Obstructive Sleep Apnea

Question 1

Essentials of Diagnosis:

• Daytime somnolence or fatigue.
• History of loud snoring with witnessed apneic events.
• Overnight polysomnography demonstrating apneic episodes with hypoxemia.

Answer 1

Obstructive Sleep Apnea

Question 2

General Considerations:

Clinical risk factors are: KNOWN
* Advancing age
* Male Gender
* Obesity
* Craniofacial morphology or upper airway soft tissue abnormalities.
* Additional factors : smoking, nasal congestion, menopause, and family history.

Rates are also increased in association with certain medical conditions, such as pregnancy, end-stage renal disease, congestive heart failure, chronic lung disease, posttraumatic stress disorder, and stroke.

Answer 2

Obstructive Sleep Apnea

Question 3

Physical Examination:

• Craniofacial and upper airway soft tissue abnormalities each increase the likelihood
• Other risk factors - Nasal congestion confers an approximately two-fold increase in the prevalence compared with controls, regardless of cause.
• Smoking appears to increase the risk or at least aggravate preexisting symptoms.
• Menopausal women appear to have an increased risk compared with premenopausal women
• Patients often report a family history of snoring.
• While a variety of substances and medications, including alcohol, benzodiazepines, and narcotics, may exacerbate, a causative link is unproven.

Answer 3

Obstructive Sleep Apnea

Question 4

Labs/Imaging: OSA

STOP BANG Questionnaire

Answer 4

S (snore): Yes or No
T (tired):
* Do you feel fatigued during the day?
* Do you wake up feeling like you haven’t slept?

O(obstruction):
* Have you been told you stop breathing at night?
* Do you gasp for air or choke while sleeping?

P(pressure):
* Do you have high blood pressure or on medications for HBP)

B(BMI):
* Is your BMI > 28

A(Age):
* Are you older then 50

N(Neck):
* For males is your neck > 17 inches, For females is your neck > 16 inches

G(Gender):
* Are you a male

Question 5

Complication with OSA can be:

Answer 5

Pnuemonia

Question 6

Labs/Imaging: OSA

Scoring the questionnaire: What is Low High and Lab for OSA?

Answer 6

• If you answer is YES to 3 or more questions (categories) then you are high risk of having OSA and require referral for sleep study.
• If you answer YES to less then 3 questions (categories) then you are considered low risk of having OSA and no further work up is required, unless there is other information that makes the diagnosis more likely to be OSA, then you can refer for a sleep study.
• In-laboratory polysomnography is the first-line diagnostic study when OSA is suspected.

Question 7

Differential Diagnosis:

• The differential diagnosis of OSA includes those conditions that produce disrupted sleep and/or excessive daytime sleepiness,
• Alternative diagnoses to consider in patients with a primary complaint of abrupt awakenings, choking, or gasping sensations during sleep are aspiration, gastroesophageal reflux disease, and panic attacks especially in those with panic disorders.
• PTSD
• Retired

Answer 7

Obstructive Sleep Apnea

Question 8

Treatment:

Lifestyle changes

The maximum benefits of positive airway pressure therapy are realized when patients use their devices regularly during sleep. CPAP use should be routinely determined using objective criteria and monitored sequentially over time.

Weight Loss

Oral Appliances

Upper Airway Surgery

Answer 8

Obstructive Sleep Apnea

Question 9

Dx:

Complications
* Motor vehicle crashes #1 cause
* Cardiovascular morbidity
* Metabolic syndrome and type 2 diabetes
* Nonalcoholic fatty liver disease

Medications:
* None, treat underlying causes.

Answer 9

Obstructive Sleep Apnea