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Obstructive Sleep Apnea and Upper Airway Resistance Syndrome PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Obstructive Sleep Apnea and Upper Airway Resistance Syndrome" by Dragos Manta, MD.
This medical PowerPoint presentation talks about Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS).
Obstructive Sleep Apnea and Upper Airway Resistance Syndrome are two sleep-related breathing disorders that can affect the quality of life and overall health of those who suffer from them.
OSA is a condition in which a persons airway becomes partially or completely blocked during sleep, causing them to stop breathing for brief periods of time (typically lasting a few seconds to a minute). This results in disrupted sleep, loud snoring, and daytime fatigue. OSA is often associated with obesity, hypertension, and other health problems.
UARS, on the other hand, is a similar condition in which the airway becomes partially blocked during sleep, but the blockage is not severe enough to completely stop breathing. This can still lead to disrupted sleep, but is often associated with less severe symptoms than OSA.
Both OSA and UARS can be diagnosed through a sleep study, which involves monitoring a persons breathing patterns, oxygen levels, and other physiological variables during sleep. Treatment options may include lifestyle changes (such as weight loss and avoiding alcohol and sedatives), continuous positive airway pressure (CPAP) therapy, oral appliances, and, in severe cases, surgery. It is important to seek treatment for these conditions, as untreated sleep apnea can lead to serious health problems such as heart disease, stroke, and diabetes.

Tags : Obstructive Sleep Apnea, OSA, Upper Airway Resistance Syndrome, UARS, breathing disorders, disrupted sleep, loud snoring, daytime fatigue

Published on : Mar 21, 2023 | Views : 1198 | Downloads : 3

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Slide 1-

Obstructive Sleep Apnea andUpper Airway Resistance Syndrome Dragos Manta, MD Assistant Professor of Medicine Division of Pulmonary, Critical Care and Sleep Medicine
Slide 2-

Sleep Architecture
Slide 3-

What is Obstructive Sleep Apnea (OSA) ? Intermittent partial or complete airway collapse during sleep Leading to Frequent night-time arousals Sleep Fragmentation Decreased oxygen levels Non-restorative sleep
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Daytime Consequences Causes excessive daytime fatigue (EDF) and sleepiness (EDS) Increased risk of motor vehicle accidents Decreased work productivity
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Other Daytime Consequences Increased risk of complications following sedation/anesthesia for procedures/surgery Tell your anesthesiologist if you have OSA Bring you machine for procedures/surgery
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Long Term Consequences Increased cardio-vascular risk Hypertension and diabetes Myocardial infarction/ Coronary artery disease Atrial fibrillation recurrence after cardioversion/ ablation Strokes Dementia Erectile dysfunction
Slide 8-

Who Is At Risk? Obese Men over 40 Women post-menopausal Non-Caucasian race Elderly (more than 40% of people over 65 have OSA) Children enlarged tonsils/adenoids
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Symptoms of OSA Snoring Apneic episodes observed by bed partner Unexplained night-time arousals Agitated sleep Insomnia Nocturia Non-restorative sleep Morning headaches Drowsiness Excessive daytime sleepiness Need to take naps Excessive caffeine usage
Slide 10-

