Osahs obstructive sleep apnoea hypopnoea syndrome
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OSAHS Obstructive Sleep Apnoea Hypopnoea Syndrome. Liam Doherty Consultant Respiratory Physician, Bon Secours Hospital, Cork. Definition. OSAHS is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. Who cares?.

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OSAHS Obstructive Sleep Apnoea Hypopnoea Syndrome

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Osahs obstructive sleep apnoea hypopnoea syndrome

OSAHSObstructive Sleep Apnoea Hypopnoea Syndrome

Liam Doherty

Consultant Respiratory Physician,

Bon Secours Hospital, Cork


Definition

Definition

OSAHS is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep


Who cares

Who cares?


Kaplan meier survival curve for cardiovascular death in cpap treated and untreated patients

Kaplan-Meier survival curve for cardiovascular death in CPAP treated and untreated patients.

Aaa

100

95

95

90

90

% surviving

85

85

Untreated group

N=61

N=61

p=0.009

CPAP group

80

80

N=107

75

75

0

25

50

75

100

time (months)

Doherty et al - CHEST 2005;


Osahs obstructive sleep apnoea hypopnoea syndrome

Who?


Osahs obstructive sleep apnoea hypopnoea syndrome

Who else?

  • Children

  • Cranio-facial abnormalities

    • Micrognathia, macroglossia

  • Neuro-muscular diesases

  • Syndromes

    • Downs, Prada-Willi, Treacher-Collins, Pierre-Rubin

  • Miscellaneous

    • Pregnancy, Renal failure, hypothyroid, CVA


How common

How common?


Osahs obstructive sleep apnoea hypopnoea syndrome

The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults

Terry Young, Mari Palta, Jerome Dempsey, James Skatrud, Steven Weber, and Safwan Badr

1993;328:1230-1235

n=602


Symptoms

symptoms


Classical symptoms of osahs

Classical symptoms of OSAHS

  • Excessive daytime sleepiness

  • Heavy snoring

  • Witnessed apnoeas/nocturnal choking

    Other symptoms

  • Dyspepsia

  • Nocturia, Enuresis

  • Nightmares

  • Insomnia

  • Excess sweating


Assessing sleepiness

Assessing sleepiness

  • Epworth Sleepines Score (ESS)

  • Stanford Sleepiness Scale

  • Multiple Sleep Latency Test (MSLT)

  • Maintenance of Wakefulness Test (MWT)

  • Oxford Sleep Resistance test (OSLER)


Osahs obstructive sleep apnoea hypopnoea syndrome

Epworth Sleepiness ScaleUse the following scale to choose the most appropriate number for each situation:

0 = would never doze or sleep

1 = slight chance of dozing or sleeping

2 = moderate chance of dozing or sleeping

3 = high chance of dozing or sleeping

Situation-Chance of Dozing or Sleeping

  • Sitting and reading

  • Watching TV

  • Sitting inactive in a public place

  • Being a passenger in a motor vehicle for an hour or more

  • Lying down in the afternoon

  • Sitting and talking to someone

  • Sitting quietly after lunch (no alcohol)

  • Stopped for a few minutes in traffic while driving


Diagnostic tests

Diagnostic tests

  • Polysomnography (PSG)

  • Limited sleep studies e.g. embletta

  • Overnight oximetry


Psg montage

EEG C4/A1 or C3/A2

EOG

Chin and anterior tibialis EMG

ECG

Blood Pressure

(optional)

Airflow

Saturations

Sonogram

Respitrace

rib

abdomen

Sum

PSG :- Montage


Diagnosis of osa

Diagnosis of OSA

  • Apnoea:- cessation of airflow > 10sec

  • Hypopnea:- > 30% reduction in airflow accompanied by > 4% drop in O2 saturations and/or an arousal.


Osahs obstructive sleep apnoea hypopnoea syndrome

Obstructive Sleep Apnoea


Diagnosis of osa1

Diagnosis of OSA

  • AHI >5 mild

  • AHI 15-30 moderate

  • AHI >30 severe

    This must only be interpreted with symptoms i.e. Epworth Score, and cardiovascular risk factors e.g. Hypertension, IHD, CVA, arrhythmias


Treatment

Treatment


Conservative

Conservative

  • Lose weight

  • Reduce alcohol

  • Proper sleep hygiene

  • Sleep on side


Nasal cpap therapy

Nasal CPAP therapy


Oral appliances

Oral appliances

  • Tongue-retainers

  • Anterior mandibular displacement


Surgery

Surgery

  • Septoplasty

  • Tonsillectomy

  • Polypectomy

  • Pharyngoplasty

  • UPPP (uvulo-palato-pharyngo-plasty)

  • Tracheostomy


Take home messages

Take home messages

  • Very common disorder (2-4% population)

  • Substantial morbidity and ?mortality

  • Diagnosis by sleep studies

  • Very easy to treat

  • On successful treatment, huge improvements in quality of life


Osahs obstructive sleep apnoea hypopnoea syndrome

“I want to die peacefully in my sleep like my Grandfather, not screaming in terror like the other passengers in his car”

Anonymous


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