Shyamala Pradeepan Staff Specialist-‐ Department of Respiratory and Sleep Medicine. John
Hunter Hospital. Conjoint lecturer –University of New Castle.
What is sleep apnoea?? � Repetitive upper airway narrowing and closure, leading to increased number of brain arousals and oxygen desaturations.
Types � Obstructive-‐ Common � Central-‐ many causes-‐ Hear failure, drugs, high altitude, brain stem lesions and ventilatory instability
l Airway narrowing/obstruction l Decreased air flow l Increased effort l Oxygen saturation swings
and hypoxia l Increased BP and HR l Disrupted sleep
Burden of the disease � 1.5 million Australian suffer from sleep disoders. � 9% population. � 20 million Americans have sleep apnoea. � 1990 data-‐ 4% men and 2% women have sleep apnoea syndrome.
Effects of sleep apnoea
u Due to increased arousals-Excessive day time somnolence.
u Due to repetitive de oxygenation and re oxygenation-CVS morbidity and mortality
Sleep Heart health study Ø 1927 men and 2495 women ≥40 years of age and free of coronary heart disease and heart failure at the Ame of baseline had polysomnography.
Ø Followed up for a median of 8.7 Yrs Ø ProspecAve longitudinal epidemiological study. Ø obstrucAve sleep apnoea was a significant was a significant predictor of incident coronary heart Ø Among men AHI ≥30 were 68% more likely to develop coronary heart disease than those with AHI <5. Ø ObstrucAve sleep apnoea predicted incident heart failure in men(adjusted hazard raAo 1.13 [95% confidence interval 1.02 to 1.26] per 10-‐unit increase in AHI). Ø Men with AHI ≥30 were 58% more likely to develop heart failure than those with AHI <5.
Risk factors
l Age l Male sex l Obesity l Oro facial anatomical abnormality. l Family history of sleep apnoea l Drugs and alcohol.
Screening for sleep apnoea
l OSA 50 l Berlin Questionnaire l Stop Bang l Epworth Sleepiness
scale(ESS)
OSA50 screening questionnaire.
Chai-Coetzer C L et al. Thorax doi:10.1136/thx.2010.152801
Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.
Diagnosis
• Types of studies • Level 1-‐ in lab Polysomnography • Level2 –Home based Polysomnography • Level 3-‐ Limited channel home sleep study. • Level 4 – Home Oxymetry.
Treatment � Weight loss. � CPAP-‐Continuous positive airway pressure. � Mandibular advancement splints � ENT surgical procedure � Positional devices
� 264 healthy men, 377 simple snorers, 403 with untreated mild-‐moderate obstructive sleep apnoea-‐hypopnoea, 235 with untreated severe disease, and 372 with the disease and treated with CPAP were included in the analysis.
� Patients with untreated severe disease -‐fatal cardiovascular events (1.06 per 100 person-‐years) -‐non-‐fatal cardiovascular events (2.13 per 100 person-‐years)
� Untreated patients with mild-‐moderate disease (0.55, p=0.02 and 0.89, p<0.0001),
� Simple snorers (0.34, p=0.0006 and 0.58, p<0.0001), � patients treated with CPAP (0.35, p=0.0008 and 0.64, p<0.0001), � healthy participants (0.3, p=0.0012 and 0.45, p<0.0001). � Multivariate analysis, adjusted for potential confounders, showed that
untreated severe obstructive sleep apnoea-‐hypopnoea significantly increased the risk of fatal (odds ratio 2.87, 95%CI 1.17-‐7.51) and non-‐fatal (3.17, 1.12-‐7.51) cardiovascular events compared with healthy participants.
ENT surgical opAons � 28 Yr old male, BMI 30, had significant tonsillar enlargement. Was found to have large adenoids.
� Had surgery to remove both with some weight loss options.
Summary
• Sleep apnoea is a significant problem in our populaAon.
• RecogniAon, invesAgaAon , treatment and follow up is rewarding to the paAent and to the community
• More than anything else…. gives lot of saAsfacAon to me.
Thank you
• Shyamala Pradeepan contact details • Email [email protected]
• Numbers • 4942 2457-‐ Private • 49223150-‐Public