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

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



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;


Who? CPAP treated and untreated patients.


Who else? CPAP treated and untreated patients.

  • 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? CPAP treated and untreated patients.


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 Middle-Aged Adults


Classical symptoms of osahs
Classical symptoms of OSAHS Middle-Aged Adults

  • Excessive daytime sleepiness

  • Heavy snoring

  • Witnessed apnoeas/nocturnal choking

    Other symptoms

  • Dyspepsia

  • Nocturia, Enuresis

  • Nightmares

  • Insomnia

  • Excess sweating


Assessing sleepiness

Assessing sleepiness Middle-Aged Adults

  • Epworth Sleepines Score (ESS)

  • Stanford Sleepiness Scale

  • Multiple Sleep Latency Test (MSLT)

  • Maintenance of Wakefulness Test (MWT)

  • Oxford Sleep Resistance test (OSLER)


Epworth Sleepiness Scale Middle-Aged AdultsUse 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 Middle-Aged Adults

  • Polysomnography (PSG)

  • Limited sleep studies e.g. embletta

  • Overnight oximetry


Psg montage

EEG C4/A1 or C3/A2 Middle-Aged Adults

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 Middle-Aged Adults

  • Apnoea:- cessation of airflow > 10sec

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


Obstructive Sleep Apnoea Middle-Aged Adults


Diagnosis of osa1
Diagnosis of OSA Middle-Aged Adults

  • 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 Middle-Aged Adults


Conservative
Conservative Middle-Aged Adults

  • Lose weight

  • Reduce alcohol

  • Proper sleep hygiene

  • Sleep on side


Nasal cpap therapy
Nasal CPAP therapy Middle-Aged Adults


Oral appliances
Oral appliances Middle-Aged Adults

  • Tongue-retainers

  • Anterior mandibular displacement


Surgery
Surgery Middle-Aged Adults

  • Septoplasty

  • Tonsillectomy

  • Polypectomy

  • Pharyngoplasty

  • UPPP (uvulo-palato-pharyngo-plasty)

  • Tracheostomy


Take home messages
Take home messages Middle-Aged Adults

  • 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


“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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