OSA


Consequences
  • High blood pressure
  • CVD
  • Sleep disturbance
  • Memory problems
  • Weight gain, impotence, headaches.
  • May lead to daytime sleepiness, job impairment, and motor vehicle crashes
Diagnosis
  • Epworth Sleepiness Scale, 0-3 for each factor
  • Sitting, in a car, watching TV, etc.
  • Scoring:
    – 0-10: Normal
    – 10-12: Borderline
    – 13-24: Abnormal
     
  • Sleep study, whole night or a “split-night” study.
    • If obstructive sleep apnea is found, the patient is awakened and fitted with a PAP device and re-tested.
  • The apnea-hypopnea index, or AHI.
    • An apnea is not breathing for > 10 seconds.
    • Hypopnea is a constricted breath that lasts > 10 seconds.
    • The AHI is the number of apneas and hypopneas per hour.
  • An AHI Score
    • 5 to 15 is mild;
    • 15 to 30 is moderate OSA;
    • > 30 is severe
Treatment
  • Weight loss (a factor in 70% of cases)
  • Nasal decongestant
  • Positional therapy (tennis ball behind the head)
  • Surgery—multiple options, individual; uvulopalatopharyngoplasty, or UPPP
  • Sleeping appliance
  • Positive airway pressure device
    • CPAP or BiPAP
    • PAP is the most effective treatment, per AHRQ 2011 national report
    • Reduces AHI
    • Reduces blood pressure
    • Improved daytime alertness