ 1 week - sham CPAP (n=31), CPAP (n=30) • In CPAP group, insulin sensitivity ↑ in 1 week • In CPAP groupwithBMI≥25,insulin sensitivity ↑ in 12 weeks 29 Lam JCM. ERJ 2010;35:138-45

  30. Effect on Mortality • Healthy (n=264), primary snoring (n=377), mild-moderate OSA (n=403), severe OSA (n=235), severe OSA with CPAP use (n=372) - 10 yrs follow-up • 3-fold ↑ in fatal&non-fatal CVS events in pts without tx Non-fatal KVS olaylar Fatal KVS olaylar 30 Marin JM. Lancet 2005;365:1046-53

  31. Other Effects • Reduction in inflammatory changes and sympathetic activation • Improvement in cognitive function • Decrease in nocturia • Enhancement in erectil dysfunction • Decrease in epilepsy seizures • Reduction in adverse effects of bariatric surgery Montserrat JM. Eur Respir Mon 2010; 50: 244-66

  32. Comorbidities are better…

  33. Recommended Procedures in CPAP Follow-up CPAP adherence Mask leaks Information about AHI Weight and habits Evaluation of daytime sleepiness with ESS Improvement in sleep and symptoms Adverse effects Blood pressure if patient had HT Secondary effects of treatment 33 Montserrat JM. Eur Respir Mon 2010; 50: 244-66

  34. What are the Success Criteria in OSAS Treatment? Apnea-hypopnea index and oxygen saturation Symptoms (daytime sleepiness), quality of sleep and life Blood pressure Other cardiovascular and metabolic comorbidities Mortality ALL 34 34

  35. Thanks…

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