OSAHS Obstructive Sleep Apnoea Hypopnoea Syndrome

1. OSAHSObstructive Sleep Apnoea Hypopnoea Syndrome Liam Doherty Consultant Respiratory Physician, Bon Secours Hospital, Cork

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

3. Who cares?

9. 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;

11. Who?

13. 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

14. How common?

15. 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

16. symptoms

17. Classical symptoms of OSAHS • Excessive daytime sleepiness • Heavy snoring • Witnessed apnoeas/nocturnal choking Other symptoms • Dyspepsia • Nocturia, Enuresis • Nightmares • Insomnia • Excess sweating

18. Assessing sleepiness • Epworth Sleepines Score (ESS) • Stanford Sleepiness Scale • Multiple Sleep Latency Test (MSLT) • Maintenance of Wakefulness Test (MWT) • Oxford Sleep Resistance test (OSLER)

19. 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

20. Diagnostic tests • Polysomnography (PSG) • Limited sleep studies e.g. embletta • Overnight oximetry

21. 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

22. Diagnosis of OSA • Apnoea:- cessation of airflow > 10sec • Hypopnea:- > 30% reduction in airflow accompanied by > 4% drop in O2 saturations and/or an arousal.

23. Obstructive Sleep Apnoea

25. 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

26. Treatment

28. Conservative • Lose weight • Reduce alcohol • Proper sleep hygiene • Sleep on side

29. Nasal CPAP therapy

30. Oral appliances • Tongue-retainers • Anterior mandibular displacement

31. Surgery • Septoplasty • Tonsillectomy • Polypectomy • Pharyngoplasty • UPPP (uvulo-palato-pharyngo-plasty) • Tracheostomy

32. 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

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