Signs of OSA Narrow airway Thick neck (usually over 16 inches in women and 17 inches in men) Swelling of the lower extremities
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Other Signs of OSA Difficult to control blood pressure Difficult to control blood sugars Recurrent atrial fibrillation Fluid retention
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Testing for OSA In-lab sleep study Ambulatory monitoring or portable studies in patients with high risk for OSA and no other medical problems Caveat: does not rule it out
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2 min of Sleep in OSA
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Upper Airway Resistance Syndrome (UARS)
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UARS-Definition Increased upper airway resistance during sleep that leads to arousals and sleep fragmentation Without causing partial or complete airway collapse
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OSA R. G. Norman, D M. Rapoport et al. Sleep 1997
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UARS R. G. Norman, D M. Rapoport et al. Sleep 1997
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Why UARS? Associated with functional somatic syndromes Fibromyagia Chronic fatigue syndrome Migraine headaches Irritable bowel syndrome Associated with insomnia
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Demographics of UARS Tend to be younger than typical OSA patients BMI can be normal or lower than of patients with OSA Women and men equally affected
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Symptoms UARS Snoring is not universal Have a lot of nighttime arousals Tend to have superficial sleep Patients are sleepy like most OSA patients Fatigue rather than sleepiness in some patients
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Fatigue vs Sleepiness Characterized by physical exhaustion Worse in the morning and evenings Sleepiness means the propensity of falling asleep Worse in the afternoon
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Insomnia and OSA/UARS Wickwire, Emerson; Collop, Nancy. Chest. 137(6):1449-1463, June 2010
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Treatment of OSA/UARS PAP (positive airway pressure) Oral Appliances Surgery Adjunctive therapies Emerging therapies
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CPAP – GOLD Standard
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CPAP Most efficacious option Most commonly prescribed Acts as a “pneumatic splint” splinting the upper airway and preventing airway collapse during sleep. Immediate improves sleep Improves quality of life, daytime sleepiness Improves hypertension control Improves glycemic control in patients with diabetes
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CPAP Prescription A fixed pressure is prescribed after Titration during monitored overnight PSG Auto-CPAP trial
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CPAP pressure Severity of OSA Body position Weight Sleep stage ( N2 and REM sleep require highest pressures)
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Auto-CPAP or APAP For high pressure intolerance For OSA concentrated by sleep stage (N2, REM) position (supine)
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Certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients with moderate to severe OSA without significant comorbidities (Option) Morgenthaler TI et al. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep. 2008;31(1):141-147.
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BIPAP Offers no significant advantage over CPAP for OSA patients (Gay PC et al. Sleep. 2003;26(7):864-869) For patients that require high pressures of CPAP > 15 cm H2O For patients intolerant to CPAP due to perceived difficulties with exhalation For patients with OSA and OHS or COPD
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Masks Interfaces Nasal masks are the standard of care Nasal inserts (“pillows”) are popular Nasal-oral (full face) masks
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Follow Up after Initiation of CPAP Office visit Data Download Compliance Residual apneic episodes Mask Leaks
Slide 35-

Oral Appliance (OA) Therapy Mandibular Advancement Devices (MADs) Effectiveness of MADs No significant difference between OAs and CPAP in the percentage of mild OSA patients achieving their target AHI/RDI. For moderate to severe OSA, however, the odds of achieving the target AHI were significantly greater with CPAP than with OAs.
Slide 36-

Summary of Recommendations AASM 2015 OAs are recommended for primary snoring after OSA is ruled out by sleep physician Patients with OSA who are intolerant of CPAP therapy or prefer alternate therapy Qualified dentist use a custom, titratable appliance over non-custom oral devices Sleep physicians and qualified dentists provide follow up
Slide 37-

Summary of Recommendations AASM 2015 Sleep physicians conduct follow-up sleep testing To document or improve treatment efficacy If patients develop recurrent symptoms If substantial weight gain With diagnoses of comorbidities relevant to OSA Impact of OAs on resistant HTN or long term consequences of OSA not well studied
Slide 38-

Surgical Treatment Apart from tracheostomy, surgery is less predictable and effective Counseling about alternative therapies, success rates and complications Can be considered for selected patients that failed or not willing to consider PAP and OA therapy Further research is needed to clarify patient selection, safety and efficacy of surgical approaches for OSA
Slide 39-

Adjunctive Therapies Weight loss should be advised for all obese patients with OSA Caveat: the magnitude of correlation of OSA severity and weight is greater with weight gain rather than weight loss Bariatric surgery related weight loss provides either resolution of OSA (around 40%) or major improvements of AHI, sleep architecture, CPAP requirements and daytime sleepiness
Slide 40-

Adjunctive Therapies Exercise Sedentary lifestyle associated with OSA Avoidance of alcohol or sedatives before bedtime
Slide 41-

Positional Therapy For purely supine apnea Tennis ball sawn in a back pajama pocket Commercially available devices that prevents rolling to supine position Objectively document effectiveness with position monitor
Slide 42-

3 New FDA-Approved Therapies Nasal expiratory PAP devices (Nasal EPAP) Oral pressure therapy (OPT) Electrical Stimulation (ES)
Slide 43-

Nasal Expiratory PAP Devices Unidirectional flow resistance valves Expiratory flow resistance without any inspiratory resistance For Mild OSA
Slide 44-

Oral Pressure Therapy (OPT) Gentle oral suction sufficient to displace the soft palate and the tongue anterior and superior For mild OSA
Slide 45-

Electrical Stimulation (ES)
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Electrical Stimulation (ES) Promising for moderate and severe OSA in non-obese patients Adherence was improved For selected patients ?Long term efficacy and side effects
Slide 47-

Thank You! Questions?